St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ECMO/ECLS DAILY MANAGEMENT EACH DAY VENO-VENOUS

Professional

Both

$1,015.60

Service Code	HCPCS 33948
Min. Negotiated Rate	$761.70
Max. Negotiated Rate	$761.70
Rate for Payer: Cash Price	$271.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$761.70
Rate for Payer: SOMOS Essential	$761.70

PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL

Professional

Both

$982.59

Service Code	HCPCS 33949
Min. Negotiated Rate	$736.94
Max. Negotiated Rate	$736.94
Rate for Payer: Cash Price	$266.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$736.94
Rate for Payer: SOMOS Essential	$736.94

PR ECMO/ECLS ECLS REPOS CENTRAL CNULA 6YRS & OLDER

Professional

Both

$2,166.40

Service Code	HCPCS 33964
Min. Negotiated Rate	$1,624.80
Max. Negotiated Rate	$1,624.80
Rate for Payer: Cash Price	$573.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,624.80
Rate for Payer: SOMOS Essential	$1,624.80

PR ECMO/ECLS INITIATION VENO-ARTERIAL

Professional

Both

$1,496.78

Service Code	HCPCS 33947
Min. Negotiated Rate	$1,122.58
Max. Negotiated Rate	$1,122.58
Rate for Payer: Cash Price	$398.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,122.58
Rate for Payer: SOMOS Essential	$1,122.58

PR ECMO/ECLS INITIATION VENO-VENOUS

Professional

Both

$1,350.97

Service Code	HCPCS 33946
Min. Negotiated Rate	$1,013.23
Max. Negotiated Rate	$1,013.23
Rate for Payer: Cash Price	$359.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,013.23
Rate for Payer: SOMOS Essential	$1,013.23

PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER

Professional

Both

$3,698.49

Service Code	HCPCS 33956
Min. Negotiated Rate	$2,773.87
Max. Negotiated Rate	$2,773.87
Rate for Payer: Cash Price	$980.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,773.87
Rate for Payer: SOMOS Essential	$2,773.87

PR ECMO/ECLS INSJ OF CENTRAL CANNULA BIRTH-5 YRS

Professional

Both

$3,633.14

Service Code	HCPCS 33955
Min. Negotiated Rate	$2,724.86
Max. Negotiated Rate	$2,724.86
Rate for Payer: Cash Price	$961.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,724.86
Rate for Payer: SOMOS Essential	$2,724.86

PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN

Professional

Both

$2,096.82

Service Code	HCPCS 33954
Min. Negotiated Rate	$1,572.62
Max. Negotiated Rate	$1,572.62
Rate for Payer: Cash Price	$557.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,572.62
Rate for Payer: SOMOS Essential	$1,572.62

PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ

Professional

Both

$1,875.69

Service Code	HCPCS 33952
Min. Negotiated Rate	$1,406.77
Max. Negotiated Rate	$1,406.77
Rate for Payer: Cash Price	$497.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,406.77
Rate for Payer: SOMOS Essential	$1,406.77

PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN

Professional

Both

$2,077.11

Service Code	HCPCS 33953
Min. Negotiated Rate	$1,557.83
Max. Negotiated Rate	$1,557.83
Rate for Payer: Cash Price	$548.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,557.83
Rate for Payer: SOMOS Essential	$1,557.83

PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS PERQ

Professional

Both

$1,864.77

Service Code	HCPCS 33951
Min. Negotiated Rate	$1,398.58
Max. Negotiated Rate	$1,398.58
Rate for Payer: Cash Price	$491.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,398.58
Rate for Payer: SOMOS Essential	$1,398.58

PR ECMO/ECLS REMOVAL OF CENTRAL CANNULA BIRTH-5 YRS

Professional

Both

$2,258.41

Service Code	HCPCS 33985
Min. Negotiated Rate	$1,693.81
Max. Negotiated Rate	$1,693.81
Rate for Payer: Cash Price	$595.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,693.81
Rate for Payer: SOMOS Essential	$1,693.81

PR ECMO/ECLS REPOS CENTRAL PERPH CANNULA BIRTH-5YRS

Professional

Both

$2,050.83

Service Code	HCPCS 33963
Min. Negotiated Rate	$1,538.12
Max. Negotiated Rate	$1,538.12
Rate for Payer: Cash Price	$542.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,538.12
Rate for Payer: SOMOS Essential	$1,538.12

