St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ENZYME HISTOCHEMISTRY

Professional

Both

$471.21

Service Code	HCPCS 88319 TC
Min. Negotiated Rate	$353.41
Max. Negotiated Rate	$353.41
Rate for Payer: Cash Price	$130.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$353.41
Rate for Payer: SOMOS Essential	$353.41

PRE-OPRTV CRE FRST HALF HR

Facility

$58.83

Hospital Charge Code	40199963
Hospital Revenue Code	710
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$47.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.42
Rate for Payer: Aetna Government	$29.42
Rate for Payer: Brighton Health Commercial	$44.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.00
Rate for Payer: Group Health Inc Commercial	$29.42
Rate for Payer: Group Health Inc Medicare	$20.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.42
Rate for Payer: Hamaspik Choice Inc Medicare	$29.42

PRE-OPRTV ECH ADDI QUATR HR

Facility

$29.41

Hospital Charge Code	40199965
Hospital Revenue Code	710
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$23.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.70
Rate for Payer: Aetna Government	$14.70
Rate for Payer: Brighton Health Commercial	$22.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.00
Rate for Payer: Group Health Inc Commercial	$14.70
Rate for Payer: Group Health Inc Medicare	$10.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.70
Rate for Payer: Hamaspik Choice Inc Medicare	$14.70

PRE-ORTHODONTIC TREATMENT VISIT

Facility

$72.50

Service Code	HCPCS D8660
Hospital Charge Code	42303368
Hospital Revenue Code	361
Min. Negotiated Rate	$25.38
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.55
Rate for Payer: Aetna Government	$26.55
Rate for Payer: Brighton Health Commercial	$54.38
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	$36.25
Rate for Payer: Group Health Inc Medicare	$25.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.25
Rate for Payer: Hamaspik Choice Inc Medicare	$36.25

PR EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE

Professional

Both

$758.07

Service Code	HCPCS 93640 26
Min. Negotiated Rate	$568.55
Max. Negotiated Rate	$568.55
Rate for Payer: Cash Price	$201.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$568.55
Rate for Payer: SOMOS Essential	$568.55

PR EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE

Professional

Both

$1,460.41

Service Code	HCPCS 93640 TC
Min. Negotiated Rate	$1,095.31
Max. Negotiated Rate	$1,095.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,095.31
Rate for Payer: SOMOS Essential	$1,095.31

PR EPHYS EVAL PACG CVDFB LDS INITIAL IMPLAN/REPLACE

Professional

Both

$2,218.48

Service Code	HCPCS 93640
Min. Negotiated Rate	$1,663.86
Max. Negotiated Rate	$1,663.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,663.86
Rate for Payer: SOMOS Essential	$1,663.86

PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN

Professional

Both

$2,794.09

Service Code	HCPCS 93641
Min. Negotiated Rate	$2,095.57
Max. Negotiated Rate	$2,095.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,095.57
Rate for Payer: SOMOS Essential	$2,095.57

PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN

Professional

Both

$1,460.41

Service Code	HCPCS 93641 TC
Min. Negotiated Rate	$1,095.31
Max. Negotiated Rate	$1,095.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,095.31
Rate for Payer: SOMOS Essential	$1,095.31

PR EPHYS EVAL PACG CVDFB LDS W/TSTG OF PULSE GEN

Professional

Both

$1,333.68

Service Code	HCPCS 93641 26
Min. Negotiated Rate	$1,000.26
Max. Negotiated Rate	$1,000.26
Rate for Payer: Cash Price	$353.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,000.26
Rate for Payer: SOMOS Essential	$1,000.26

PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS

Professional

Both

$1,085.60

Service Code	HCPCS 93642 26
Min. Negotiated Rate	$814.20
Max. Negotiated Rate	$814.20
Rate for Payer: Cash Price	$287.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$814.20
Rate for Payer: SOMOS Essential	$814.20

PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS

Professional

Both

$360.26

Service Code	HCPCS 93642 TC
Min. Negotiated Rate	$270.20
Max. Negotiated Rate	$270.20
Rate for Payer: Cash Price	$96.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$270.20
Rate for Payer: SOMOS Essential	$270.20

