St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR EXTENDED VISUAL FIELD XM UNI/BI I&R

Professional

Both

$155.12

Service Code	HCPCS 92083 TC
Min. Negotiated Rate	$116.34
Max. Negotiated Rate	$116.34
Rate for Payer: Cash Price	$43.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$116.34
Rate for Payer: SOMOS Essential	$116.34

PR EXTENDED VISUAL FIELD XM UNI/BI I&R

Professional

Both

$260.72

Service Code	HCPCS 92083
Min. Negotiated Rate	$195.54
Max. Negotiated Rate	$195.54
Rate for Payer: Cash Price	$72.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$195.54
Rate for Payer: SOMOS Essential	$195.54

PR EXTENDED VISUAL FIELD XM UNI/BI I&R

Professional

Both

$105.60

Service Code	HCPCS 92083 26
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$79.20
Rate for Payer: Cash Price	$29.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.20
Rate for Payer: SOMOS Essential	$79.20

PR EXTENSIVE RETINOPATHY 1/> SESS PRETERM INFANT

Professional

Both

$4,743.94

Service Code	HCPCS 67229
Min. Negotiated Rate	$3,557.96
Max. Negotiated Rate	$3,557.96
Rate for Payer: Cash Price	$1,304.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,557.96
Rate for Payer: SOMOS Essential	$3,557.96

PR EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS

Professional

Both

$475.90

Service Code	HCPCS 59412
Min. Negotiated Rate	$356.92
Max. Negotiated Rate	$356.92
Rate for Payer: Cash Price	$125.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$356.92
Rate for Payer: SOMOS Essential	$356.92

PR EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN

Professional

Both

$4,963.88

Service Code	HCPCS 48510
Min. Negotiated Rate	$3,722.91
Max. Negotiated Rate	$3,722.91
Rate for Payer: Cash Price	$1,322.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,722.91
Rate for Payer: SOMOS Essential	$3,722.91

PR EXTERNAL ECG REC>48HR<7D RECORDING

Professional

Both

$53.06

Service Code	HCPCS 93242
Min. Negotiated Rate	$39.80
Max. Negotiated Rate	$39.80
Rate for Payer: Cash Price	$14.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.80
Rate for Payer: SOMOS Essential	$39.80

PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION

Professional

Both

$92.54

Service Code	HCPCS 93244
Min. Negotiated Rate	$69.40
Max. Negotiated Rate	$69.40
Rate for Payer: Cash Price	$24.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.40
Rate for Payer: SOMOS Essential	$69.40

PR EXTERNAL ECG REC>48HR<7D SCAN ALYS REPORT R&I

Professional

Both

$1,130.12

Service Code	HCPCS 93241
Min. Negotiated Rate	$847.59
Max. Negotiated Rate	$847.59
Rate for Payer: Cash Price	$303.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$847.59
Rate for Payer: SOMOS Essential	$847.59

PR EXTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT

Professional

Both

$984.55

Service Code	HCPCS 93243
Min. Negotiated Rate	$738.41
Max. Negotiated Rate	$738.41
Rate for Payer: Cash Price	$263.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$738.41
Rate for Payer: SOMOS Essential	$738.41

PR EXTERNAL ECG REC>7D<15D RECORDING

Professional

Both

$53.06

Service Code	HCPCS 93246
Min. Negotiated Rate	$39.80
Max. Negotiated Rate	$39.80
Rate for Payer: Cash Price	$14.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.80
Rate for Payer: SOMOS Essential	$39.80

PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION

Professional

Both

$101.68

Service Code	HCPCS 93248
Min. Negotiated Rate	$76.26
Max. Negotiated Rate	$76.26
Rate for Payer: Cash Price	$27.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$76.26
Rate for Payer: SOMOS Essential	$76.26

PR EXTERNAL ECG REC>7D<15D SCAN ALYS REPORT R&I

Professional

Both

$1,189.58

Service Code	HCPCS 93245
Min. Negotiated Rate	$892.18
Max. Negotiated Rate	$892.18
Rate for Payer: Cash Price	$318.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$892.18
Rate for Payer: SOMOS Essential	$892.18

