St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE

Professional

Both

$4,606.70

Service Code	HCPCS 44310
Min. Negotiated Rate	$3,455.02
Max. Negotiated Rate	$3,455.02
Rate for Payer: Cash Price	$1,232.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,455.02
Rate for Payer: SOMOS Essential	$3,455.02

PR ILIAC ART ANGIO,CARDIAC CATH

Professional

Both

$60.66

Service Code	HCPCS G0278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$45.50
Rate for Payer: Cash Price	$16.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.50
Rate for Payer: SOMOS Essential	$45.50

PRIM 3CMX3CM 0.40MM-1.04MM MESH

Facility

$1,368.00

Service Code	HCPCS Q4110
Hospital Charge Code	40203458
Hospital Revenue Code	636
Min. Negotiated Rate	$684.00
Max. Negotiated Rate	$684.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.00
Rate for Payer: Hamaspik Choice Inc Medicare	$684.00

PRIM 3CMX3CM 0.40MM-1.04MM MESH

Facility

$1,368.00

Service Code	HCPCS Q4110
Hospital Charge Code	40203458
Hospital Revenue Code	636
Min. Negotiated Rate	$43.43
Max. Negotiated Rate	$889.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$752.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.43
Rate for Payer: Aetna Government	$43.43
Rate for Payer: Brighton Health Commercial	$820.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$684.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$786.60
Rate for Payer: Group Health Inc Commercial	$684.00
Rate for Payer: Group Health Inc Medicare	$478.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$684.00
Rate for Payer: Hamaspik Choice Inc Medicare	$684.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$889.20

PR IM ADM INTRANSL/ORAL 1 VACCINE

Professional

Both

$68.60

Service Code	HCPCS 90473
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: Cash Price	$19.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.45
Rate for Payer: SOMOS Essential	$51.45

PR IM ADM INTRANSL/ORAL EA VACCINE

Professional

Both

$48.83

Service Code	HCPCS 90474
Min. Negotiated Rate	$36.62
Max. Negotiated Rate	$36.62
Rate for Payer: Cash Price	$13.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.62
Rate for Payer: SOMOS Essential	$36.62

PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE

Professional

Both

$84.42

Service Code	HCPCS 90471
Min. Negotiated Rate	$63.32
Max. Negotiated Rate	$63.32
Rate for Payer: Cash Price	$23.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$63.32
Rate for Payer: SOMOS Essential	$63.32

PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE

Professional

Both

$60.34

Service Code	HCPCS 90472
Min. Negotiated Rate	$45.26
Max. Negotiated Rate	$45.26
Rate for Payer: Cash Price	$16.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.26
Rate for Payer: SOMOS Essential	$45.26

PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX

Professional

Both

$94.47

Service Code	HCPCS 90460
Min. Negotiated Rate	$70.85
Max. Negotiated Rate	$70.85
Rate for Payer: Cash Price	$26.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.85
Rate for Payer: SOMOS Essential	$70.85

PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT

Professional

Both

$41.09

Service Code	HCPCS 90461
Min. Negotiated Rate	$30.82
Max. Negotiated Rate	$30.82
Rate for Payer: Cash Price	$9.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30.82
Rate for Payer: SOMOS Essential	$30.82

PR IMAGE FLUID COLLXN DRAINAG CATH TRANSREC/VAGINAL

Professional

Both

$843.89

Service Code	HCPCS 49407
Min. Negotiated Rate	$632.92
Max. Negotiated Rate	$632.92
Rate for Payer: Cash Price	$228.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$632.92
Rate for Payer: SOMOS Essential	$632.92

PR IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ

Professional

Both

$791.84

Service Code	HCPCS 49405
Min. Negotiated Rate	$593.88
Max. Negotiated Rate	$593.88
Rate for Payer: Cash Price	$214.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$593.88
Rate for Payer: SOMOS Essential	$593.88

PRIMAQUINE 26.3 MG TAB

Facility

$3.00

Hospital Charge Code	41650780
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

PRIMAQUINE 26.3 MG TAB

Facility

$3.00

Hospital Charge Code	41640780
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

PRIMAQUINE PHOSPHATE 26.3 (15 BASE) MG PO TABS [179299]

Facility

$2.46

Service Code	NDC 00024159601
Hospital Charge Code	00024159601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.23
Rate for Payer: Aetna Government	$1.23
Rate for Payer: Brighton Health Commercial	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: Group Health Inc Commercial	$1.23
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.60

