St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO

Professional

Both

$405.51

Service Code	HCPCS 95717
Min. Negotiated Rate	$304.13
Max. Negotiated Rate	$304.13
Rate for Payer: Cash Price	$117.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$304.13
Rate for Payer: SOMOS Essential	$304.13

PR EEG PHYS/QHP 2-12 HR WITH VEEG

Professional

Both

$539.04

Service Code	HCPCS 95718
Min. Negotiated Rate	$404.28
Max. Negotiated Rate	$404.28
Rate for Payer: Cash Price	$149.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$404.28
Rate for Payer: SOMOS Essential	$404.28

PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID

Professional

Both

$634.31

Service Code	HCPCS 95719
Min. Negotiated Rate	$475.73
Max. Negotiated Rate	$475.73
Rate for Payer: Cash Price	$178.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$475.73
Rate for Payer: SOMOS Essential	$475.73

PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG

Professional

Both

$834.37

Service Code	HCPCS 95720
Min. Negotiated Rate	$625.78
Max. Negotiated Rate	$625.78
Rate for Payer: Cash Price	$230.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$625.78
Rate for Payer: SOMOS Essential	$625.78

PR EEG W/O VID BY TECH EA INCR 12-26 HR INTMT MNTR

Professional

Both

$2,123.66

Service Code	HCPCS 95709
Min. Negotiated Rate	$1,592.74
Max. Negotiated Rate	$1,592.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,592.74
Rate for Payer: SOMOS Essential	$1,592.74

PR EEG W/O VID BY TECH EA INCR 12-26HR UNMONITORED

Professional

Both

$626.05

Service Code	HCPCS 95708
Min. Negotiated Rate	$469.54
Max. Negotiated Rate	$469.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$469.54
Rate for Payer: SOMOS Essential	$469.54

PR EEG W/O VIDEO BY TECH 2-12HR CONTINUOUS R-T MNTR

Professional

Both

$1,643.71

Service Code	HCPCS 95707
Min. Negotiated Rate	$1,232.78
Max. Negotiated Rate	$1,232.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,232.78
Rate for Payer: SOMOS Essential	$1,232.78

PR EEG W/O VIDEO BY TECH 2-12 HR INTERMITTENT MNTR

Professional

Both

$1,196.37

Service Code	HCPCS 95706
Min. Negotiated Rate	$897.28
Max. Negotiated Rate	$897.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$897.28
Rate for Payer: SOMOS Essential	$897.28

PR EEG W/O VIDEO BY TECH 2-12 HR UNMONITORED

Professional

Both

$372.75

Service Code	HCPCS 95705
Min. Negotiated Rate	$279.56
Max. Negotiated Rate	$279.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$279.56
Rate for Payer: SOMOS Essential	$279.56

PR EEG W/O VID TECH EA INCR 12-26 HR CONT R-T MNTR

Professional

Both

$2,748.76

Service Code	HCPCS 95710
Min. Negotiated Rate	$2,061.57
Max. Negotiated Rate	$2,061.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,061.57
Rate for Payer: SOMOS Essential	$2,061.57

PREFABRICATED ABUTMENT

Facility

$1,000.00

Service Code	HCPCS D6056
Hospital Charge Code	42303319
Hospital Revenue Code	361
Min. Negotiated Rate	$139.55
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$139.55
Rate for Payer: Aetna Government	$139.55
Rate for Payer: Brighton Health Commercial	$750.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

PREFABRICATED POST AND CORE IN AD

Facility

$312.50

Service Code	HCPCS D2954
Hospital Charge Code	42300660
Hospital Revenue Code	361
Min. Negotiated Rate	$156.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$234.38
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

PREFABRICATED POST AND CORE IN AD

Facility

$312.50

Service Code	HCPCS D2954
Hospital Charge Code	42300660
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

PREFABRICATED RESIN CROWN

Facility

$290.00

Service Code	HCPCS D2932
Hospital Charge Code	42300625
Hospital Revenue Code	361
Min. Negotiated Rate	$145.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$159.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$217.50
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

PREFABRICATED RESIN CROWN

Facility

$290.00

Service Code	HCPCS D2932
Hospital Charge Code	42300625
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

PREFAB STAINLESS STEEL CR PERM

Facility

$290.00

Service Code	HCPCS D2931
Hospital Charge Code	42300620
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

PREFAB STAINLESS STEEL CR PERM

Facility

$290.00

Service Code	HCPCS D2931
Hospital Charge Code	42300620
Hospital Revenue Code	361
Min. Negotiated Rate	$145.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$159.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$217.50
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

PREFAB STAINLESS STEEL CR PRIM

Facility

$290.00

Service Code	HCPCS D2930
Hospital Charge Code	42300615
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

PREFAB STAINLESS STEEL CR PRIM

Facility

$290.00

Service Code	HCPCS D2930
Hospital Charge Code	42300615
Hospital Revenue Code	361
Min. Negotiated Rate	$145.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$159.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$217.50
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

PREFAB STAINLESS STEEL CR W/W

Facility

$325.00

Service Code	HCPCS D2933
Hospital Charge Code	42300630
Hospital Revenue Code	361
Min. Negotiated Rate	$162.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$243.75
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

PREFAB STAINLESS STEEL CR W/W

Facility

$325.00

Service Code	HCPCS D2933
Hospital Charge Code	42300630
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

PREGABALIN 100 MG CAP

Facility

$6.12

Hospital Charge Code	41644833
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PREGABALIN 100 MG CAP

Facility

$6.12

Hospital Charge Code	41654833
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$4.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.06
Rate for Payer: Aetna Government	$3.06
Rate for Payer: Brighton Health Commercial	$4.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.16
Rate for Payer: Group Health Inc Commercial	$3.06
Rate for Payer: Group Health Inc Medicare	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.06
Rate for Payer: Hamaspik Choice Inc Medicare	$3.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.98

PREGABALIN 100 MG PO CAPS [42165]

Facility

$1.01

Service Code	NDC 00904700161
Hospital Charge Code	00904700161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

PREGABALIN 100 MG PO CAPS [42165]

Facility

$8.43

Service Code	NDC 50228035390
Hospital Charge Code	50228035390
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$6.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.21
Rate for Payer: Aetna Government	$4.21
Rate for Payer: Brighton Health Commercial	$6.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.73
Rate for Payer: Group Health Inc Commercial	$4.21
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.21
Rate for Payer: Hamaspik Choice Inc Medicare	$4.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.48

Know your out-of-pocket cost for care.

All Charges