St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR IMPLTJ INTRAVITREAL DRUG DLVR SYS RMVL VTS

Professional

Both

$3,479.81

Service Code	HCPCS 67027
Min. Negotiated Rate	$2,609.86
Max. Negotiated Rate	$2,609.86
Rate for Payer: Cash Price	$957.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,609.86
Rate for Payer: SOMOS Essential	$2,609.86

PR IMPLTJ NONBIOL/SYNTH IMPLT FASC RNFCMT ABDL WALL

Professional

Both

$1,313.41

Service Code	HCPCS 0437T
Min. Negotiated Rate	$985.06
Max. Negotiated Rate	$985.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$985.06
Rate for Payer: SOMOS Essential	$985.06

PR IMPLTJ OI IMPLT SKULL PERQ ATTACHMENT ESP

Professional

Both

$2,133.04

Service Code	HCPCS 69714
Min. Negotiated Rate	$1,599.78
Max. Negotiated Rate	$1,599.78
Rate for Payer: Cash Price	$580.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,599.78
Rate for Payer: SOMOS Essential	$1,599.78

PR IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM

Professional

Both

$1,750.63

Service Code	HCPCS 62350
Min. Negotiated Rate	$1,312.97
Max. Negotiated Rate	$1,312.97
Rate for Payer: Cash Price	$474.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,312.97
Rate for Payer: SOMOS Essential	$1,312.97

PR IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM

Professional

Both

$4,246.45

Service Code	HCPCS 62351
Min. Negotiated Rate	$3,184.84
Max. Negotiated Rate	$3,184.84
Rate for Payer: Cash Price	$1,144.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,184.84
Rate for Payer: SOMOS Essential	$3,184.84

PR IMPLTJ/RPLCMT FS NON-PRGRBL PUMP

Professional

Both

$2,063.01

Service Code	HCPCS 62361
Min. Negotiated Rate	$1,547.26
Max. Negotiated Rate	$1,547.26
Rate for Payer: Cash Price	$551.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,547.26
Rate for Payer: SOMOS Essential	$1,547.26

PR IMPLTJ/RPLCMT GASTRIC NSTIM ELTRDE ANTRUM OPEN

Professional

Both

$3,585.47

Service Code	HCPCS 43881
Min. Negotiated Rate	$2,689.10
Max. Negotiated Rate	$2,689.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,689.10
Rate for Payer: SOMOS Essential	$2,689.10

PR IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP

Professional

Both

$1,722.95

Service Code	HCPCS 62362
Min. Negotiated Rate	$1,292.21
Max. Negotiated Rate	$1,292.21
Rate for Payer: Cash Price	$464.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,292.21
Rate for Payer: SOMOS Essential	$1,292.21

PR IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR

Professional

Both

$1,426.60

Service Code	HCPCS 62360
Min. Negotiated Rate	$1,069.95
Max. Negotiated Rate	$1,069.95
Rate for Payer: Cash Price	$373.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,069.95
Rate for Payer: SOMOS Essential	$1,069.95

PR IMPLTJ TOTAL RPLCMT HEART SYS W/RCP CARDIECTOMY

Professional

Both

$11,329.61

Service Code	HCPCS 33927
Min. Negotiated Rate	$8,497.21
Max. Negotiated Rate	$8,497.21
Rate for Payer: Cash Price	$2,997.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,497.21
Rate for Payer: SOMOS Essential	$8,497.21

PR IMPRESSION & PREPARATION AURICULAR PROSTHESIS

Professional

Both

$5,317.41

Service Code	HCPCS 21086
Min. Negotiated Rate	$3,988.06
Max. Negotiated Rate	$3,988.06
Rate for Payer: Cash Price	$1,446.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,988.06
Rate for Payer: SOMOS Essential	$3,988.06

PR IMPRESSION & PREPARATION FACIAL PROSTHESIS

Professional

Both

$4,267.31

Service Code	HCPCS 21088
Min. Negotiated Rate	$3,200.48
Max. Negotiated Rate	$3,200.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,200.48
Rate for Payer: SOMOS Essential	$3,200.48

PR IMPRESSION & PREPARATION INTERIM OBTURATOR PROST

Professional

Both

$4,842.43

Service Code	HCPCS 21079
Min. Negotiated Rate	$3,631.82
Max. Negotiated Rate	$3,631.82
Rate for Payer: Cash Price	$1,321.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,631.82
Rate for Payer: SOMOS Essential	$3,631.82