PR EPHYS EVAL PACG CVDFB PRGRMG/REPRGRMG PARAMETERS

Professional

Both

$1,445.85

Service Code	HCPCS 93642
Min. Negotiated Rate	$1,084.39
Max. Negotiated Rate	$1,084.39
Rate for Payer: Cash Price	$384.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,084.39
Rate for Payer: SOMOS Essential	$1,084.39

PR EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR

Professional

Both

$556.19

Service Code	HCPCS 93644 26
Min. Negotiated Rate	$417.14
Max. Negotiated Rate	$417.14
Rate for Payer: Cash Price	$152.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$417.14
Rate for Payer: SOMOS Essential	$417.14

PR EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR

Professional

Both

$218.37

Service Code	HCPCS 93644 TC
Min. Negotiated Rate	$163.78
Max. Negotiated Rate	$163.78
Rate for Payer: Cash Price	$59.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$163.78
Rate for Payer: SOMOS Essential	$163.78

PR EPHYS EVAL SUBQ IMPLANTABLE DEFIBRILLATOR

Professional

Both

$774.55

Service Code	HCPCS 93644
Min. Negotiated Rate	$580.91
Max. Negotiated Rate	$580.91
Rate for Payer: Cash Price	$212.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$580.91
Rate for Payer: SOMOS Essential	$580.91

PR EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/<

Professional

Both

$2,963.38

Service Code	HCPCS 15115
Min. Negotiated Rate	$2,222.54
Max. Negotiated Rate	$2,222.54
Rate for Payer: Cash Price	$811.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,222.54
Rate for Payer: SOMOS Essential	$2,222.54

PR EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM

Professional

Both

$620.31

Service Code	HCPCS 15116
Min. Negotiated Rate	$465.23
Max. Negotiated Rate	$465.23
Rate for Payer: Cash Price	$163.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$465.23
Rate for Payer: SOMOS Essential	$465.23

PR EPIDIDYMECTOMY BILATERAL

Professional

Both

$2,386.30

Service Code	HCPCS 54861
Min. Negotiated Rate	$1,789.72
Max. Negotiated Rate	$1,789.72
Rate for Payer: Cash Price	$655.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,789.72
Rate for Payer: SOMOS Essential	$1,789.72

PR EPIDIDYMECTOMY UNILATERAL

Professional

Both

$1,763.27

Service Code	HCPCS 54860
Min. Negotiated Rate	$1,322.45
Max. Negotiated Rate	$1,322.45
Rate for Payer: Cash Price	$484.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,322.45
Rate for Payer: SOMOS Essential	$1,322.45

PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS BI

Professional

Both

$4,426.28

Service Code	HCPCS 54901
Min. Negotiated Rate	$3,319.71
Max. Negotiated Rate	$3,319.71
Rate for Payer: Cash Price	$1,208.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,319.71
Rate for Payer: SOMOS Essential	$3,319.71

PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI

Professional

Both

$3,353.56

Service Code	HCPCS 54900
Min. Negotiated Rate	$2,515.17
Max. Negotiated Rate	$2,515.17
Rate for Payer: Cash Price	$916.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,515.17
Rate for Payer: SOMOS Essential	$2,515.17

PR EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD

Professional

Both

$3,119.80

Service Code	HCPCS 15110
Min. Negotiated Rate	$2,339.85
Max. Negotiated Rate	$2,339.85
Rate for Payer: Cash Price	$844.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,339.85
Rate for Payer: SOMOS Essential	$2,339.85

PR EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD

Professional

Both

$454.58

Service Code	HCPCS 15111
Min. Negotiated Rate	$340.94
Max. Negotiated Rate	$340.94
Rate for Payer: Cash Price	$120.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$340.94
Rate for Payer: SOMOS Essential	$340.94

PR EPIGLOTTIDECTOMY

Professional

Both

$3,599.82

Service Code	HCPCS 31420
Min. Negotiated Rate	$2,699.86
Max. Negotiated Rate	$2,699.86
Rate for Payer: Cash Price	$974.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,699.86
Rate for Payer: SOMOS Essential	$2,699.86

Know your out-of-pocket cost for care.

All Charges