St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR MD SERVICE REQUIRED FOR PMD

Professional

Both

$35.53

Service Code	HCPCS G0372
Min. Negotiated Rate	$26.65
Max. Negotiated Rate	$26.65
Rate for Payer: Cash Price	$9.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.65
Rate for Payer: SOMOS Essential	$26.65

PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ

Professional

Both

$844.24

Service Code	HCPCS 90710
Min. Negotiated Rate	$633.18
Max. Negotiated Rate	$633.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$633.18
Rate for Payer: SOMOS Essential	$633.18

PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ

Professional

Both

$299.25

Service Code	HCPCS 90707
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 MEAS OCULAR BLOOD FLOW REPEAT IO PRES SAMP W/I&R

Professional

Both

$359.94

Service Code	HCPCS 0198T
Min. Negotiated Rate	$269.96
Max. Negotiated Rate	$269.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$269.96
Rate for Payer: SOMOS Essential	$269.96

PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP

Professional

Both

$47.29

Service Code	HCPCS 51798
Min. Negotiated Rate	$35.47
Max. Negotiated Rate	$35.47
Rate for Payer: Cash Price	$13.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.47
Rate for Payer: SOMOS Essential	$35.47

PR MEAS SPIRO FRCD EXP FLO PRE&POST BRONCH INF/2YRS

Professional

Both

$556.99

Service Code	HCPCS 94012
Min. Negotiated Rate	$417.74
Max. Negotiated Rate	$417.74
Rate for Payer: Cash Price	$153.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$417.74
Rate for Payer: SOMOS Essential	$417.74

PR MEAS SPIROMTRC FORCD EXPIRATORY FLO INFANT&/2 Y

Professional

Both

$344.02

Service Code	HCPCS 94011
Min. Negotiated Rate	$258.02
Max. Negotiated Rate	$258.02
Rate for Payer: Cash Price	$93.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$258.02
Rate for Payer: SOMOS Essential	$258.02

PR MEASUREMENT LUNG VOLUMES INFANT/CHILD/2 YRS

Professional

Both

$78.12

Service Code	HCPCS 94013
Min. Negotiated Rate	$58.59
Max. Negotiated Rate	$58.59
Rate for Payer: Cash Price	$20.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$58.59
Rate for Payer: SOMOS Essential	$58.59

PR MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT

Professional

Both

$404.08

Service Code	HCPCS 53020
Min. Negotiated Rate	$303.06
Max. Negotiated Rate	$303.06
Rate for Payer: Cash Price	$110.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$303.06
Rate for Payer: SOMOS Essential	$303.06

PR MEATOTOMY CUTTING MEATUS SPX INFANT

Professional

Both

$287.67

Service Code	HCPCS 53025
Min. Negotiated Rate	$215.75
Max. Negotiated Rate	$215.75
Rate for Payer: Cash Price	$78.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.75
Rate for Payer: SOMOS Essential	$215.75

PR MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION

Professional

Both

$85.96

Service Code	HCPCS 94669
Min. Negotiated Rate	$64.47
Max. Negotiated Rate	$64.47
Rate for Payer: Cash Price	$24.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64.47
Rate for Payer: SOMOS Essential	$64.47

PR MEDIAL CANTHOPEXY SEPARATE PROCEDURE

Professional

Both

$2,478.35

Service Code	HCPCS 21280
Min. Negotiated Rate	$1,858.76
Max. Negotiated Rate	$1,858.76
Rate for Payer: Cash Price	$681.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,858.76
Rate for Payer: SOMOS Essential	$1,858.76

PR MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY

Professional

Both

$1,367.94

Service Code	HCPCS 39401
Min. Negotiated Rate	$1,025.96
Max. Negotiated Rate	$1,025.96
Rate for Payer: Cash Price	$363.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,025.96
Rate for Payer: SOMOS Essential	$1,025.96

PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES

Professional

Both

$1,789.80

Service Code	HCPCS 39402
Min. Negotiated Rate	$1,342.35
Max. Negotiated Rate	$1,342.35
Rate for Payer: Cash Price	$476.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,342.35
Rate for Payer: SOMOS Essential	$1,342.35

PR MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR

Professional

Both

$2,123.77

Service Code	HCPCS 39000
Min. Negotiated Rate	$1,592.83
Max. Negotiated Rate	$1,592.83
Rate for Payer: Cash Price	$601.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,592.83
Rate for Payer: SOMOS Essential	$1,592.83

PR MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR

Professional

Both

$3,500.00

Service Code	HCPCS 39010
Min. Negotiated Rate	$2,625.00
Max. Negotiated Rate	$2,625.00
Rate for Payer: Cash Price	$937.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,625.00
Rate for Payer: SOMOS Essential	$2,625.00

PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI

Professional

Both

$129.50

Service Code	HCPCS 97802
Min. Negotiated Rate	$97.12
Max. Negotiated Rate	$97.12
Rate for Payer: Cash Price	$35.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$97.12
Rate for Payer: SOMOS Essential	$97.12

PR MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M

Professional

Both

$109.41

Service Code	HCPCS 97803
Min. Negotiated Rate	$82.06
Max. Negotiated Rate	$82.06
Rate for Payer: Cash Price	$30.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$82.06
Rate for Payer: SOMOS Essential	$82.06

PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI

Professional

Both

$62.79

Service Code	HCPCS 97804
Min. Negotiated Rate	$47.09
Max. Negotiated Rate	$47.09
Rate for Payer: Cash Price	$17.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.09
Rate for Payer: SOMOS Essential	$47.09

PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

Professional

Both

$397.64

Service Code	HCPCS 93463
Min. Negotiated Rate	$298.23
Max. Negotiated Rate	$298.23
Rate for Payer: Cash Price	$107.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$298.23
Rate for Payer: SOMOS Essential	$298.23

PR MEDROXYPROGESTERONE ACETATE

Professional

Both

$1.05

Service Code	HCPCS J1050
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$0.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.79
Rate for Payer: SOMOS Essential	$0.79

PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE

Professional

Both

$382.65

Service Code	HCPCS 90734
Min. Negotiated Rate	$286.99
Max. Negotiated Rate	$286.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$286.99
Rate for Payer: SOMOS Essential	$286.99

PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE

Professional

Both

$520.10

Service Code	HCPCS 90619
Min. Negotiated Rate	$390.08
Max. Negotiated Rate	$390.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$390.08
Rate for Payer: SOMOS Essential	$390.08

PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM

Professional

Both

$610.46

Service Code	HCPCS 90620
Min. Negotiated Rate	$457.84
Max. Negotiated Rate	$457.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$457.84
Rate for Payer: SOMOS Essential	$457.84

PR MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM

Professional

Both

$718.23

Service Code	HCPCS 90621
Min. Negotiated Rate	$538.67
Max. Negotiated Rate	$538.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$538.67
Rate for Payer: SOMOS Essential	$538.67

Know your out-of-pocket cost for care.

All Charges