St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR

Professional

Both

$3,961.20

Service Code	HCPCS 27535
Min. Negotiated Rate	$2,970.90
Max. Negotiated Rate	$2,970.90
Rate for Payer: Cash Price	$1,067.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,970.90
Rate for Payer: SOMOS Essential	$2,970.90

PR OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC

Professional

Both

$3,266.76

Service Code	HCPCS 25685
Min. Negotiated Rate	$2,450.07
Max. Negotiated Rate	$2,450.07
Rate for Payer: Cash Price	$883.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,450.07
Rate for Payer: SOMOS Essential	$2,450.07

PR OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP

Professional

Both

$4,337.90

Service Code	HCPCS 27823
Min. Negotiated Rate	$3,253.42
Max. Negotiated Rate	$3,253.42
Rate for Payer: Cash Price	$1,172.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,253.42
Rate for Payer: SOMOS Essential	$3,253.42

PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP

Professional

Both

$3,849.09

Service Code	HCPCS 27822
Min. Negotiated Rate	$2,886.82
Max. Negotiated Rate	$2,886.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,886.82
Rate for Payer: SOMOS Essential	$2,886.82

PR OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL

Professional

Both

$193.87

Service Code	HCPCS 92136
Min. Negotiated Rate	$145.40
Max. Negotiated Rate	$145.40
Rate for Payer: Cash Price	$53.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$145.40
Rate for Payer: SOMOS Essential	$145.40

PR OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL

Professional

Both

$119.25

Service Code	HCPCS 92136 26
Min. Negotiated Rate	$89.44
Max. Negotiated Rate	$89.44
Rate for Payer: Cash Price	$32.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$89.44
Rate for Payer: SOMOS Essential	$89.44

PR OPH BMTRY PRTL COHER INTRFRMTRY IO LENS PWR CAL

Professional

Both

$74.62

Service Code	HCPCS 92136 TC
Min. Negotiated Rate	$55.96
Max. Negotiated Rate	$55.96
Rate for Payer: Cash Price	$20.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.96
Rate for Payer: SOMOS Essential	$55.96

PROPH CRYO

Facility

$1,535.38

Service Code	HCPCS 67145
Hospital Charge Code	30302035
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$672.19
Rate for Payer: Aetna Government	$672.19
Rate for Payer: Affinity Essential Plan 1&2	$470.53
Rate for Payer: Affinity Essential Plan 3&4	$470.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$470.53
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$672.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$672.19
Rate for Payer: Fidelis Essential Plan Aliesa	$571.36
Rate for Payer: Fidelis Essential Plan QHP	$598.25
Rate for Payer: Fidelis Medicare Advantage	$672.19
Rate for Payer: Fidelis Qualified Health Plan	$598.25
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$767.69
Rate for Payer: Hamaspik Choice Inc Medicare	$672.19
Rate for Payer: Healthfirst Medicare Advantage	$571.36
Rate for Payer: Healthfirst QHP	$672.19
Rate for Payer: Humana Medicare	$685.63
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$672.19
Rate for Payer: Senior Whole Health Medicare Advantage	$672.19
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$672.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$672.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$537.75
Rate for Payer: Wellcare Medicare	$638.58

PROPH CRYO

Facility

$1,535.38

Service Code	HCPCS 67210
Hospital Charge Code	40074314
Hospital Revenue Code	360
Min. Negotiated Rate	$470.53
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$672.19
Rate for Payer: Aetna Government	$672.19
Rate for Payer: Affinity Essential Plan 1&2	$470.53
Rate for Payer: Affinity Essential Plan 3&4	$470.53
Rate for Payer: Affinity Medicaid/CHP/HARP	$470.53
Rate for Payer: Brighton Health Commercial	$1,151.54
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Cash Price	$672.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$672.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$672.19
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$571.36
Rate for Payer: Fidelis Essential Plan QHP	$598.25
Rate for Payer: Fidelis Medicare Advantage	$672.19
Rate for Payer: Fidelis Qualified Health Plan	$598.25
Rate for Payer: Group Health Inc Commercial	$672.19
Rate for Payer: Group Health Inc Medicare	$672.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$767.69
Rate for Payer: Hamaspik Choice Inc Medicare	$672.19
Rate for Payer: Healthfirst Medicare Advantage	$571.36
Rate for Payer: Healthfirst QHP	$672.19
Rate for Payer: Humana Medicare	$685.63
Rate for Payer: Senior Whole Health Medicare Advantage	$672.19
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$672.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$672.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$537.75
Rate for Payer: Wellcare Medicare	$638.58

PROPH CRYO

Facility

$1,535.38

Service Code	HCPCS 67210
Hospital Charge Code	40074314
Hospital Revenue Code	360
Rate for Payer: Cash Price	$672.19

PROPH CRYO

Facility

$1,535.38

Service Code	HCPCS 67145
Hospital Charge Code	30302035
Hospital Revenue Code	510
Rate for Payer: Cash Price	$672.19

PR OPH SCVS MEDICAL XM&EVAL INTERMEDIATE NEW PT

Professional

Both

$180.39

Service Code	HCPCS 92002
Min. Negotiated Rate	$135.29
Max. Negotiated Rate	$135.29
Rate for Payer: Cash Price	$49.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$135.29
Rate for Payer: SOMOS Essential	$135.29

