St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL

Professional

Both

$585.17

Service Code	HCPCS 62282
Min. Negotiated Rate	$438.88
Max. Negotiated Rate	$438.88
Rate for Payer: Cash Price	$161.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$438.88
Rate for Payer: SOMOS Essential	$438.88

PR INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC

Professional

Both

$660.31

Service Code	HCPCS 62281
Min. Negotiated Rate	$495.23
Max. Negotiated Rate	$495.23
Rate for Payer: Cash Price	$175.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$495.23
Rate for Payer: SOMOS Essential	$495.23

PR INPT TELEHEALTH CON 70/>M

Professional

Both

$751.52

Service Code	HCPCS G0427
Min. Negotiated Rate	$563.64
Max. Negotiated Rate	$563.64
Rate for Payer: Cash Price	$205.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$563.64
Rate for Payer: SOMOS Essential	$563.64

PR INPT TELEHEALTH CONSULT 30M

Professional

Both

$383.18

Service Code	HCPCS G0425
Min. Negotiated Rate	$287.38
Max. Negotiated Rate	$287.38
Rate for Payer: Cash Price	$103.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$287.38
Rate for Payer: SOMOS Essential	$287.38

PR INPT TELEHEALTH CONSULT 50M

Professional

Both

$535.15

Service Code	HCPCS G0426
Min. Negotiated Rate	$401.36
Max. Negotiated Rate	$401.36
Rate for Payer: Cash Price	$146.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$401.36
Rate for Payer: SOMOS Essential	$401.36

PR INSERT ANTER DRAINAGE DEV W/O EXTRAOC RESERVOIR

Professional

Both

$4,239.69

Service Code	HCPCS 66183
Min. Negotiated Rate	$3,179.77
Max. Negotiated Rate	$3,179.77
Rate for Payer: Cash Price	$1,169.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,179.77
Rate for Payer: SOMOS Essential	$3,179.77

PR INSERT CECOSTOMY/OTHER COLONIC TUBE PERCUTANEOUS

Professional

Both

$840.56

Service Code	HCPCS 49442
Min. Negotiated Rate	$630.42
Max. Negotiated Rate	$630.42
Rate for Payer: Cash Price	$229.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$630.42
Rate for Payer: SOMOS Essential	$630.42

PR INSERT DRUG DEL IMPLANT, >=4

Professional

Both

$391.72

Service Code	HCPCS G0516
Min. Negotiated Rate	$293.79
Max. Negotiated Rate	$293.79
Rate for Payer: Cash Price	$107.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$293.79
Rate for Payer: SOMOS Essential	$293.79

PR INSERT DUODENOSTOMY/JEJUNOSTOMY TUBE PERQ

Professional

Both

$1,000.69

Service Code	HCPCS 49441
Min. Negotiated Rate	$750.52
Max. Negotiated Rate	$750.52
Rate for Payer: Cash Price	$272.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$750.52
Rate for Payer: SOMOS Essential	$750.52

PR INSERT GASTROSTOMY TUBE PERCUTANEOUS

Professional

Both

$835.84

Service Code	HCPCS 49440
Min. Negotiated Rate	$626.88
Max. Negotiated Rate	$626.88
Rate for Payer: Cash Price	$225.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$626.88
Rate for Payer: SOMOS Essential	$626.88

PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY

Professional

Both

$3,337.57

Service Code	HCPCS 19340
Min. Negotiated Rate	$2,503.18
Max. Negotiated Rate	$2,503.18
Rate for Payer: Cash Price	$900.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,503.18
Rate for Payer: SOMOS Essential	$2,503.18

PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE

Professional

Both

$203.70

Service Code	HCPCS 59200
Min. Negotiated Rate	$152.78
Max. Negotiated Rate	$152.78
Rate for Payer: Cash Price	$54.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.78
Rate for Payer: SOMOS Essential	$152.78

PR INSERTION DRUG DELIVERY IMPLANT

Professional

Both

$272.27

Service Code	HCPCS 11981
Min. Negotiated Rate	$204.20
Max. Negotiated Rate	$204.20
Rate for Payer: Cash Price	$73.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$204.20
Rate for Payer: SOMOS Essential	$204.20

