St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROPARACAINE HCL 0.5 % OP SOLN [6644]

Facility

$2.93

Service Code	NDC 61314001601
Hospital Charge Code	61314001601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.46
Rate for Payer: Aetna Government	$1.46
Rate for Payer: Brighton Health Commercial	$2.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.99
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.90

PROPARACAINE HCL 0.5 % OP SOLN [6644]

Facility

$2.93

Service Code	NDC 17478026312
Hospital Charge Code	17478026312
Hospital Revenue Code	250
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$2.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.46
Rate for Payer: Aetna Government	$1.46
Rate for Payer: Brighton Health Commercial	$2.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.99
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.90

PR OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND

Professional

Both

$5,076.40

Service Code	HCPCS 50250
Min. Negotiated Rate	$3,807.30
Max. Negotiated Rate	$3,807.30
Rate for Payer: Cash Price	$1,386.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,807.30
Rate for Payer: SOMOS Essential	$3,807.30

PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES

Professional

Both

$2,004.14

Service Code	HCPCS 38531
Min. Negotiated Rate	$1,503.10
Max. Negotiated Rate	$1,503.10
Rate for Payer: Cash Price	$539.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,503.10
Rate for Payer: SOMOS Essential	$1,503.10

PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA

Professional

Both

$12,482.89

Service Code	HCPCS 32815
Min. Negotiated Rate	$9,362.17
Max. Negotiated Rate	$9,362.17
Rate for Payer: Cash Price	$3,311.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,362.17
Rate for Payer: SOMOS Essential	$9,362.17

PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB

Professional

Both

$820.51

Service Code	HCPCS 35600
Min. Negotiated Rate	$615.38
Max. Negotiated Rate	$615.38
Rate for Payer: Cash Price	$217.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$615.38
Rate for Payer: SOMOS Essential	$615.38

PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN

Professional

Both

$2,656.05

Service Code	HCPCS 64568
Min. Negotiated Rate	$1,992.04
Max. Negotiated Rate	$1,992.04
Rate for Payer: Cash Price	$721.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,992.04
Rate for Payer: SOMOS Essential	$1,992.04

PR OPEN IMPLANTATION NEA NEUROMUSCULAR

Professional

Both

$1,420.02

Service Code	HCPCS 64580
Min. Negotiated Rate	$1,065.02
Max. Negotiated Rate	$1,065.02
Rate for Payer: Cash Price	$381.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,065.02
Rate for Payer: SOMOS Essential	$1,065.02

PR OPEN IMPLANTATION NEA PERIPHERAL NERVE

Professional

Both

$1,331.09

Service Code	HCPCS 64575
Min. Negotiated Rate	$998.32
Max. Negotiated Rate	$998.32
Rate for Payer: Cash Price	$370.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$998.32
Rate for Payer: SOMOS Essential	$998.32

PR OPEN IMPLANTATION NEA SACRAL NERVE

Professional

Both

$2,781.91

Service Code	HCPCS 64581
Min. Negotiated Rate	$2,086.43
Max. Negotiated Rate	$2,086.43
Rate for Payer: Cash Price	$756.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,086.43
Rate for Payer: SOMOS Essential	$2,086.43

PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR

Professional

Both

$3,791.87

Service Code	HCPCS 64582
Min. Negotiated Rate	$2,843.90
Max. Negotiated Rate	$2,843.90
Rate for Payer: Cash Price	$973.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,843.90
Rate for Payer: SOMOS Essential	$2,843.90

PR OPEN OSTEOCHONDRAL AUTOGRAFT TALUS

Professional

Both

$5,411.56

Service Code	HCPCS 28446
Min. Negotiated Rate	$4,058.67
Max. Negotiated Rate	$4,058.67
Rate for Payer: Cash Price	$1,459.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,058.67
Rate for Payer: SOMOS Essential	$4,058.67

PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL

Professional

Both

$648.55

Service Code	HCPCS 37239
Min. Negotiated Rate	$486.41
Max. Negotiated Rate	$486.41
Rate for Payer: Cash Price	$172.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$486.41
Rate for Payer: SOMOS Essential	$486.41

PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL

Professional

Both

$917.88

Service Code	HCPCS 37237
Min. Negotiated Rate	$688.41
Max. Negotiated Rate	$688.41
Rate for Payer: Cash Price	$245.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$688.41
Rate for Payer: SOMOS Essential	$688.41

PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL

Professional

Both

$1,930.88

Service Code	HCPCS 37236
Min. Negotiated Rate	$1,448.16
Max. Negotiated Rate	$1,448.16
Rate for Payer: Cash Price	$510.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,448.16
Rate for Payer: SOMOS Essential	$1,448.16

PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST

Professional

Both

$1,315.69

Service Code	HCPCS 37238
Min. Negotiated Rate	$986.77
Max. Negotiated Rate	$986.77
Rate for Payer: Cash Price	$352.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$986.77
Rate for Payer: SOMOS Essential	$986.77

PR OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT

Professional

Both

$5,455.77

Service Code	HCPCS 23616
Min. Negotiated Rate	$4,091.83
Max. Negotiated Rate	$4,091.83
Rate for Payer: Cash Price	$1,471.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,091.83
Rate for Payer: SOMOS Essential	$4,091.83

PR OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE

Professional

Both

$3,501.05

Service Code	HCPCS 25525
Min. Negotiated Rate	$2,625.79
Max. Negotiated Rate	$2,625.79
Rate for Payer: Cash Price	$948.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,625.79
Rate for Payer: SOMOS Essential	$2,625.79

PR OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE

Professional

Both

$4,239.41

Service Code	HCPCS 25526
Min. Negotiated Rate	$3,179.56
Max. Negotiated Rate	$3,179.56
Rate for Payer: Cash Price	$1,146.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,179.56
Rate for Payer: SOMOS Essential	$3,179.56

PR OPEN REPAIR OF ROTATOR CUFF ACUTE

Professional

Both

$3,630.66

Service Code	HCPCS 23410
Min. Negotiated Rate	$2,723.00
Max. Negotiated Rate	$2,723.00
Rate for Payer: Cash Price	$979.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,723.00
Rate for Payer: SOMOS Essential	$2,723.00

PR OPEN REPAIR OF ROTATOR CUFF CHRONIC

Professional

Both

$3,771.50

Service Code	HCPCS 23412
Min. Negotiated Rate	$2,828.62
Max. Negotiated Rate	$2,828.62
Rate for Payer: Cash Price	$1,018.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,828.62
Rate for Payer: SOMOS Essential	$2,828.62

PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE

Professional

Both

$3,373.65

Service Code	HCPCS 27814
Min. Negotiated Rate	$2,530.24
Max. Negotiated Rate	$2,530.24
Rate for Payer: Cash Price	$911.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,530.24
Rate for Payer: SOMOS Essential	$2,530.24

PR OPEN TREATMENT CALCANEAL FRACTURE

Professional

Both

$4,894.72

Service Code	HCPCS 28415
Min. Negotiated Rate	$3,671.04
Max. Negotiated Rate	$3,671.04
Rate for Payer: Cash Price	$1,321.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,671.04
Rate for Payer: SOMOS Essential	$3,671.04

PR OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT

Professional

Both

$5,736.36

Service Code	HCPCS 28420
Min. Negotiated Rate	$4,302.27
Max. Negotiated Rate	$4,302.27
Rate for Payer: Cash Price	$1,546.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,302.27
Rate for Payer: SOMOS Essential	$4,302.27

PR OPEN TREATMENT COCCYGEAL FRACTURE

Professional

Both

$2,345.46

Service Code	HCPCS 27202
Min. Negotiated Rate	$1,759.10
Max. Negotiated Rate	$1,759.10
Rate for Payer: Cash Price	$634.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,759.10
Rate for Payer: SOMOS Essential	$1,759.10

Know your out-of-pocket cost for care.

All Charges