PR EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT

Professional

Both

$1,034.85

Service Code	HCPCS 93247
Min. Negotiated Rate	$776.14
Max. Negotiated Rate	$776.14
Rate for Payer: Cash Price	$276.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$776.14
Rate for Payer: SOMOS Essential	$776.14

PR EXTERNAL ECG SCANNING ANALYSIS REPORT

Professional

Both

$156.56

Service Code	HCPCS 93226
Min. Negotiated Rate	$117.42
Max. Negotiated Rate	$117.42
Rate for Payer: Cash Price	$42.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$117.42
Rate for Payer: SOMOS Essential	$117.42

PR EXTRACORPOREAL SHOCK WAVE MUSCSKEL SYS NOS

Professional

Both

$1,228.36

Service Code	HCPCS 0101T
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 EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY

Professional

Both

$7,656.25

Service Code	HCPCS 32540
Min. Negotiated Rate	$5,742.19
Max. Negotiated Rate	$5,742.19
Rate for Payer: Cash Price	$2,048.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,742.19
Rate for Payer: SOMOS Essential	$5,742.19

PR EXTRNL COUNTERPULSE, PER TX

Professional

Both

$453.71

Service Code	HCPCS G0166
Min. Negotiated Rate	$340.28
Max. Negotiated Rate	$340.28
Rate for Payer: Cash Price	$121.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$340.28
Rate for Payer: SOMOS Essential	$340.28

PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>

Professional

Both

$1,837.68

Service Code	HCPCS 26111
Min. Negotiated Rate	$1,378.26
Max. Negotiated Rate	$1,378.26
Rate for Payer: Cash Price	$499.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,378.26
Rate for Payer: SOMOS Essential	$1,378.26

PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>

Professional

Both

$2,414.41

Service Code	HCPCS 26113
Min. Negotiated Rate	$1,810.81
Max. Negotiated Rate	$1,810.81
Rate for Payer: Cash Price	$656.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,810.81
Rate for Payer: SOMOS Essential	$1,810.81

PREZISTA 800MG TAB

Facility

$45.87

Hospital Charge Code	41648409
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$36.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.94
Rate for Payer: Aetna Government	$22.94
Rate for Payer: Brighton Health Commercial	$34.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.19
Rate for Payer: Group Health Inc Commercial	$22.94
Rate for Payer: Group Health Inc Medicare	$16.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.94
Rate for Payer: Hamaspik Choice Inc Medicare	$22.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.82

PREZISTA 800MG TAB

Facility

$45.87

Hospital Charge Code	41658409
Hospital Revenue Code	250
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$36.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.94
Rate for Payer: Aetna Government	$22.94
Rate for Payer: Brighton Health Commercial	$34.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.19
Rate for Payer: Group Health Inc Commercial	$22.94
Rate for Payer: Group Health Inc Medicare	$16.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.94
Rate for Payer: Hamaspik Choice Inc Medicare	$22.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.82

PR F18 FDG

Professional

Both

$1,846.85

Service Code	HCPCS A9552
Min. Negotiated Rate	$1,385.14
Max. Negotiated Rate	$1,385.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,385.14
Rate for Payer: SOMOS Essential	$1,385.14

PR FACIAL NERVE FUNCTION STUDIES

Professional

Both

$94.99

Service Code	HCPCS 92516
Min. Negotiated Rate	$71.24
Max. Negotiated Rate	$71.24
Rate for Payer: Cash Price	$25.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.24
Rate for Payer: SOMOS Essential	$71.24

PR FAMILY PSYCHOTHERAPY W/O PATIENT PRESENT 50 MINS

Professional

Both

$368.62

Service Code	HCPCS 90846
Min. Negotiated Rate	$276.46
Max. Negotiated Rate	$276.46
Rate for Payer: Cash Price	$105.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$276.46
Rate for Payer: SOMOS Essential	$276.46

Know your out-of-pocket cost for care.

All Charges