PR ECMO/ECLS REPOS PERIPH CANNULA PERQ BIRTH-5 YRS

Professional

Both

$809.59

Service Code	HCPCS 33957
Min. Negotiated Rate	$607.19
Max. Negotiated Rate	$607.19
Rate for Payer: Cash Price	$213.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$607.19
Rate for Payer: SOMOS Essential	$607.19

PR ECMO/ECLS REPOS PERPH CANNULA OPEN 6 YRS & OLDER

Professional

Both

$1,024.66

Service Code	HCPCS 33962
Min. Negotiated Rate	$768.50
Max. Negotiated Rate	$768.50
Rate for Payer: Cash Price	$273.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$768.50
Rate for Payer: SOMOS Essential	$768.50

PR ECMO/ECLS REPOS PERPH CANNULA OPEN BIRTH-5 YRS

Professional

Both

$1,024.66

Service Code	HCPCS 33959
Min. Negotiated Rate	$768.50
Max. Negotiated Rate	$768.50
Rate for Payer: Cash Price	$273.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$768.50
Rate for Payer: SOMOS Essential	$768.50

PR ECMO/ECLS REPOS PERPH CANNULA PRQ 6 YRS & OLDER

Professional

Both

$809.59

Service Code	HCPCS 33958
Min. Negotiated Rate	$607.19
Max. Negotiated Rate	$607.19
Rate for Payer: Cash Price	$213.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$607.19
Rate for Payer: SOMOS Essential	$607.19

PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER

Professional

Both

$2,314.20

Service Code	HCPCS 33986
Min. Negotiated Rate	$1,735.65
Max. Negotiated Rate	$1,735.65
Rate for Payer: Cash Price	$613.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,735.65
Rate for Payer: SOMOS Essential	$1,735.65

PR ECMO/ECLS RMVL OF PERPH CANNULA OPEN BIRTH-5 YRS

Professional

Both

$1,198.05

Service Code	HCPCS 33969
Min. Negotiated Rate	$898.54
Max. Negotiated Rate	$898.54
Rate for Payer: Cash Price	$316.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$898.54
Rate for Payer: SOMOS Essential	$898.54

PR ECMO/ECLS RMVL OF PERPH CANNULA PERQ BIRTH-5 YRS

Professional

Both

$809.59

Service Code	HCPCS 33965
Min. Negotiated Rate	$607.19
Max. Negotiated Rate	$607.19
Rate for Payer: Cash Price	$213.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$607.19
Rate for Payer: SOMOS Essential	$607.19

PR ECMO/ECLS RMVL OF PRPH CANNULA PRQ 6 YRS & OLDER

Professional

Both

$1,033.17

Service Code	HCPCS 33966
Min. Negotiated Rate	$774.88
Max. Negotiated Rate	$774.88
Rate for Payer: Cash Price	$277.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$774.88
Rate for Payer: SOMOS Essential	$774.88

PR ECMO/ECLS RMVL PRPH CANNULA OPEN 6 YRS & OLDER

Professional

Both

$1,256.89

Service Code	HCPCS 33984
Min. Negotiated Rate	$942.67
Max. Negotiated Rate	$942.67
Rate for Payer: Cash Price	$332.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$942.67
Rate for Payer: SOMOS Essential	$942.67

PREC NIT K-WIRE BEVEL TIP

Facility

$322.83

Service Code	HCPCS C1713
Hospital Charge Code	64906036
Hospital Revenue Code	278
Min. Negotiated Rate	$161.42
Max. Negotiated Rate	$161.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.42
Rate for Payer: Hamaspik Choice Inc Medicare	$161.42

PREC NIT K-WIRE BEVEL TIP

Facility

$322.83

Service Code	HCPCS C1713
Hospital Charge Code	64906036
Hospital Revenue Code	278
Min. Negotiated Rate	$112.99
Max. Negotiated Rate	$338.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$177.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$193.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$161.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$185.63
Rate for Payer: EmblemHealth Commercial	$161.42
Rate for Payer: Fidelis Medicare Advantage	$338.97
Rate for Payer: Group Health Inc Commercial	$161.42
Rate for Payer: Group Health Inc Medicare	$112.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$161.42
Rate for Payer: Hamaspik Choice Inc Medicare	$161.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$209.84

PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS

Professional

Both

$435.23

Service Code	HCPCS 95836
Min. Negotiated Rate	$326.42
Max. Negotiated Rate	$326.42
Rate for Payer: Cash Price	$117.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$326.42
Rate for Payer: SOMOS Essential	$326.42

Know your out-of-pocket cost for care.

All Charges