St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM

Professional

Both

$69.88

Service Code	HCPCS 90744
Min. Negotiated Rate	$52.41
Max. Negotiated Rate	$52.41
Rate for Payer: Cash Price	$30.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.41
Rate for Payer: SOMOS Essential	$52.41

PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE

Professional

Both

$93.49

Service Code	HCPCS 90647
Min. Negotiated Rate	$70.12
Max. Negotiated Rate	$70.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.12
Rate for Payer: SOMOS Essential	$70.12

PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE

Professional

Both

$38.03

Service Code	HCPCS 90648
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$28.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28.52
Rate for Payer: SOMOS Essential	$28.52

PR HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT

Professional

Both

$205.31

Service Code	HCPCS 94452
Min. Negotiated Rate	$153.98
Max. Negotiated Rate	$153.98
Rate for Payer: Cash Price	$58.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$153.98
Rate for Payer: SOMOS Essential	$153.98

PR HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT

Professional

Both

$150.82

Service Code	HCPCS 94452 TC
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$113.12
Rate for Payer: Cash Price	$43.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.12
Rate for Payer: SOMOS Essential	$113.12

PR HIGH ALTITUDE SIMULATJ TEST W/PHYS INTERP&REPORT

Professional

Both

$54.50

Service Code	HCPCS 94452 26
Min. Negotiated Rate	$40.88
Max. Negotiated Rate	$40.88
Rate for Payer: Cash Price	$14.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$40.88
Rate for Payer: SOMOS Essential	$40.88

PR HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION

Professional

Both

$72.84

Service Code	HCPCS 94453 26
Min. Negotiated Rate	$54.63
Max. Negotiated Rate	$54.63
Rate for Payer: Cash Price	$19.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54.63
Rate for Payer: SOMOS Essential	$54.63

PR HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION

Professional

Both

$209.58

Service Code	HCPCS 94453 TC
Min. Negotiated Rate	$157.18
Max. Negotiated Rate	$157.18
Rate for Payer: Cash Price	$58.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$157.18
Rate for Payer: SOMOS Essential	$157.18

PR HIGH ALTITUDE SIMULATJ W/PHYS I&R W/O2 TITRATION

Professional

Both

$282.42

Service Code	HCPCS 94453
Min. Negotiated Rate	$211.82
Max. Negotiated Rate	$211.82
Rate for Payer: Cash Price	$78.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211.82
Rate for Payer: SOMOS Essential	$211.82

PR HIGH INTEN BEH COUNS STD 30M

Professional

Both

$93.17

Service Code	HCPCS G0445
Min. Negotiated Rate	$69.88
Max. Negotiated Rate	$69.88
Rate for Payer: Cash Price	$25.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$69.88
Rate for Payer: SOMOS Essential	$69.88

PR HISTOCHEMICAL STAIN

Professional

Both

$79.21

Service Code	HCPCS 88314 26
Min. Negotiated Rate	$59.41
Max. Negotiated Rate	$59.41
Rate for Payer: Cash Price	$21.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59.41
Rate for Payer: SOMOS Essential	$59.41

PR HISTOCHEMICAL STAIN

Professional

Both

$382.41

Service Code	HCPCS 88314
Min. Negotiated Rate	$286.81
Max. Negotiated Rate	$286.81
Rate for Payer: Cash Price	$103.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$286.81
Rate for Payer: SOMOS Essential	$286.81

PR HISTOCHEMICAL STAIN

Professional

Both

$303.17

Service Code	HCPCS 88314 TC
Min. Negotiated Rate	$227.38
Max. Negotiated Rate	$227.38
Rate for Payer: Cash Price	$81.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$227.38
Rate for Payer: SOMOS Essential	$227.38

PR HOME HEALTH CARE SUPERVISION

Professional

Both

$425.04

Service Code	HCPCS G0181
Min. Negotiated Rate	$318.78
Max. Negotiated Rate	$318.78
Rate for Payer: Cash Price	$118.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$318.78
Rate for Payer: SOMOS Essential	$318.78

PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES

Professional

Both

$756.49

Service Code	HCPCS 99350
Min. Negotiated Rate	$567.37
Max. Negotiated Rate	$567.37
Rate for Payer: Cash Price	$206.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$567.37
Rate for Payer: SOMOS Essential	$567.37

PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES

Professional

Both

$306.08

Service Code	HCPCS 99348
Min. Negotiated Rate	$229.56
Max. Negotiated Rate	$229.56
Rate for Payer: Cash Price	$84.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$229.56
Rate for Payer: SOMOS Essential	$229.56

PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES

Professional

Both

$518.88

Service Code	HCPCS 99349
Min. Negotiated Rate	$389.16
Max. Negotiated Rate	$389.16
Rate for Payer: Cash Price	$141.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$389.16
Rate for Payer: SOMOS Essential	$389.16

PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES

Professional

Both

$178.29

Service Code	HCPCS 99347
Min. Negotiated Rate	$133.72
Max. Negotiated Rate	$133.72
Rate for Payer: Cash Price	$50.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$133.72
Rate for Payer: SOMOS Essential	$133.72

PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES

Professional

Both

$820.30

Service Code	HCPCS 99345
Min. Negotiated Rate	$615.22
Max. Negotiated Rate	$615.22
Rate for Payer: Cash Price	$224.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$615.22
Rate for Payer: SOMOS Essential	$615.22

PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES

Professional

Both

$310.49

Service Code	HCPCS 99342
Min. Negotiated Rate	$232.87
Max. Negotiated Rate	$232.87
Rate for Payer: Cash Price	$86.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$232.87
Rate for Payer: SOMOS Essential	$232.87

PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES

Professional

Both

$581.21

Service Code	HCPCS 99344
Min. Negotiated Rate	$435.91
Max. Negotiated Rate	$435.91
Rate for Payer: Cash Price	$157.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$435.91
Rate for Payer: SOMOS Essential	$435.91

PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES

Professional

Both

$193.69

Service Code	HCPCS 99341
Min. Negotiated Rate	$145.27
Max. Negotiated Rate	$145.27
Rate for Payer: Cash Price	$54.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.27
Rate for Payer: SOMOS Essential	$145.27

PR HOME SLEEP TEST/TYPE 2 PORTA

Professional

Both

$551.50

Service Code	HCPCS G0398 TC
Min. Negotiated Rate	$413.62
Max. Negotiated Rate	$413.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$413.62
Rate for Payer: SOMOS Essential	$413.62

PR HOME SLEEP TEST/TYPE 2 PORTA

Professional

Both

$255.57

Service Code	HCPCS G0398 26
Min. Negotiated Rate	$191.68
Max. Negotiated Rate	$191.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$191.68
Rate for Payer: SOMOS Essential	$191.68

PR HOME SLEEP TEST/TYPE 2 PORTA

Professional

Both

$807.03

Service Code	HCPCS G0398
Min. Negotiated Rate	$605.27
Max. Negotiated Rate	$605.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$605.27
Rate for Payer: SOMOS Essential	$605.27

Know your out-of-pocket cost for care.

All Charges