St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM

Professional

Both

$936.60

Service Code	HCPCS 93724 26
Min. Negotiated Rate	$702.45
Max. Negotiated Rate	$702.45
Rate for Payer: Cash Price	$252.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$702.45
Rate for Payer: SOMOS Essential	$702.45

PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM

Professional

Both

$1,137.71

Service Code	HCPCS 93724
Min. Negotiated Rate	$853.28
Max. Negotiated Rate	$853.28
Rate for Payer: Cash Price	$307.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$853.28
Rate for Payer: SOMOS Essential	$853.28

PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM

Professional

Both

$201.11

Service Code	HCPCS 93724 TC
Min. Negotiated Rate	$150.83
Max. Negotiated Rate	$150.83
Rate for Payer: Cash Price	$54.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.83
Rate for Payer: SOMOS Essential	$150.83

PR ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT

Professional

Both

$456.09

Service Code	HCPCS 92270
Min. Negotiated Rate	$342.07
Max. Negotiated Rate	$342.07
Rate for Payer: Cash Price	$135.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$342.07
Rate for Payer: SOMOS Essential	$342.07

PR ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT

Professional

Both

$292.99

Service Code	HCPCS 92270 TC
Min. Negotiated Rate	$219.74
Max. Negotiated Rate	$219.74
Rate for Payer: Cash Price	$90.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$219.74
Rate for Payer: SOMOS Essential	$219.74

PR ELECTRO-OCULOGRAPY W/INTERPRETATION & REPORT

Professional

Both

$163.14

Service Code	HCPCS 92270 26
Min. Negotiated Rate	$122.36
Max. Negotiated Rate	$122.36
Rate for Payer: Cash Price	$45.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122.36
Rate for Payer: SOMOS Essential	$122.36

PR ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT

Professional

Both

$1,068.38

Service Code	HCPCS 93624 26
Min. Negotiated Rate	$801.28
Max. Negotiated Rate	$801.28
Rate for Payer: Cash Price	$274.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$801.28
Rate for Payer: SOMOS Essential	$801.28

PR ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT

Professional

Both

$1,488.97

Service Code	HCPCS 93624
Min. Negotiated Rate	$1,116.73
Max. Negotiated Rate	$1,116.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,116.73
Rate for Payer: SOMOS Essential	$1,116.73

PR ELECTROPHYSIOLOGIC FOLLOW-UP W/PAC/REC W/ARRHYT

Professional

Both

$420.60

Service Code	HCPCS 93624 TC
Min. Negotiated Rate	$315.45
Max. Negotiated Rate	$315.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$315.45
Rate for Payer: SOMOS Essential	$315.45

PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL

Professional

Both

$4,985.61

Service Code	HCPCS 62000
Min. Negotiated Rate	$3,739.21
Max. Negotiated Rate	$3,739.21
Rate for Payer: Cash Price	$1,318.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,739.21
Rate for Payer: SOMOS Essential	$3,739.21

PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL

Professional

Both

$6,141.21

Service Code	HCPCS 62005
Min. Negotiated Rate	$4,605.91
Max. Negotiated Rate	$4,605.91
Rate for Payer: Cash Price	$1,622.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,605.91
Rate for Payer: SOMOS Essential	$4,605.91

PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN

Professional

Both

$7,418.15

Service Code	HCPCS 62010
Min. Negotiated Rate	$5,563.61
Max. Negotiated Rate	$5,563.61
Rate for Payer: Cash Price	$1,958.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,563.61
Rate for Payer: SOMOS Essential	$5,563.61

PREMASOL 10 % IV SOLN [36160]

Facility

$0.12

Service Code	NDC 00338113004
Hospital Charge Code	00338113004
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Fidelis Medicare Advantage	$0.13
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

PREMASOL 10 % IV SOLN [36160]

Facility

$0.12

Service Code	NDC 00338113004
Hospital Charge Code	00338113004
Hospital Revenue Code	278
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06

PREMATURITY WITH MAJOR PROBLEMS

Facility

$88,209.29

Service Code	MSDRG 791
Min. Negotiated Rate	$3,163.00
Max. Negotiated Rate	$88,209.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60,420.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$64,152.21
Rate for Payer: Aetna Government	$64,152.21
Rate for Payer: Brighton Health Commercial	$59,416.65
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$65,435.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70,763.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$58,396.81
Rate for Payer: Elderplan Medicare Advantage	$60,944.60
Rate for Payer: EmblemHealth Commercial	$35,137.80
Rate for Payer: Fidelis Medicare Advantage	$64,152.21
Rate for Payer: Group Health Inc Commercial	$64,152.21
Rate for Payer: Group Health Inc Medicare	$64,152.21
Rate for Payer: Hamaspik Choice Inc Medicare	$64,152.21
Rate for Payer: Healthfirst Medicare Advantage	$29,830.78
Rate for Payer: Humana Medicare	$88,209.29
Rate for Payer: Senior Whole Health Medicare Advantage	$64,152.21
Rate for Payer: United Healthcare Commercial	$3,163.00
Rate for Payer: United Healthcare Medicare Advantage	$64,152.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$64,152.21
Rate for Payer: Wellcare Medicare	$60,944.60

PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$57,220.56

Service Code	MSDRG 792
Min. Negotiated Rate	$3,163.00
Max. Negotiated Rate	$57,220.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36,457.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41,614.95
Rate for Payer: Aetna Government	$41,614.95
Rate for Payer: Brighton Health Commercial	$35,851.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$42,447.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42,697.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$35,235.89
Rate for Payer: Elderplan Medicare Advantage	$39,534.20
Rate for Payer: EmblemHealth Commercial	$21,201.70
Rate for Payer: Fidelis Medicare Advantage	$41,614.95
Rate for Payer: Group Health Inc Commercial	$41,614.95
Rate for Payer: Group Health Inc Medicare	$41,614.95
Rate for Payer: Hamaspik Choice Inc Medicare	$41,614.95
Rate for Payer: Healthfirst Medicare Advantage	$19,350.95
Rate for Payer: Humana Medicare	$57,220.56
Rate for Payer: Senior Whole Health Medicare Advantage	$41,614.95
Rate for Payer: United Healthcare Commercial	$3,163.00
Rate for Payer: United Healthcare Medicare Advantage	$41,614.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41,614.95
Rate for Payer: Wellcare Medicare	$39,534.20

PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART

Professional

Both

$2,656.12

Service Code	HCPCS 34101
Min. Negotiated Rate	$1,992.09
Max. Negotiated Rate	$1,992.09
Rate for Payer: Cash Price	$702.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,992.09
Rate for Payer: SOMOS Essential	$1,992.09

PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART

Professional

Both

$4,071.06

Service Code	HCPCS 34001
Min. Negotiated Rate	$3,053.30
Max. Negotiated Rate	$3,053.30
Rate for Payer: Cash Price	$1,078.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,053.30
Rate for Payer: SOMOS Essential	$3,053.30

PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART

Professional

Both

$4,539.33

Service Code	HCPCS 34201
Min. Negotiated Rate	$3,404.50
Max. Negotiated Rate	$3,404.50
Rate for Payer: Cash Price	$1,202.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,404.50
Rate for Payer: SOMOS Essential	$3,404.50

PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY

Professional

Both

$4,379.38

Service Code	HCPCS 34051
Min. Negotiated Rate	$3,284.54
Max. Negotiated Rate	$3,284.54
Rate for Payer: Cash Price	$1,167.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,284.54
Rate for Payer: SOMOS Essential	$3,284.54

PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC

Professional

Both

$4,211.03

Service Code	HCPCS 34203
Min. Negotiated Rate	$3,158.27
Max. Negotiated Rate	$3,158.27
Rate for Payer: Cash Price	$1,116.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,158.27
Rate for Payer: SOMOS Essential	$3,158.27

PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART

Professional

Both

$6,179.15

Service Code	HCPCS 34151
Min. Negotiated Rate	$4,634.36
Max. Negotiated Rate	$4,634.36
Rate for Payer: Cash Price	$1,637.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,634.36
Rate for Payer: SOMOS Essential	$4,634.36

PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC

Professional

Both

$2,662.14

Service Code	HCPCS 34111
Min. Negotiated Rate	$1,996.60
Max. Negotiated Rate	$1,996.60
Rate for Payer: Cash Price	$701.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,996.60
Rate for Payer: SOMOS Essential	$1,996.60

PR EMERGENCY DEPARTMENT VISIT HIGH MDM

Professional

Both

$729.47

Service Code	HCPCS 99285
Min. Negotiated Rate	$547.10
Max. Negotiated Rate	$547.10
Rate for Payer: Cash Price	$196.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$547.10
Rate for Payer: SOMOS Essential	$547.10

PR EMERGENCY DEPARTMENT VISIT LOW MDM

Professional

Both

$299.95

Service Code	HCPCS 99283
Min. Negotiated Rate	$224.96
Max. Negotiated Rate	$224.96
Rate for Payer: Cash Price	$79.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$224.96
Rate for Payer: SOMOS Essential	$224.96

Know your out-of-pocket cost for care.

All Charges