St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 1 VISIT

Professional

Both

$1,311.94

Service Code	HCPCS 90959
Min. Negotiated Rate	$983.96
Max. Negotiated Rate	$983.96
Rate for Payer: Cash Price	$362.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$983.96
Rate for Payer: SOMOS Essential	$983.96

PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 2/3 VISITS

Professional

Both

$2,015.62

Service Code	HCPCS 90958
Min. Negotiated Rate	$1,511.72
Max. Negotiated Rate	$1,511.72
Rate for Payer: Cash Price	$553.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,511.72
Rate for Payer: SOMOS Essential	$1,511.72

PR ESRD RELATED SVC MONTHLY 12-19 YR OLD 4/> VISITS

Professional

Both

$3,100.30

Service Code	HCPCS 90957
Min. Negotiated Rate	$2,325.22
Max. Negotiated Rate	$2,325.22
Rate for Payer: Cash Price	$850.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,325.22
Rate for Payer: SOMOS Essential	$2,325.22

PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT

Professional

Both

$819.28

Service Code	HCPCS 90962
Min. Negotiated Rate	$614.46
Max. Negotiated Rate	$614.46
Rate for Payer: Cash Price	$225.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$614.46
Rate for Payer: SOMOS Essential	$614.46

PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS

Professional

Both

$1,186.89

Service Code	HCPCS 90961
Min. Negotiated Rate	$890.17
Max. Negotiated Rate	$890.17
Rate for Payer: Cash Price	$326.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$890.17
Rate for Payer: SOMOS Essential	$890.17

PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS

Professional

Both

$1,423.14

Service Code	HCPCS 90960
Min. Negotiated Rate	$1,067.36
Max. Negotiated Rate	$1,067.36
Rate for Payer: Cash Price	$392.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,067.36
Rate for Payer: SOMOS Essential	$1,067.36

PR ESRD RELATED SVC MONTHLY 2-11 YR OLD 1 VISIT

Professional

Both

$1,397.06

Service Code	HCPCS 90956
Min. Negotiated Rate	$1,047.80
Max. Negotiated Rate	$1,047.80
Rate for Payer: Cash Price	$385.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,047.80
Rate for Payer: SOMOS Essential	$1,047.80

PR ESRD RELATED SVC MONTHLY 2-11 YR OLD 2/3 VISITS

Professional

Both

$2,090.80

Service Code	HCPCS 90955
Min. Negotiated Rate	$1,568.10
Max. Negotiated Rate	$1,568.10
Rate for Payer: Cash Price	$578.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,568.10
Rate for Payer: SOMOS Essential	$1,568.10

PR ESRD RELATED SVC MONTHLY 2-11 YR OLD 4/> VISITS

Professional

Both

$4,053.39

Service Code	HCPCS 90954
Min. Negotiated Rate	$3,040.04
Max. Negotiated Rate	$3,040.04
Rate for Payer: Cash Price	$1,109.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,040.04
Rate for Payer: SOMOS Essential	$3,040.04

PR ESRD RELATED SVC MONTHLY & <2 YR OLD 4/> VISITS

Professional

Both

$4,741.84

Service Code	HCPCS 90951
Min. Negotiated Rate	$3,556.38
Max. Negotiated Rate	$3,556.38
Rate for Payer: Cash Price	$1,297.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,556.38
Rate for Payer: SOMOS Essential	$3,556.38

PR ESRD SVC HOME DIALYSIS FULL MONTH 12-19 YR OLD

Professional

Both

$2,009.84

Service Code	HCPCS 90965
Min. Negotiated Rate	$1,507.38
Max. Negotiated Rate	$1,507.38
Rate for Payer: Cash Price	$553.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,507.38
Rate for Payer: SOMOS Essential	$1,507.38

PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD

Professional

Both

$1,185.45

Service Code	HCPCS 90966
Min. Negotiated Rate	$889.09
Max. Negotiated Rate	$889.09
Rate for Payer: Cash Price	$326.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$889.09
Rate for Payer: SOMOS Essential	$889.09

PR ESRD SVC HOME DIALYSIS FULL MONTH 2-11 YR OLD

Professional

Both

$2,102.77

Service Code	HCPCS 90964
Min. Negotiated Rate	$1,577.08
Max. Negotiated Rate	$1,577.08
Rate for Payer: Cash Price	$576.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,577.08
Rate for Payer: SOMOS Essential	$1,577.08

PR ESRD SVC HOME DIALYSIS FULL MONTH <2YR OLD

Professional

Both

$2,446.82

Service Code	HCPCS 90963
Min. Negotiated Rate	$1,835.12
Max. Negotiated Rate	$1,835.12
Rate for Payer: Cash Price	$671.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,835.12
Rate for Payer: SOMOS Essential	$1,835.12