PR IMPRESSION & PREPARATION NASAL PROSTHESIS

Professional

Both

$5,317.41

Service Code	HCPCS 21087
Min. Negotiated Rate	$3,988.06
Max. Negotiated Rate	$3,988.06
Rate for Payer: Cash Price	$1,446.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,988.06
Rate for Payer: SOMOS Essential	$3,988.06

PR IMPRESSION & PREPARATION ORAL SURGICAL SPLINT

Professional

Both

$2,012.19

Service Code	HCPCS 21085
Min. Negotiated Rate	$1,509.14
Max. Negotiated Rate	$1,509.14
Rate for Payer: Cash Price	$549.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,509.14
Rate for Payer: SOMOS Essential	$1,509.14

PR IMPRESSION & PREPARATION ORBITAL PROSTHESIS

Professional

Both

$7,209.83

Service Code	HCPCS 21077
Min. Negotiated Rate	$5,407.37
Max. Negotiated Rate	$5,407.37
Rate for Payer: Cash Price	$1,963.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,407.37
Rate for Payer: SOMOS Essential	$5,407.37

PR IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS

Professional

Both

$4,274.52

Service Code	HCPCS 21083
Min. Negotiated Rate	$3,205.89
Max. Negotiated Rate	$3,205.89
Rate for Payer: Cash Price	$1,167.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,205.89
Rate for Payer: SOMOS Essential	$3,205.89

PR IMPRESSION & PREPARATION SPEECH AID PROSTHESIS

Professional

Both

$4,944.10

Service Code	HCPCS 21084
Min. Negotiated Rate	$3,708.08
Max. Negotiated Rate	$3,708.08
Rate for Payer: Cash Price	$1,350.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,708.08
Rate for Payer: SOMOS Essential	$3,708.08

PR IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES

Professional

Both

$2,936.78

Service Code	HCPCS 21076
Min. Negotiated Rate	$2,202.58
Max. Negotiated Rate	$2,202.58
Rate for Payer: Cash Price	$799.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,202.58
Rate for Payer: SOMOS Essential	$2,202.58

PR IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES

Professional

Both

$5,510.33

Service Code	HCPCS 21080
Min. Negotiated Rate	$4,132.75
Max. Negotiated Rate	$4,132.75
Rate for Payer: Cash Price	$1,490.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,132.75
Rate for Payer: SOMOS Essential	$4,132.75

PR IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES

Professional

Both

$5,039.93

Service Code	HCPCS 21081
Min. Negotiated Rate	$3,779.95
Max. Negotiated Rate	$3,779.95
Rate for Payer: Cash Price	$1,369.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,779.95
Rate for Payer: SOMOS Essential	$3,779.95

PR IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES

Professional

Both

$4,609.68

Service Code	HCPCS 21082
Min. Negotiated Rate	$3,457.26
Max. Negotiated Rate	$3,457.26
Rate for Payer: Cash Price	$1,263.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,457.26
Rate for Payer: SOMOS Essential	$3,457.26

PRIMRY TIBIAL BASEPLTE#2 CEMENTED

Facility

$3,290.00

Service Code	HCPCS C1713
Hospital Charge Code	40201286
Hospital Revenue Code	278
Min. Negotiated Rate	$1,645.00
Max. Negotiated Rate	$1,645.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,645.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,645.00

PRIMRY TIBIAL BASEPLTE#2 CEMENTED

Facility

$3,290.00

Service Code	HCPCS C1713
Hospital Charge Code	40201286
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,454.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,809.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,974.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,645.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,891.75
Rate for Payer: EmblemHealth Commercial	$1,645.00
Rate for Payer: Fidelis Medicare Advantage	$3,454.50
Rate for Payer: Group Health Inc Commercial	$1,645.00
Rate for Payer: Group Health Inc Medicare	$1,151.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,645.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,645.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,138.50

PR IN111 CAPROMAB

Professional

Both

$5,746.16

Service Code	HCPCS A9507
Min. Negotiated Rate	$4,309.62
Max. Negotiated Rate	$4,309.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,309.62
Rate for Payer: SOMOS Essential	$4,309.62

Know your out-of-pocket cost for care.

All Charges