St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$93.70

Service Code	HCPCS 93931 26
Min. Negotiated Rate	$70.28
Max. Negotiated Rate	$70.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.28
Rate for Payer: SOMOS Essential	$70.28

PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY

Professional

Both

$436.73

Service Code	HCPCS 93931 TC
Min. Negotiated Rate	$327.55
Max. Negotiated Rate	$327.55
Rate for Payer: Cash Price	$119.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$327.55
Rate for Payer: SOMOS Essential	$327.55

PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

Professional

Both

$676.52

Service Code	HCPCS 93970 TC
Min. Negotiated Rate	$507.39
Max. Negotiated Rate	$507.39
Rate for Payer: Cash Price	$183.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$507.39
Rate for Payer: SOMOS Essential	$507.39

PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

Professional

Both

$135.73

Service Code	HCPCS 93970 26
Min. Negotiated Rate	$101.80
Max. Negotiated Rate	$101.80
Rate for Payer: Cash Price	$36.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101.80
Rate for Payer: SOMOS Essential	$101.80

PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY

Professional

Both

$812.21

Service Code	HCPCS 93970
Min. Negotiated Rate	$609.16
Max. Negotiated Rate	$609.16
Rate for Payer: Cash Price	$219.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$609.16
Rate for Payer: SOMOS Essential	$609.16

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$426.65

Service Code	HCPCS 93971 TC
Min. Negotiated Rate	$319.99
Max. Negotiated Rate	$319.99
Rate for Payer: Cash Price	$116.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$319.99
Rate for Payer: SOMOS Essential	$319.99

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$514.08

Service Code	HCPCS 93971
Min. Negotiated Rate	$385.56
Max. Negotiated Rate	$385.56
Rate for Payer: Cash Price	$139.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$385.56
Rate for Payer: SOMOS Essential	$385.56

PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY

Professional

Both

$87.43

Service Code	HCPCS 93971 26
Min. Negotiated Rate	$65.57
Max. Negotiated Rate	$65.57
Rate for Payer: Cash Price	$23.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65.57
Rate for Payer: SOMOS Essential	$65.57

PR DURAL GRAFT SPINAL

Professional

Both

$4,956.04

Service Code	HCPCS 63710
Min. Negotiated Rate	$3,717.03
Max. Negotiated Rate	$3,717.03
Rate for Payer: Cash Price	$1,331.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,717.03
Rate for Payer: SOMOS Essential	$3,717.03

PR DX DARK ADAPTATION EXAM INTERPRETATION & REPORT

Professional

Both

$199.68

Service Code	HCPCS 92284
Min. Negotiated Rate	$149.76
Max. Negotiated Rate	$149.76
Rate for Payer: Cash Price	$44.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.76
Rate for Payer: SOMOS Essential	$149.76

PR DYNAMIC CAVERNOSOMETRY NJX VASOACTIVE DRUGS

Professional

Both

$483.46

Service Code	HCPCS 54231
Min. Negotiated Rate	$362.60
Max. Negotiated Rate	$362.60
Rate for Payer: Cash Price	$132.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$362.60
Rate for Payer: SOMOS Essential	$362.60

PR DYN FINE WIRE EMG WALKG/FUNCJAL ACTV 1 MUSC

Professional

Both

$64.89

Service Code	HCPCS 96003
Min. Negotiated Rate	$48.67
Max. Negotiated Rate	$48.67
Rate for Payer: Cash Price	$17.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48.67
Rate for Payer: SOMOS Essential	$48.67

PR DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC

Professional

Both

$89.60

Service Code	HCPCS 96002
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$67.20
Rate for Payer: Cash Price	$23.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67.20
Rate for Payer: SOMOS Essential	$67.20