PR OPH SVCS MEDICAL XM&EVAL COMPRE EST PT 1/>VST

Professional

Both

$300.93

Service Code	HCPCS 92014
Min. Negotiated Rate	$225.70
Max. Negotiated Rate	$225.70
Rate for Payer: Cash Price	$82.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.70
Rate for Payer: SOMOS Essential	$225.70

PR OPH SVCS MEDICAL XM&EVAL COMPRE NEW PT 1/> VST

Professional

Both

$369.71

Service Code	HCPCS 92004
Min. Negotiated Rate	$277.28
Max. Negotiated Rate	$277.28
Rate for Payer: Cash Price	$101.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$277.28
Rate for Payer: SOMOS Essential	$277.28

PR OPH SVCS MEDICAL XM&EVAL INTERMEDIATE EST PT

Professional

Both

$202.37

Service Code	HCPCS 92012
Min. Negotiated Rate	$151.78
Max. Negotiated Rate	$151.78
Rate for Payer: Cash Price	$54.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$151.78
Rate for Payer: SOMOS Essential	$151.78

PR OPHTHALMIC MUCOUS MEMBRANE TESTS

Professional

Both

$162.30

Service Code	HCPCS 95060
Min. Negotiated Rate	$121.72
Max. Negotiated Rate	$121.72
Rate for Payer: Cash Price	$46.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$121.72
Rate for Payer: SOMOS Essential	$121.72

PR OPHTHALMODYNAMOMETRY

Professional

Both

$42.18

Service Code	HCPCS 92260
Min. Negotiated Rate	$31.64
Max. Negotiated Rate	$31.64
Rate for Payer: Cash Price	$11.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$31.64
Rate for Payer: SOMOS Essential	$31.64

PROPHYLAXIS-ADULT

Facility

$112.50

Service Code	HCPCS D1110
Hospital Charge Code	42300240
Hospital Revenue Code	361
Min. Negotiated Rate	$56.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$61.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$152.87
Rate for Payer: Aetna Government	$152.87
Rate for Payer: Affinity Essential Plan 1&2	$107.01
Rate for Payer: Affinity Essential Plan 3&4	$107.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$107.01
Rate for Payer: Brighton Health Commercial	$84.38
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$152.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$152.87
Rate for Payer: EmblemHealth Commercial	$152.87
Rate for Payer: Fidelis Essential Plan Aliesa	$129.94
Rate for Payer: Fidelis Essential Plan QHP	$136.05
Rate for Payer: Fidelis Medicare Advantage	$152.87
Rate for Payer: Fidelis Qualified Health Plan	$136.05
Rate for Payer: Group Health Inc Commercial	$152.87
Rate for Payer: Group Health Inc Medicare	$152.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$56.25
Rate for Payer: Hamaspik Choice Inc Medicare	$152.87
Rate for Payer: Healthfirst Medicare Advantage	$129.94
Rate for Payer: Healthfirst QHP	$152.87
Rate for Payer: Humana Medicare	$155.93
Rate for Payer: Senior Whole Health Medicare Advantage	$152.87
Rate for Payer: United Healthcare Medicare Advantage	$152.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.30
Rate for Payer: Wellcare Medicare	$145.23

PROPHYLAXIS-ADULT

Facility

$112.50

Service Code	HCPCS D1110
Hospital Charge Code	42300240
Hospital Revenue Code	361
Rate for Payer: Cash Price	$152.87

PROPHYLAXIS-CHILD

Facility

$107.50

Service Code	HCPCS D1120
Hospital Charge Code	42300245
Hospital Revenue Code	361
Min. Negotiated Rate	$17.95
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.95
Rate for Payer: Aetna Government	$17.95
Rate for Payer: Brighton Health Commercial	$80.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$53.75
Rate for Payer: Group Health Inc Medicare	$37.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$53.75
Rate for Payer: Hamaspik Choice Inc Medicare	$53.75

PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ

Professional

Both

$1,643.53

Service Code	HCPCS 34716
Min. Negotiated Rate	$1,232.65
Max. Negotiated Rate	$1,232.65
Rate for Payer: Cash Price	$435.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,232.65
Rate for Payer: SOMOS Essential	$1,232.65

PR OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI

Professional

Both

$1,330.81

Service Code	HCPCS 34715
Min. Negotiated Rate	$998.11
Max. Negotiated Rate	$998.11
Rate for Payer: Cash Price	$350.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$998.11
Rate for Payer: SOMOS Essential	$998.11

PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI

Professional

Both

$577.33

Service Code	HCPCS 34834
Min. Negotiated Rate	$433.00
Max. Negotiated Rate	$433.00
Rate for Payer: Cash Price	$151.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$433.00
Rate for Payer: SOMOS Essential	$433.00

PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI

Professional

Both

$911.93

Service Code	HCPCS 34812
Min. Negotiated Rate	$683.95
Max. Negotiated Rate	$683.95
Rate for Payer: Cash Price	$241.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$683.95
Rate for Payer: SOMOS Essential	$683.95

PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH

Professional

Both

$1,192.35

Service Code	HCPCS 34714
Min. Negotiated Rate	$894.26
Max. Negotiated Rate	$894.26
Rate for Payer: Cash Price	$315.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$894.26
Rate for Payer: SOMOS Essential	$894.26

Know your out-of-pocket cost for care.

All Charges