St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ETONOGESTREL IMPLANT SYSTEM

Professional

Both

$2,250.00

Service Code	HCPCS J7307
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$1,687.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,687.50
Rate for Payer: SOMOS Essential	$1,687.50

PR EVACUATION SUBUNGUAL HEMATOMA

Professional

Both

$134.93

Service Code	HCPCS 11740
Min. Negotiated Rate	$101.20
Max. Negotiated Rate	$101.20
Rate for Payer: Cash Price	$37.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$101.20
Rate for Payer: SOMOS Essential	$101.20

PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV 1ST HR

Professional

Both

$296.98

Service Code	HCPCS 92626
Min. Negotiated Rate	$222.74
Max. Negotiated Rate	$222.74
Rate for Payer: Cash Price	$81.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$222.74
Rate for Payer: SOMOS Essential	$222.74

PR EVAL AUD FUNCJ CAND/PO SURG IMPLT DEV EA ADDL 15

Professional

Both

$69.93

Service Code	HCPCS 92627
Min. Negotiated Rate	$52.45
Max. Negotiated Rate	$52.45
Rate for Payer: Cash Price	$19.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.45
Rate for Payer: SOMOS Essential	$52.45

PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN

Professional

Both

$317.84

Service Code	HCPCS 92620
Min. Negotiated Rate	$238.38
Max. Negotiated Rate	$238.38
Rate for Payer: Cash Price	$86.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.38
Rate for Payer: SOMOS Essential	$238.38

PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN

Professional

Both

$73.89

Service Code	HCPCS 92621
Min. Negotiated Rate	$55.42
Max. Negotiated Rate	$55.42
Rate for Payer: Cash Price	$20.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.42
Rate for Payer: SOMOS Essential	$55.42

PR EVAL&/FITG VOICE PROSTC DEV SUPLMNT ORAL SPEEC

Professional

Both

$289.52

Service Code	HCPCS 92597
Min. Negotiated Rate	$217.14
Max. Negotiated Rate	$217.14
Rate for Payer: Cash Price	$80.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$217.14
Rate for Payer: SOMOS Essential	$217.14

PR EVAL ORAL&PHARYNGEAL SWLNG FUNCJ

Professional

Both

$280.14

Service Code	HCPCS 92610
Min. Negotiated Rate	$210.10
Max. Negotiated Rate	$210.10
Rate for Payer: Cash Price	$77.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210.10
Rate for Payer: SOMOS Essential	$210.10

PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION

Professional

Both

$917.98

Service Code	HCPCS 92523
Min. Negotiated Rate	$688.48
Max. Negotiated Rate	$688.48
Rate for Payer: Cash Price	$254.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$688.48
Rate for Payer: SOMOS Essential	$688.48

PR EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)

Professional

Both

$535.61

Service Code	HCPCS 92521
Min. Negotiated Rate	$401.71
Max. Negotiated Rate	$401.71
Rate for Payer: Cash Price	$148.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$401.71
Rate for Payer: SOMOS Essential	$401.71

PR EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE

Professional

Both

$449.37

Service Code	HCPCS 92522
Min. Negotiated Rate	$337.03
Max. Negotiated Rate	$337.03
Rate for Payer: Cash Price	$124.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$337.03
Rate for Payer: SOMOS Essential	$337.03

PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST

Professional

Both

$2,643.55

Service Code	HCPCS 61650
Min. Negotiated Rate	$1,982.66
Max. Negotiated Rate	$1,982.66
Rate for Payer: Cash Price	$714.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,982.66
Rate for Payer: SOMOS Essential	$1,982.66

PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL

Professional

Both

$1,146.50

Service Code	HCPCS 61651
Min. Negotiated Rate	$859.88
Max. Negotiated Rate	$859.88
Rate for Payer: Cash Price	$305.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$859.88
Rate for Payer: SOMOS Essential	$859.88

