St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR INS/RPLCMNT PERM SUBQ IMPLTBL DFB W/SUBQ ELTRD

Professional

Both

$2,481.78

Service Code	HCPCS 33270
Min. Negotiated Rate	$1,861.34
Max. Negotiated Rate	$1,861.34
Rate for Payer: Cash Price	$656.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,861.34
Rate for Payer: SOMOS Essential	$1,861.34

PR INS/RPLC PERPH SAC/GSTRC NPG/RCVR PCKT CRTJ&CONN

Professional

Both

$688.70

Service Code	HCPCS 64590
Min. Negotiated Rate	$516.52
Max. Negotiated Rate	$516.52
Rate for Payer: Cash Price	$341.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$516.52
Rate for Payer: SOMOS Essential	$516.52

PR INSTLJ CH TUBE/CATH AGENT FBRNLYSIS SBSQ DAY

Professional

Both

$249.69

Service Code	HCPCS 32562
Min. Negotiated Rate	$187.27
Max. Negotiated Rate	$187.27
Rate for Payer: Cash Price	$67.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$187.27
Rate for Payer: SOMOS Essential	$187.27

PR INSTLJ THER AGENT RENAL PELVIS&/URETER VIA TUB

Professional

Both

$404.74

Service Code	HCPCS 50391
Min. Negotiated Rate	$303.56
Max. Negotiated Rate	$303.56
Rate for Payer: Cash Price	$110.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$303.56
Rate for Payer: SOMOS Essential	$303.56

PR INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS

Professional

Both

$321.93

Service Code	HCPCS 32560
Min. Negotiated Rate	$241.45
Max. Negotiated Rate	$241.45
Rate for Payer: Cash Price	$86.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$241.45
Rate for Payer: SOMOS Essential	$241.45

PR INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY

Professional

Both

$282.42

Service Code	HCPCS 32561
Min. Negotiated Rate	$211.82
Max. Negotiated Rate	$211.82
Rate for Payer: Cash Price	$75.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211.82
Rate for Payer: SOMOS Essential	$211.82

PR INT ANAST PANCREATIC CYST GI TRACT DIRECT

Professional

Both

$4,985.89

Service Code	HCPCS 48520
Min. Negotiated Rate	$3,739.42
Max. Negotiated Rate	$3,739.42
Rate for Payer: Cash Price	$1,326.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,739.42
Rate for Payer: SOMOS Essential	$3,739.42

PR INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y

Professional

Both

$5,923.09

Service Code	HCPCS 48540
Min. Negotiated Rate	$4,442.32
Max. Negotiated Rate	$4,442.32
Rate for Payer: Cash Price	$1,574.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,442.32
Rate for Payer: SOMOS Essential	$4,442.32

PR INTENS BEHAVE THER CARDIO DX

Professional

Both

$94.61

Service Code	HCPCS G0446
Min. Negotiated Rate	$70.96
Max. Negotiated Rate	$70.96
Rate for Payer: Cash Price	$25.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.96
Rate for Payer: SOMOS Essential	$70.96

PR INTENS CARDIAC REHAB NO EXER

Professional

Both

$485.91

Service Code	HCPCS G0423
Min. Negotiated Rate	$364.43
Max. Negotiated Rate	$364.43
Rate for Payer: Cash Price	$145.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$364.43
Rate for Payer: SOMOS Essential	$364.43

PR INTENS CARDIAC REHAB W/EXERC

Professional

Both

$485.91

Service Code	HCPCS G0422
Min. Negotiated Rate	$364.43
Max. Negotiated Rate	$364.43
Rate for Payer: Cash Price	$145.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$364.43
Rate for Payer: SOMOS Essential	$364.43

PR INTERCALARY ALLOGRAFT COMPLETE

Professional

Both

$3,316.71

Service Code	HCPCS 20934
Min. Negotiated Rate	$2,487.53
Max. Negotiated Rate	$2,487.53
Rate for Payer: Cash Price	$885.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,487.53
Rate for Payer: SOMOS Essential	$2,487.53