PR INSERTION EPICARDIAL ELECTRODE ENDOSCOPIC

Professional

Both

$3,603.32

Service Code	HCPCS 33203
Min. Negotiated Rate	$2,702.49
Max. Negotiated Rate	$2,702.49
Rate for Payer: Cash Price	$960.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,702.49
Rate for Payer: SOMOS Essential	$2,702.49

PR INSERTION EPICARDIAL ELECTRODE OPEN

Professional

Both

$3,423.07

Service Code	HCPCS 33202
Min. Negotiated Rate	$2,567.30
Max. Negotiated Rate	$2,567.30
Rate for Payer: Cash Price	$911.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,567.30
Rate for Payer: SOMOS Essential	$2,567.30

PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING

Professional

Both

$357.25

Service Code	HCPCS 93503
Min. Negotiated Rate	$267.94
Max. Negotiated Rate	$267.94
Rate for Payer: Cash Price	$96.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$267.94
Rate for Payer: SOMOS Essential	$267.94

PR INSERTION HEYMAN CAPSULES CLINICAL BRACHYTHERAPY

Professional

Both

$2,068.68

Service Code	HCPCS 58346
Min. Negotiated Rate	$1,551.51
Max. Negotiated Rate	$1,551.51
Rate for Payer: Cash Price	$567.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,551.51
Rate for Payer: SOMOS Essential	$1,551.51

PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER

Professional

Both

$860.09

Service Code	HCPCS 32550
Min. Negotiated Rate	$645.07
Max. Negotiated Rate	$645.07
Rate for Payer: Cash Price	$231.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$645.07
Rate for Payer: SOMOS Essential	$645.07

PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ

Professional

Both

$1,130.54

Service Code	HCPCS 33967
Min. Negotiated Rate	$847.90
Max. Negotiated Rate	$847.90
Rate for Payer: Cash Price	$301.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$847.90
Rate for Payer: SOMOS Essential	$847.90

PR INSERTION INTRAUTERINE DEVICE IUD

Professional

Both

$215.00

Service Code	HCPCS 58300
Min. Negotiated Rate	$161.25
Max. Negotiated Rate	$161.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$161.25
Rate for Payer: SOMOS Essential	$161.25

PR INSERTION NASAL SEPTAL PROSTHESIS BUTTON

Professional

Both

$551.15

Service Code	HCPCS 30220
Min. Negotiated Rate	$413.36
Max. Negotiated Rate	$413.36
Rate for Payer: Cash Price	$151.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$413.36
Rate for Payer: SOMOS Essential	$413.36

PR INSERTION PERITONEAL-VENOUS SHUNT

Professional

Both

$3,533.60

Service Code	HCPCS 49425
Min. Negotiated Rate	$2,650.20
Max. Negotiated Rate	$2,650.20
Rate for Payer: Cash Price	$944.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,650.20
Rate for Payer: SOMOS Essential	$2,650.20

PR INSERTION PICC W/O IMG GDN < 5 YR

Professional

Both

$383.01

Service Code	HCPCS 36568
Min. Negotiated Rate	$287.26
Max. Negotiated Rate	$287.26
Rate for Payer: Cash Price	$102.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$287.26
Rate for Payer: SOMOS Essential	$287.26

PR INSERTION PICC W/O IMG GDN 5 YR/>

Professional

Both

$393.93

Service Code	HCPCS 36569
Min. Negotiated Rate	$295.45
Max. Negotiated Rate	$295.45
Rate for Payer: Cash Price	$107.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$295.45
Rate for Payer: SOMOS Essential	$295.45

PR INSERTION PICC W/RS&I < 5 YR

Professional

Both

$337.02

Service Code	HCPCS 36572
Min. Negotiated Rate	$252.76
Max. Negotiated Rate	$252.76
Rate for Payer: Cash Price	$90.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$252.76
Rate for Payer: SOMOS Essential	$252.76

Know your out-of-pocket cost for care.

All Charges