St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID

Professional

Both

$62.74

Service Code	HCPCS 90630
Min. Negotiated Rate	$47.05
Max. Negotiated Rate	$47.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.05
Rate for Payer: SOMOS Essential	$47.05

PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI

Professional

Both

$13,724.10

Service Code	HCPCS 61591
Min. Negotiated Rate	$10,293.08
Max. Negotiated Rate	$10,293.08
Rate for Payer: Cash Price	$3,665.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,293.08
Rate for Payer: SOMOS Essential	$10,293.08

PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN

Professional

Both

$13,346.52

Service Code	HCPCS 61590
Min. Negotiated Rate	$10,009.89
Max. Negotiated Rate	$10,009.89
Rate for Payer: Cash Price	$3,569.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,009.89
Rate for Payer: SOMOS Essential	$10,009.89

PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES

Professional

Both

$269.75

Service Code	HCPCS 95079
Min. Negotiated Rate	$202.31
Max. Negotiated Rate	$202.31
Rate for Payer: Cash Price	$74.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$202.31
Rate for Payer: SOMOS Essential	$202.31

PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES

Professional

Both

$291.97

Service Code	HCPCS 95076
Min. Negotiated Rate	$218.98
Max. Negotiated Rate	$218.98
Rate for Payer: Cash Price	$80.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$218.98
Rate for Payer: SOMOS Essential	$218.98

PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX

Professional

Both

$3,709.27

Service Code	HCPCS 38760
Min. Negotiated Rate	$2,781.95
Max. Negotiated Rate	$2,781.95
Rate for Payer: Cash Price	$994.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,781.95
Rate for Payer: SOMOS Essential	$2,781.95

PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC

Professional

Both

$5,805.87

Service Code	HCPCS 38765
Min. Negotiated Rate	$4,354.40
Max. Negotiated Rate	$4,354.40
Rate for Payer: Cash Price	$1,552.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,354.40
Rate for Payer: SOMOS Essential	$4,354.40

PR INHLJ BRNCL CHALLENGE TSTG W/HISTAM/METHACHOL

Professional

Both

$150.68

Service Code	HCPCS 95070
Min. Negotiated Rate	$113.01
Max. Negotiated Rate	$113.01
Rate for Payer: Cash Price	$41.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.01
Rate for Payer: SOMOS Essential	$113.01

PR INITIAL FOOT EXAM PT LOPS

Professional

Both

$157.12

Service Code	HCPCS G0245
Min. Negotiated Rate	$117.84
Max. Negotiated Rate	$117.84
Rate for Payer: Cash Price	$43.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$117.84
Rate for Payer: SOMOS Essential	$117.84

PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL

Professional

Both

$1,369.17

Service Code	HCPCS 99477
Min. Negotiated Rate	$1,026.88
Max. Negotiated Rate	$1,026.88
Rate for Payer: Cash Price	$374.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,026.88
Rate for Payer: SOMOS Essential	$1,026.88

PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN

Professional

Both

$108.75

Service Code	HCPCS 99251
Min. Negotiated Rate	$81.56
Max. Negotiated Rate	$81.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.56
Rate for Payer: SOMOS Essential	$81.56

PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES

Professional

Both

$737.17

Service Code	HCPCS 99306
Min. Negotiated Rate	$552.88
Max. Negotiated Rate	$552.88
Rate for Payer: Cash Price	$202.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$552.88
Rate for Payer: SOMOS Essential	$552.88

PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES

Professional

Both

$543.48

Service Code	HCPCS 99305
Min. Negotiated Rate	$407.61
Max. Negotiated Rate	$407.61
Rate for Payer: Cash Price	$148.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$407.61
Rate for Payer: SOMOS Essential	$407.61

PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN

Professional

Both

$328.65

Service Code	HCPCS 99304
Min. Negotiated Rate	$246.49
Max. Negotiated Rate	$246.49
Rate for Payer: Cash Price	$89.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$246.49
Rate for Payer: SOMOS Essential	$246.49

PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS

Professional

Both

$3,126.69

Service Code	HCPCS 99471
Min. Negotiated Rate	$2,345.02
Max. Negotiated Rate	$2,345.02
Rate for Payer: Cash Price	$856.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,345.02
Rate for Payer: SOMOS Essential	$2,345.02

PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS

Professional

Both

$2,276.30

Service Code	HCPCS 99475
Min. Negotiated Rate	$1,707.22
Max. Negotiated Rate	$1,707.22
Rate for Payer: Cash Price	$621.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,707.22
Rate for Payer: SOMOS Essential	$1,707.22

PR INITIAL PLMT DRUG ELUTING OCULAR INSERT UNI/BI

Professional

Both

$650.41

Service Code	HCPCS 0444T
Min. Negotiated Rate	$487.81
Max. Negotiated Rate	$487.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$487.81
Rate for Payer: SOMOS Essential	$487.81

PR INITIAL PREVENTIVE EXAM

Professional

Both

$533.02

Service Code	HCPCS G0402
Min. Negotiated Rate	$399.76
Max. Negotiated Rate	$399.76
Rate for Payer: Cash Price	$145.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$399.76
Rate for Payer: SOMOS Essential	$399.76

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR

Professional

Both

$248.25

Service Code	HCPCS 99381
Min. Negotiated Rate	$186.19
Max. Negotiated Rate	$186.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$186.19
Rate for Payer: SOMOS Essential	$186.19

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS

Professional

Both

$345.00

Service Code	HCPCS 99386
Min. Negotiated Rate	$258.75
Max. Negotiated Rate	$258.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$258.75
Rate for Payer: SOMOS Essential	$258.75

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>

Professional

Both

$372.00

Service Code	HCPCS 99387
Min. Negotiated Rate	$279.00
Max. Negotiated Rate	$279.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$279.00
Rate for Payer: SOMOS Essential	$279.00

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR

Professional

Both

$308.25

Service Code	HCPCS 99384
Min. Negotiated Rate	$231.19
Max. Negotiated Rate	$231.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.19
Rate for Payer: SOMOS Essential	$231.19

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS

Professional

Both

$258.75

Service Code	HCPCS 99382
Min. Negotiated Rate	$194.06
Max. Negotiated Rate	$194.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$194.06
Rate for Payer: SOMOS Essential	$194.06

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS

Professional

Both

$299.25

Service Code	HCPCS 99385
Min. Negotiated Rate	$224.44
Max. Negotiated Rate	$224.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$224.44
Rate for Payer: SOMOS Essential	$224.44

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS

Professional

Both

$268.50

Service Code	HCPCS 99383
Min. Negotiated Rate	$201.38
Max. Negotiated Rate	$201.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$201.38
Rate for Payer: SOMOS Essential	$201.38

Know your out-of-pocket cost for care.

All Charges