PRESSFIT STEM 14MM X 120MM

Facility

$3,840.00

Service Code	HCPCS C1713
Hospital Charge Code	64903978
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,032.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,112.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,304.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,920.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,208.00
Rate for Payer: EmblemHealth Commercial	$1,920.00
Rate for Payer: Fidelis Medicare Advantage	$4,032.00
Rate for Payer: Group Health Inc Commercial	$1,920.00
Rate for Payer: Group Health Inc Medicare	$1,344.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,920.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,920.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,496.00

PRESSFIT STEM 14MM X 120MM

Facility

$3,840.00

Service Code	HCPCS C1713
Hospital Charge Code	64903978
Hospital Revenue Code	278
Min. Negotiated Rate	$1,920.00
Max. Negotiated Rate	$1,920.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,920.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,920.00

PRESSURE BALANCE ELEMENT

Facility

$79.75

Hospital Charge Code	64905969
Hospital Revenue Code	270
Min. Negotiated Rate	$27.91
Max. Negotiated Rate	$63.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.88
Rate for Payer: Aetna Government	$39.88
Rate for Payer: Brighton Health Commercial	$59.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.23
Rate for Payer: Group Health Inc Commercial	$39.88
Rate for Payer: Group Health Inc Medicare	$27.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.88
Rate for Payer: Hamaspik Choice Inc Medicare	$39.88

PRESSURE DOME

Facility

$102.06

Hospital Charge Code	40204839
Hospital Revenue Code	270
Min. Negotiated Rate	$35.72
Max. Negotiated Rate	$81.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$51.03
Rate for Payer: Aetna Government	$51.03
Rate for Payer: Brighton Health Commercial	$76.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.40
Rate for Payer: Group Health Inc Commercial	$51.03
Rate for Payer: Group Health Inc Medicare	$35.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.03
Rate for Payer: Hamaspik Choice Inc Medicare	$51.03

PRESTO INFLATION DEVICE

Facility

$320.00

Hospital Charge Code	40004772
Hospital Revenue Code	270
Min. Negotiated Rate	$112.00
Max. Negotiated Rate	$256.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$176.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$160.00
Rate for Payer: Aetna Government	$160.00
Rate for Payer: Brighton Health Commercial	$240.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$256.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$217.60
Rate for Payer: Group Health Inc Commercial	$160.00
Rate for Payer: Group Health Inc Medicare	$112.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$160.00

PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE

Professional

Both

$1,228.36

Service Code	HCPCS 0102T
Min. Negotiated Rate	$921.27
Max. Negotiated Rate	$921.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$921.27
Rate for Payer: SOMOS Essential	$921.27

PR ESW INTEGUMENTARY WOUND HEALING INITIAL WOUND

Professional

Both

$1,429.82

Service Code	HCPCS 0512T
Min. Negotiated Rate	$1,072.36
Max. Negotiated Rate	$1,072.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,072.36
Rate for Payer: SOMOS Essential	$1,072.36

PR ESWT HI NRG PHYS/QHP W/US GDN INVG PLNTAR FASCIA

Professional

Both

$912.80

Service Code	HCPCS 28890
Min. Negotiated Rate	$684.60
Max. Negotiated Rate	$684.60
Rate for Payer: Cash Price	$257.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$684.60
Rate for Payer: SOMOS Essential	$684.60

PR ETHMOIDECTOMY EXTRANASAL TOTAL

Professional

Both

$3,977.47

Service Code	HCPCS 31205
Min. Negotiated Rate	$2,983.10
Max. Negotiated Rate	$2,983.10
Rate for Payer: Cash Price	$1,088.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,983.10
Rate for Payer: SOMOS Essential	$2,983.10

PR ETHMOIDECTOMY INTRANASAL ANTERIOR

Professional

Both

$2,668.86

Service Code	HCPCS 31200
Min. Negotiated Rate	$2,001.64
Max. Negotiated Rate	$2,001.64
Rate for Payer: Cash Price	$730.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,001.64
Rate for Payer: SOMOS Essential	$2,001.64

PR ETHMOIDECTOMY INTRANASAL TOTAL

Professional

Both

$3,475.64

Service Code	HCPCS 31201
Min. Negotiated Rate	$2,606.73
Max. Negotiated Rate	$2,606.73
Rate for Payer: Cash Price	$916.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,606.73
Rate for Payer: SOMOS Essential	$2,606.73

Know your out-of-pocket cost for care.

All Charges