St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR EVASC RPR ILIAC ART TM OF A-ILIAC ART NDGFT UNI

Professional

Both

$1,957.69

Service Code	HCPCS 34717
Min. Negotiated Rate	$1,468.27
Max. Negotiated Rate	$1,468.27
Rate for Payer: Cash Price	$518.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,468.27
Rate for Payer: SOMOS Essential	$1,468.27

PR EVASC ST RPR COARCJ THRC/AA ACRS MAJ SIDE BRNCH

Professional

Both

$4,313.89

Service Code	HCPCS 33894
Min. Negotiated Rate	$3,235.42
Max. Negotiated Rate	$3,235.42
Rate for Payer: Cash Price	$1,145.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,235.42
Rate for Payer: SOMOS Essential	$3,235.42

PR EVASC ST RPR COARCJ THRC/AA XCRSG MAJ SIDE BRNCH

Professional

Both

$3,428.85

Service Code	HCPCS 33895
Min. Negotiated Rate	$2,571.64
Max. Negotiated Rate	$2,571.64
Rate for Payer: Cash Price	$911.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,571.64
Rate for Payer: SOMOS Essential	$2,571.64

PR EVASC TEMP BALLOON ARTL OCCLUSION HEAD/NECK

Professional

Both

$2,663.19

Service Code	HCPCS 61623
Min. Negotiated Rate	$1,997.39
Max. Negotiated Rate	$1,997.39
Rate for Payer: Cash Price	$704.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,997.39
Rate for Payer: SOMOS Essential	$1,997.39

PREVENTIVE RESTORATION, PERM TH

Facility

$75.00

Service Code	HCPCS D1352
Hospital Charge Code	42300731
Hospital Revenue Code	361
Min. Negotiated Rate	$18.19
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.19
Rate for Payer: Aetna Government	$18.19
Rate for Payer: Brighton Health Commercial	$56.25
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	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

PREVENT MED COUNSELING 15 MIN

Facility

$89.35

Service Code	HCPCS 99401
Hospital Charge Code	30303350
Hospital Revenue Code	510
Min. Negotiated Rate	$18.18
Max. Negotiated Rate	$5,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.18
Rate for Payer: Aetna Government	$18.18
Rate for Payer: Affinity Essential Plan 1&2	$118.35
Rate for Payer: Affinity Essential Plan 3&4	$118.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$52.60
Rate for Payer: Amida Care Medicaid	$52.60
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5,260.00
Rate for Payer: Fidelis Essential Plan Aliesa	$52.60
Rate for Payer: Fidelis Essential Plan QHP	$52.60
Rate for Payer: Fidelis Qualified Health Plan	$55.23
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.60
Rate for Payer: Hamaspik Choice Inc Medicare	$44.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$52.60
Rate for Payer: Healthfirst Essential Plan	$118.35
Rate for Payer: Healthfirst QHP	$52.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.60
Rate for Payer: SOMOS Essential	$118.35
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$118.35
Rate for Payer: United Healthcare Essential Plan 3&4	$57.86
Rate for Payer: United Healthcare Medicaid	$52.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$52.60

PREVENT MED COUNSELING 30 MIN

Facility

$153.43

Service Code	HCPCS 99402
Hospital Charge Code	30303351
Hospital Revenue Code	510
Min. Negotiated Rate	$37.13
Max. Negotiated Rate	$6,529.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.13
Rate for Payer: Aetna Government	$37.13
Rate for Payer: Affinity Essential Plan 1&2	$146.90
Rate for Payer: Affinity Essential Plan 3&4	$146.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$65.29
Rate for Payer: Amida Care Medicaid	$65.29
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$65.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6,529.00
Rate for Payer: Fidelis Essential Plan Aliesa	$65.29
Rate for Payer: Fidelis Essential Plan QHP	$65.29
Rate for Payer: Fidelis Qualified Health Plan	$68.55
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.29
Rate for Payer: Hamaspik Choice Inc Medicare	$76.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$65.29
Rate for Payer: Healthfirst Essential Plan	$146.90
Rate for Payer: Healthfirst QHP	$65.29
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$65.88
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$148.23
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$148.23
Rate for Payer: Optum Medicaid	$65.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65.29
Rate for Payer: SOMOS Essential	$146.90
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$146.90
Rate for Payer: United Healthcare Essential Plan 3&4	$71.82
Rate for Payer: United Healthcare Medicaid	$65.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$65.29