PRIMARY HEMI MAND PLATE, LEFT

Facility

$1,986.00

Service Code	HCPCS C1713
Hospital Charge Code	40201279
Hospital Revenue Code	278
Min. Negotiated Rate	$993.00
Max. Negotiated Rate	$993.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.00
Rate for Payer: Hamaspik Choice Inc Medicare	$993.00

PRIMARY HEMI MAND PLATE, LEFT

Facility

$1,986.00

Service Code	HCPCS C1713
Hospital Charge Code	40201279
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,085.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,092.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,191.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$993.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,141.95
Rate for Payer: EmblemHealth Commercial	$993.00
Rate for Payer: Fidelis Medicare Advantage	$2,085.30
Rate for Payer: Group Health Inc Commercial	$993.00
Rate for Payer: Group Health Inc Medicare	$695.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.00
Rate for Payer: Hamaspik Choice Inc Medicare	$993.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,290.90

PRIMARY HEMI MAND PLATE, RIGHT

Facility

$1,986.00

Service Code	HCPCS C1713
Hospital Charge Code	40201280
Hospital Revenue Code	278
Min. Negotiated Rate	$993.00
Max. Negotiated Rate	$993.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.00
Rate for Payer: Hamaspik Choice Inc Medicare	$993.00

PRIMARY HEMI MAND PLATE, RIGHT

Facility

$1,986.00

Service Code	HCPCS C1713
Hospital Charge Code	40201280
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,085.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,092.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,191.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$993.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,141.95
Rate for Payer: EmblemHealth Commercial	$993.00
Rate for Payer: Fidelis Medicare Advantage	$2,085.30
Rate for Payer: Group Health Inc Commercial	$993.00
Rate for Payer: Group Health Inc Medicare	$695.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$993.00
Rate for Payer: Hamaspik Choice Inc Medicare	$993.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,290.90

PRIMARY HEMI MAND PLT, LEFT

Facility

$1,896.00

Service Code	HCPCS C1713
Hospital Charge Code	40201281
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,990.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,042.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,137.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$948.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,090.20
Rate for Payer: EmblemHealth Commercial	$948.00
Rate for Payer: Fidelis Medicare Advantage	$1,990.80
Rate for Payer: Group Health Inc Commercial	$948.00
Rate for Payer: Group Health Inc Medicare	$663.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$948.00
Rate for Payer: Hamaspik Choice Inc Medicare	$948.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,232.40

PRIMARY HEMI MAND PLT, LEFT

Facility

$1,896.00

Service Code	HCPCS C1713
Hospital Charge Code	40201281
Hospital Revenue Code	278
Min. Negotiated Rate	$948.00
Max. Negotiated Rate	$948.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$948.00
Rate for Payer: Hamaspik Choice Inc Medicare	$948.00

PRIMARY HEMI MAND PLT, RIGHT

Facility

$2,234.00

Service Code	HCPCS C1713
Hospital Charge Code	40201282
Hospital Revenue Code	278
Min. Negotiated Rate	$1,117.00
Max. Negotiated Rate	$1,117.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,117.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,117.00

PRIMARY HEMI MAND PLT, RIGHT

Facility

$2,234.00

Service Code	HCPCS C1713
Hospital Charge Code	40201282
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,345.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,228.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,340.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,117.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,284.55
Rate for Payer: EmblemHealth Commercial	$1,117.00
Rate for Payer: Fidelis Medicare Advantage	$2,345.70
Rate for Payer: Group Health Inc Commercial	$1,117.00
Rate for Payer: Group Health Inc Medicare	$781.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,117.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,117.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,452.10

PRIMARY RECON PLATE,11 HOLE

Facility

$1,098.00

Service Code	HCPCS C1713
Hospital Charge Code	40201283
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,152.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$603.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$658.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$549.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$631.35
Rate for Payer: EmblemHealth Commercial	$549.00
Rate for Payer: Fidelis Medicare Advantage	$1,152.90
Rate for Payer: Group Health Inc Commercial	$549.00
Rate for Payer: Group Health Inc Medicare	$384.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$549.00
Rate for Payer: Hamaspik Choice Inc Medicare	$549.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$713.70

PRIMARY RECON PLATE,11 HOLE

Facility

$1,098.00

Service Code	HCPCS C1713
Hospital Charge Code	40201283
Hospital Revenue Code	278
Min. Negotiated Rate	$549.00
Max. Negotiated Rate	$549.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$549.00
Rate for Payer: Hamaspik Choice Inc Medicare	$549.00

Know your out-of-pocket cost for care.

All Charges