PREALBUMIN

Facility

$36.48

Service Code	HCPCS 84134
Hospital Charge Code	40609108
Hospital Revenue Code	300
Min. Negotiated Rate	$10.21
Max. Negotiated Rate	$27.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.59
Rate for Payer: Aetna Government	$14.59
Rate for Payer: Affinity Essential Plan 1&2	$10.21
Rate for Payer: Affinity Essential Plan 3&4	$10.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.21
Rate for Payer: Brighton Health Commercial	$27.36
Rate for Payer: Cash Price	$14.59
Rate for Payer: Cash Price	$14.59
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$14.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.61
Rate for Payer: Elderplan Medicare Advantage	$14.59
Rate for Payer: EmblemHealth Commercial	$14.59
Rate for Payer: Fidelis Essential Plan Aliesa	$12.40
Rate for Payer: Fidelis Essential Plan QHP	$12.99
Rate for Payer: Fidelis Medicare Advantage	$14.59
Rate for Payer: Fidelis Qualified Health Plan	$12.99
Rate for Payer: Group Health Inc Commercial	$14.59
Rate for Payer: Group Health Inc Medicare	$14.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.24
Rate for Payer: Hamaspik Choice Inc Medicare	$14.59
Rate for Payer: Healthfirst Medicare Advantage	$14.59
Rate for Payer: Healthfirst QHP	$14.59
Rate for Payer: Humana Medicare	$14.88
Rate for Payer: Senior Whole Health Medicare Advantage	$14.59
Rate for Payer: United Healthcare Commercial	$18.47
Rate for Payer: United Healthcare Medicare Advantage	$14.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.59
Rate for Payer: Wellcare CHP/FHP/Medicaid	$11.67
Rate for Payer: Wellcare Medicare	$13.13

PREALBUMIN

Facility

$36.48

Service Code	HCPCS 84134
Hospital Charge Code	40609108
Hospital Revenue Code	300
Rate for Payer: Cash Price	$14.59

PRE AND POST BRONCHODILATOR

Facility

$766.58

Service Code	HCPCS 94070 TC
Hospital Charge Code	40402709
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

PRE AND POST BRONCHODILATOR

Facility

$766.58

Service Code	HCPCS 94070 TC
Hospital Charge Code	40402709
Hospital Revenue Code	460
Min. Negotiated Rate	$254.09
Max. Negotiated Rate	$613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$383.29
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

PR EAR PROTECTOR ATTENUATION MEASUREMENTS

Professional

Both

$316.12

Service Code	HCPCS 92596
Min. Negotiated Rate	$237.09
Max. Negotiated Rate	$237.09
Rate for Payer: Cash Price	$91.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$237.09
Rate for Payer: SOMOS Essential	$237.09

PREBENT CHAMPY PLATE

Facility

$835.55

Service Code	HCPCS C1713
Hospital Charge Code	64902781
Hospital Revenue Code	278
Min. Negotiated Rate	$417.78
Max. Negotiated Rate	$417.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$417.78
Rate for Payer: Hamaspik Choice Inc Medicare	$417.78

PREBENT CHAMPY PLATE

Facility

$835.55

Service Code	HCPCS C1713
Hospital Charge Code	64902781
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$877.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$459.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$501.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$417.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$480.44
Rate for Payer: EmblemHealth Commercial	$417.78
Rate for Payer: Fidelis Medicare Advantage	$877.33
Rate for Payer: Group Health Inc Commercial	$417.78
Rate for Payer: Group Health Inc Medicare	$292.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$417.78
Rate for Payer: Hamaspik Choice Inc Medicare	$417.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$543.11

PRE-BENT LEFT CRAMPY PLATE

Facility

$733.65

Service Code	HCPCS C1713
Hospital Charge Code	64902932
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$770.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$440.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$366.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$421.85
Rate for Payer: EmblemHealth Commercial	$366.82
Rate for Payer: Fidelis Medicare Advantage	$770.33
Rate for Payer: Group Health Inc Commercial	$366.82
Rate for Payer: Group Health Inc Medicare	$256.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.82
Rate for Payer: Hamaspik Choice Inc Medicare	$366.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$476.87

PRE-BENT LEFT CRAMPY PLATE

Facility

$733.65

Service Code	HCPCS C1713
Hospital Charge Code	64902932
Hospital Revenue Code	278
Min. Negotiated Rate	$366.82
Max. Negotiated Rate	$366.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.82
Rate for Payer: Hamaspik Choice Inc Medicare	$366.82

PRECEPT NIT K-WIRE BEVT

Facility

$312.50

Service Code	HCPCS C1713
Hospital Charge Code	64905788
Hospital Revenue Code	278
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$328.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$156.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.69
Rate for Payer: EmblemHealth Commercial	$156.25
Rate for Payer: Fidelis Medicare Advantage	$328.12
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$203.12

PRECEPT NIT K-WIRE BEVT

Facility

$312.50

Service Code	HCPCS C1713
Hospital Charge Code	64905788
Hospital Revenue Code	278
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$156.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

PRECEPT SCREW, 6.5X50 POLY

Facility

$4,200.00

Service Code	HCPCS C1713
Hospital Charge Code	64905184
Hospital Revenue Code	278
Min. Negotiated Rate	$2,100.00
Max. Negotiated Rate	$2,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,100.00

Know your out-of-pocket cost for care.

All Charges