PREVENT MED COUNSELING 45 MIN

Facility

$214.43

Service Code	HCPCS 99403
Hospital Charge Code	30303352
Hospital Revenue Code	510
Min. Negotiated Rate	$55.59
Max. Negotiated Rate	$9,431.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.59
Rate for Payer: Aetna Government	$55.59
Rate for Payer: Affinity Essential Plan 1&2	$212.20
Rate for Payer: Affinity Essential Plan 3&4	$212.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$94.31
Rate for Payer: Amida Care Medicaid	$94.31
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$95.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9,431.00
Rate for Payer: Fidelis Essential Plan Aliesa	$94.31
Rate for Payer: Fidelis Essential Plan QHP	$94.31
Rate for Payer: Fidelis Qualified Health Plan	$99.03
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$94.31
Rate for Payer: Hamaspik Choice Inc Medicare	$107.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$94.31
Rate for Payer: Healthfirst Essential Plan	$212.20
Rate for Payer: Healthfirst QHP	$94.31
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$95.17
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$214.13
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$214.13
Rate for Payer: Optum Medicaid	$95.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.31
Rate for Payer: SOMOS Essential	$212.20
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$212.20
Rate for Payer: United Healthcare Essential Plan 3&4	$103.74
Rate for Payer: United Healthcare Medicaid	$94.31
Rate for Payer: Wellcare CHP/FHP/Medicaid	$94.31

PREVENT MED COUNSELING 60 MIN

Facility

$274.85

Service Code	HCPCS 99404
Hospital Charge Code	30303353
Hospital Revenue Code	510
Min. Negotiated Rate	$83.14
Max. Negotiated Rate	$12,332.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$83.14
Rate for Payer: Aetna Government	$83.14
Rate for Payer: Affinity Essential Plan 1&2	$277.47
Rate for Payer: Affinity Essential Plan 3&4	$277.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$123.32
Rate for Payer: Amida Care Medicaid	$123.32
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$124.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$12,332.00
Rate for Payer: Fidelis Essential Plan Aliesa	$123.32
Rate for Payer: Fidelis Essential Plan QHP	$123.32
Rate for Payer: Fidelis Qualified Health Plan	$129.49
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.32
Rate for Payer: Hamaspik Choice Inc Medicare	$137.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$123.32
Rate for Payer: Healthfirst Essential Plan	$277.47
Rate for Payer: Healthfirst QHP	$123.32
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$124.45
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$280.01
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$280.01
Rate for Payer: Optum Medicaid	$124.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.32
Rate for Payer: SOMOS Essential	$277.47
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$277.47
Rate for Payer: United Healthcare Essential Plan 3&4	$135.65
Rate for Payer: United Healthcare Medicaid	$123.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$123.32

PREVENT MED COUNSELING GRP 30 MIN

Facility

$40.00

Service Code	HCPCS 99411
Hospital Charge Code	30303354
Hospital Revenue Code	510
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$2,902.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.81
Rate for Payer: Aetna Government	$5.81
Rate for Payer: Affinity Essential Plan 1&2	$65.30
Rate for Payer: Affinity Essential Plan 3&4	$65.30
Rate for Payer: Affinity Medicaid/CHP/HARP	$29.02
Rate for Payer: Amida Care Medicaid	$29.02
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$29.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2,902.00
Rate for Payer: Fidelis Essential Plan Aliesa	$29.02
Rate for Payer: Fidelis Essential Plan QHP	$29.02
Rate for Payer: Fidelis Qualified Health Plan	$30.47
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.02
Rate for Payer: Hamaspik Choice Inc Medicare	$20.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.02
Rate for Payer: Healthfirst Essential Plan	$65.30
Rate for Payer: Healthfirst QHP	$29.02
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$29.28
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$65.88
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$65.88
Rate for Payer: Optum Medicaid	$29.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.02
Rate for Payer: SOMOS Essential	$65.30
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$65.30
Rate for Payer: United Healthcare Essential Plan 3&4	$31.92
Rate for Payer: United Healthcare Medicaid	$29.02
Rate for Payer: Wellcare CHP/FHP/Medicaid	$29.02

PREVENT MED COUNSELING GRP 45 MIN

Facility

$51.90

Service Code	HCPCS 99412
Hospital Charge Code	30303355
Hospital Revenue Code	510
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$5,078.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.41
Rate for Payer: Aetna Government	$9.41
Rate for Payer: Affinity Essential Plan 1&2	$114.26
Rate for Payer: Affinity Essential Plan 3&4	$114.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$50.78
Rate for Payer: Amida Care Medicaid	$50.78
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Carelon Behavioral Health HARP/QHP	$51.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5,078.00
Rate for Payer: Fidelis Essential Plan Aliesa	$50.78
Rate for Payer: Fidelis Essential Plan QHP	$50.78
Rate for Payer: Fidelis Qualified Health Plan	$53.32
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.78
Rate for Payer: Hamaspik Choice Inc Medicare	$25.95
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$50.78
Rate for Payer: Healthfirst Essential Plan	$114.26
Rate for Payer: Healthfirst QHP	$50.78
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$51.24
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$115.29
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$115.29
Rate for Payer: Optum Medicaid	$51.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$50.78
Rate for Payer: SOMOS Essential	$114.26
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Essential Plan 1&2	$114.26
Rate for Payer: United Healthcare Essential Plan 3&4	$55.86
Rate for Payer: United Healthcare Medicaid	$50.78
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.78