PR INTERDENTAL WIRING OTHER THAN FRACTURE

Professional

Both

$2,518.53

Service Code	HCPCS 21497
Min. Negotiated Rate	$1,888.90
Max. Negotiated Rate	$1,888.90
Rate for Payer: Cash Price	$682.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,888.90
Rate for Payer: SOMOS Essential	$1,888.90

PR INTER DEVC REMOTE 30D

Professional

Both

$155.12

Service Code	HCPCS G2066
Min. Negotiated Rate	$116.34
Max. Negotiated Rate	$116.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$116.34
Rate for Payer: SOMOS Essential	$116.34

PR INTERMEDIATE VISUAL FIELD XM UNI/BI I&R

Professional

Both

$81.59

Service Code	HCPCS 92082 26
Min. Negotiated Rate	$61.19
Max. Negotiated Rate	$61.19
Rate for Payer: Cash Price	$22.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.19
Rate for Payer: SOMOS Essential	$61.19

PR INTERMEDIATE VISUAL FIELD XM UNI/BI I&R

Professional

Both

$195.02

Service Code	HCPCS 92082
Min. Negotiated Rate	$146.26
Max. Negotiated Rate	$146.26
Rate for Payer: Cash Price	$54.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$146.26
Rate for Payer: SOMOS Essential	$146.26

PR INTERMEDIATE VISUAL FIELD XM UNI/BI I&R

Professional

Both

$113.44

Service Code	HCPCS 92082 TC
Min. Negotiated Rate	$85.08
Max. Negotiated Rate	$85.08
Rate for Payer: Cash Price	$31.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85.08
Rate for Payer: SOMOS Essential	$85.08

PR INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE

Professional

Both

$761.95

Service Code	HCPCS 64727
Min. Negotiated Rate	$571.46
Max. Negotiated Rate	$571.46
Rate for Payer: Cash Price	$203.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$571.46
Rate for Payer: SOMOS Essential	$571.46

PR INTERPELVIABDOMINAL AMPUTATION

Professional

Both

$7,163.49

Service Code	HCPCS 27290
Min. Negotiated Rate	$5,372.62
Max. Negotiated Rate	$5,372.62
Rate for Payer: Cash Price	$1,927.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,372.62
Rate for Payer: SOMOS Essential	$5,372.62

PR INTERROGATION DEV EVAL ICDS W/SS ELTRD IN PERSON

Professional

Both

$311.64

Service Code	HCPCS 0576T
Min. Negotiated Rate	$233.73
Max. Negotiated Rate	$233.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$233.73
Rate for Payer: SOMOS Essential	$233.73

PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB

Professional

Both

$150.82

Service Code	HCPCS 93261 TC
Min. Negotiated Rate	$113.12
Max. Negotiated Rate	$113.12
Rate for Payer: Cash Price	$41.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$113.12
Rate for Payer: SOMOS Essential	$113.12

PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB

Professional

Both

$292.08

Service Code	HCPCS 93261
Min. Negotiated Rate	$219.06
Max. Negotiated Rate	$219.06
Rate for Payer: Cash Price	$79.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$219.06
Rate for Payer: SOMOS Essential	$219.06

PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB

Professional

Both

$141.30

Service Code	HCPCS 93261 26
Min. Negotiated Rate	$105.98
Max. Negotiated Rate	$105.98
Rate for Payer: Cash Price	$38.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.98
Rate for Payer: SOMOS Essential	$105.98

PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR

Professional

Both

$133.56

Service Code	HCPCS 93292 TC
Min. Negotiated Rate	$100.17
Max. Negotiated Rate	$100.17
Rate for Payer: Cash Price	$36.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100.17
Rate for Payer: SOMOS Essential	$100.17

PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR

Professional

Both

$82.32

Service Code	HCPCS 93292 26
Min. Negotiated Rate	$61.74
Max. Negotiated Rate	$61.74
Rate for Payer: Cash Price	$22.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.74
Rate for Payer: SOMOS Essential	$61.74

Know your out-of-pocket cost for care.

All Charges