PR EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE

Professional

Both

$897.72

Service Code	HCPCS 34808
Min. Negotiated Rate	$673.29
Max. Negotiated Rate	$673.29
Rate for Payer: Cash Price	$237.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$673.29
Rate for Payer: SOMOS Essential	$673.29

PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT

Professional

Both

$5,464.69

Service Code	HCPCS 34701
Min. Negotiated Rate	$4,098.52
Max. Negotiated Rate	$4,098.52
Rate for Payer: Cash Price	$1,447.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,098.52
Rate for Payer: SOMOS Essential	$4,098.52

PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT

Professional

Both

$8,177.16

Service Code	HCPCS 34702
Min. Negotiated Rate	$6,132.87
Max. Negotiated Rate	$6,132.87
Rate for Payer: Cash Price	$2,165.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,132.87
Rate for Payer: SOMOS Essential	$6,132.87

PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT

Professional

Both

$6,752.17

Service Code	HCPCS 34705
Min. Negotiated Rate	$5,064.13
Max. Negotiated Rate	$5,064.13
Rate for Payer: Cash Price	$1,788.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,064.13
Rate for Payer: SOMOS Essential	$5,064.13

PR EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT

Professional

Both

$10,087.63

Service Code	HCPCS 34706
Min. Negotiated Rate	$7,565.72
Max. Negotiated Rate	$7,565.72
Rate for Payer: Cash Price	$2,668.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,565.72
Rate for Payer: SOMOS Essential	$7,565.72

PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT

Professional

Both

$6,094.76

Service Code	HCPCS 34703
Min. Negotiated Rate	$4,571.07
Max. Negotiated Rate	$4,571.07
Rate for Payer: Cash Price	$1,608.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,571.07
Rate for Payer: SOMOS Essential	$4,571.07

PR EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT

Professional

Both

$10,139.33

Service Code	HCPCS 34704
Min. Negotiated Rate	$7,604.50
Max. Negotiated Rate	$7,604.50
Rate for Payer: Cash Price	$2,681.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,604.50
Rate for Payer: SOMOS Essential	$7,604.50

PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT

Professional

Both

$5,154.77

Service Code	HCPCS 34707
Min. Negotiated Rate	$3,866.08
Max. Negotiated Rate	$3,866.08
Rate for Payer: Cash Price	$1,360.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,866.08
Rate for Payer: SOMOS Essential	$3,866.08

PR EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT

Professional

Both

$8,086.86

Service Code	HCPCS 34708
Min. Negotiated Rate	$6,065.14
Max. Negotiated Rate	$6,065.14
Rate for Payer: Cash Price	$2,139.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,065.14
Rate for Payer: SOMOS Essential	$6,065.14

PR EVASC RPR DTA COVERAGE ART ORIGIN 1ST ENDOPROSTH

Professional

Both

$7,924.21

Service Code	HCPCS 33880
Min. Negotiated Rate	$5,943.16
Max. Negotiated Rate	$5,943.16
Rate for Payer: Cash Price	$2,094.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,943.16
Rate for Payer: SOMOS Essential	$5,943.16

PR EVASC RPR DTA EXP COVERAGE W/O ART ORIGIN

Professional

Both

$6,784.33

Service Code	HCPCS 33881
Min. Negotiated Rate	$5,088.25
Max. Negotiated Rate	$5,088.25
Rate for Payer: Cash Price	$1,799.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,088.25
Rate for Payer: SOMOS Essential	$5,088.25

PR EVASC RPR ILIAC ART N/A A-ILIAC ART NDGFT UNI

Professional

Both

$5,460.67

Service Code	HCPCS 34718
Min. Negotiated Rate	$4,095.50
Max. Negotiated Rate	$4,095.50
Rate for Payer: Cash Price	$1,452.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,095.50
Rate for Payer: SOMOS Essential	$4,095.50

Know your out-of-pocket cost for care.

All Charges