PR EV FEMPOP ARTL REVSC TCAT PLMT IV ST GRF & CLSR

Professional

Both

$3,150.81

Service Code	HCPCS 0505T
Min. Negotiated Rate	$2,363.11
Max. Negotiated Rate	$2,363.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,363.11
Rate for Payer: SOMOS Essential	$2,363.11

PR EVISCERATION OCULAR CONTENTS W/IMPLANT

Professional

Both

$3,110.84

Service Code	HCPCS 65093
Min. Negotiated Rate	$2,333.13
Max. Negotiated Rate	$2,333.13
Rate for Payer: Cash Price	$848.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,333.13
Rate for Payer: SOMOS Essential	$2,333.13

PR EVISCERATION OCULAR CONTENTS W/O IMPLANT

Professional

Both

$3,131.21

Service Code	HCPCS 65091
Min. Negotiated Rate	$2,348.41
Max. Negotiated Rate	$2,348.41
Rate for Payer: Cash Price	$854.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,348.41
Rate for Payer: SOMOS Essential	$2,348.41

PR EXAM & SELECT ARCHIVE TISSUE MOLECULAR ANALYSIS

Professional

Both

$77.70

Service Code	HCPCS 88363
Min. Negotiated Rate	$58.28
Max. Negotiated Rate	$58.28
Rate for Payer: Cash Price	$20.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.28
Rate for Payer: SOMOS Essential	$58.28

PR EXAM,SYNOVIAL FLUID CRYSTALS

Professional

Both

$69.20

Service Code	HCPCS 89060 26
Min. Negotiated Rate	$51.90
Max. Negotiated Rate	$51.90
Rate for Payer: Cash Price	$19.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.90
Rate for Payer: SOMOS Essential	$51.90

PR EXC 1/> SMALL/LARGE LESIONS INTESTINE ENTEROTOM

Professional

Both

$3,750.71

Service Code	HCPCS 44110
Min. Negotiated Rate	$2,813.03
Max. Negotiated Rate	$2,813.03
Rate for Payer: Cash Price	$1,012.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,813.03
Rate for Payer: SOMOS Essential	$2,813.03

PR EXC 1/> SM/LG LESIONS INTESTNE MULT ENTEROTOMIE

Professional

Both

$4,374.72

Service Code	HCPCS 44111
Min. Negotiated Rate	$3,281.04
Max. Negotiated Rate	$3,281.04
Rate for Payer: Cash Price	$1,162.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,281.04
Rate for Payer: SOMOS Essential	$3,281.04

PR EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC

Professional

Both

$4,582.69

Service Code	HCPCS 27067
Min. Negotiated Rate	$3,437.02
Max. Negotiated Rate	$3,437.02
Rate for Payer: Cash Price	$1,236.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,437.02
Rate for Payer: SOMOS Essential	$3,437.02

PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<

Professional

Both

$450.56

Service Code	HCPCS 11440
Min. Negotiated Rate	$337.92
Max. Negotiated Rate	$337.92
Rate for Payer: Cash Price	$125.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$337.92
Rate for Payer: SOMOS Essential	$337.92

PR EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM

Professional

Both

$1,348.31

Service Code	HCPCS 11446
Min. Negotiated Rate	$1,011.23
Max. Negotiated Rate	$1,011.23
Rate for Payer: Cash Price	$369.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,011.23
Rate for Payer: SOMOS Essential	$1,011.23

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<

Professional

Both

$347.41

Service Code	HCPCS 11420
Min. Negotiated Rate	$260.56
Max. Negotiated Rate	$260.56
Rate for Payer: Cash Price	$95.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$260.56
Rate for Payer: SOMOS Essential	$260.56

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM

Professional

Both

$466.24

Service Code	HCPCS 11421
Min. Negotiated Rate	$349.68
Max. Negotiated Rate	$349.68
Rate for Payer: Cash Price	$126.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$349.68
Rate for Payer: SOMOS Essential	$349.68

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM

Professional

Both

$579.67

Service Code	HCPCS 11422
Min. Negotiated Rate	$434.75
Max. Negotiated Rate	$434.75
Rate for Payer: Cash Price	$158.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$434.75
Rate for Payer: SOMOS Essential	$434.75

PR EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM

Professional

Both

$666.82

Service Code	HCPCS 11423
Min. Negotiated Rate	$500.12
Max. Negotiated Rate	$500.12
Rate for Payer: Cash Price	$183.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$500.12
Rate for Payer: SOMOS Essential	$500.12

Know your out-of-pocket cost for care.

All Charges