St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD

Professional

Both

$972.79

Service Code	HCPCS 41006
Min. Negotiated Rate	$729.59
Max. Negotiated Rate	$729.59
Rate for Payer: Cash Price	$266.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$729.59
Rate for Payer: SOMOS Essential	$729.59

PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC

Professional

Both

$513.91

Service Code	HCPCS 41005
Min. Negotiated Rate	$385.43
Max. Negotiated Rate	$385.43
Rate for Payer: Cash Price	$134.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$385.43
Rate for Payer: SOMOS Essential	$385.43

PR INTRAORAL I&D TONGUE/FLOOR SUBMENTAL SPACE

Professional

Both

$924.18

Service Code	HCPCS 41007
Min. Negotiated Rate	$693.14
Max. Negotiated Rate	$693.14
Rate for Payer: Cash Price	$254.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$693.14
Rate for Payer: SOMOS Essential	$693.14

PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE

Professional

Both

$1,090.50

Service Code	HCPCS 41008
Min. Negotiated Rate	$817.88
Max. Negotiated Rate	$817.88
Rate for Payer: Cash Price	$299.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$817.88
Rate for Payer: SOMOS Essential	$817.88

PR INTRAPROCEDURAL CORONARY FFP W/3D FUNCJL MAPPING

Professional

Both

$117.32

Service Code	HCPCS 0523T
Min. Negotiated Rate	$87.99
Max. Negotiated Rate	$87.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$87.99
Rate for Payer: SOMOS Essential	$87.99

PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP

Professional

Both

$227.54

Service Code	HCPCS 94610
Min. Negotiated Rate	$170.66
Max. Negotiated Rate	$170.66
Rate for Payer: Cash Price	$62.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$170.66
Rate for Payer: SOMOS Essential	$170.66

PR INTRAUT COPPER CONTRACEPTIVE

Professional

Both

$1,850.00

Service Code	HCPCS J7300
Min. Negotiated Rate	$1,387.50
Max. Negotiated Rate	$1,387.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,387.50
Rate for Payer: SOMOS Essential	$1,387.50

PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL

Professional

Both

$303.24

Service Code	HCPCS 37253
Min. Negotiated Rate	$227.43
Max. Negotiated Rate	$227.43
Rate for Payer: Cash Price	$80.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$227.43
Rate for Payer: SOMOS Essential	$227.43

PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL

Professional

Both

$385.91

Service Code	HCPCS 37252
Min. Negotiated Rate	$289.43
Max. Negotiated Rate	$289.43
Rate for Payer: Cash Price	$101.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$289.43
Rate for Payer: SOMOS Essential	$289.43

PR INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA

Professional

Both

$1,180.17

Service Code	HCPCS 93609 26
Min. Negotiated Rate	$885.13
Max. Negotiated Rate	$885.13
Rate for Payer: Cash Price	$311.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$885.13
Rate for Payer: SOMOS Essential	$885.13

PR INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA

Professional

Both

$557.24

Service Code	HCPCS 93609 TC
Min. Negotiated Rate	$417.93
Max. Negotiated Rate	$417.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$417.93
Rate for Payer: SOMOS Essential	$417.93

PR INTRA-VENTRIC&/ATRIAL MAPG TACHYCARD W/CATH MA

Professional

Both

$1,737.40

Service Code	HCPCS 93609
Min. Negotiated Rate	$1,303.05
Max. Negotiated Rate	$1,303.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,303.05
Rate for Payer: SOMOS Essential	$1,303.05

PR INTRAVENTRICULAR PACING

Professional

Both

$331.21

Service Code	HCPCS 93612 TC
Min. Negotiated Rate	$248.41
Max. Negotiated Rate	$248.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$248.41
Rate for Payer: SOMOS Essential	$248.41

PR INTRAVENTRICULAR PACING

Professional

Both

$1,011.43

Service Code	HCPCS 93612
Min. Negotiated Rate	$758.57
Max. Negotiated Rate	$758.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$758.57
Rate for Payer: SOMOS Essential	$758.57

PR INTRAVENTRICULAR PACING

Professional

Both

$680.23

Service Code	HCPCS 93612 26
Min. Negotiated Rate	$510.17
Max. Negotiated Rate	$510.17
Rate for Payer: Cash Price	$180.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$510.17
Rate for Payer: SOMOS Essential	$510.17

PR INTRAVITREAL NJX PHARMACOLOGIC AGT SPX

Professional

Both

$374.33

Service Code	HCPCS 67028
Min. Negotiated Rate	$280.75
Max. Negotiated Rate	$280.75
Rate for Payer: Cash Price	$102.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$280.75
Rate for Payer: SOMOS Essential	$280.75

PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX

Professional

Both

$529.73

Service Code	HCPCS 57180
Min. Negotiated Rate	$397.30
Max. Negotiated Rate	$397.30
Rate for Payer: Cash Price	$142.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$397.30
Rate for Payer: SOMOS Essential	$397.30

PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I

Professional

Both

$709.87

Service Code	HCPCS 36901
Min. Negotiated Rate	$532.40
Max. Negotiated Rate	$532.40
Rate for Payer: Cash Price	$189.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$532.40
Rate for Payer: SOMOS Essential	$532.40

PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT

Professional

Both

$1,327.24

Service Code	HCPCS 36903
Min. Negotiated Rate	$995.43
Max. Negotiated Rate	$995.43
Rate for Payer: Cash Price	$356.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$995.43
Rate for Payer: SOMOS Essential	$995.43

PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP

Professional

Both

$1,003.63

Service Code	HCPCS 36902
Min. Negotiated Rate	$752.72
Max. Negotiated Rate	$752.72
Rate for Payer: Cash Price	$270.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$752.72
Rate for Payer: SOMOS Essential	$752.72

PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY

Professional

Both

$522.20

Service Code	HCPCS 36013
Min. Negotiated Rate	$391.65
Max. Negotiated Rate	$391.65
Rate for Payer: Cash Price	$141.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$391.65
Rate for Payer: SOMOS Essential	$391.65

PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA

Professional

Both

$463.26

Service Code	HCPCS 36010
Min. Negotiated Rate	$347.44
Max. Negotiated Rate	$347.44
Rate for Payer: Cash Price	$124.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$347.44
Rate for Payer: SOMOS Essential	$347.44

PR INTRODUCTION CATHETER AORTA

Professional

Both

$607.57

Service Code	HCPCS 36200
Min. Negotiated Rate	$455.68
Max. Negotiated Rate	$455.68
Rate for Payer: Cash Price	$161.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$455.68
Rate for Payer: SOMOS Essential	$455.68

PR INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE

Professional

Both

$79.91

Service Code	HCPCS 44500
Min. Negotiated Rate	$59.93
Max. Negotiated Rate	$59.93
Rate for Payer: Cash Price	$21.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59.93
Rate for Payer: SOMOS Essential	$59.93

PR INTRODUCTION NEEDLE/INTRACATHETER VEIN

Professional

Both

$65.00

Service Code	HCPCS 36000
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48.75
Rate for Payer: SOMOS Essential	$48.75

Know your out-of-pocket cost for care.

All Charges