St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROPRANOLOL HCL 80 MG PO TABS [6660]

Facility

$0.97

Service Code	NDC 00603548621
Hospital Charge Code	00603548621
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Brighton Health Commercial	$0.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.66
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.63

PR OPRATIVE ABLTJ VENTR ARRHYTHMOGENIC FOC W/BYPASS

Professional

Both

$7,094.05

Service Code	HCPCS 33261
Min. Negotiated Rate	$5,320.54
Max. Negotiated Rate	$5,320.54
Rate for Payer: Cash Price	$1,885.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,320.54
Rate for Payer: SOMOS Essential	$5,320.54

PR OPSCPY EXTND OPTIC NRV/MACULA DRAWING I&R UNI/BI

Professional

Both

$58.31

Service Code	HCPCS 92202
Min. Negotiated Rate	$43.73
Max. Negotiated Rate	$43.73
Rate for Payer: Cash Price	$15.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.73
Rate for Payer: SOMOS Essential	$43.73

PR OPSCPY EXTND RTA DRAWING & SCL DEPRSN I&R UNI/BI

Professional

Both

$90.06

Service Code	HCPCS 92201
Min. Negotiated Rate	$67.54
Max. Negotiated Rate	$67.54
Rate for Payer: Cash Price	$25.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$67.54
Rate for Payer: SOMOS Essential	$67.54

PR OPTICAL ENDOMICROSCOPIC IMAGE INTERP & REPORT

Professional

Both

$189.60

Service Code	HCPCS 88375
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$142.20
Rate for Payer: Cash Price	$52.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.20
Rate for Payer: SOMOS Essential	$142.20

PR OPTIC NERVE DECOMPRESSION

Professional

Both

$5,324.41

Service Code	HCPCS 67570
Min. Negotiated Rate	$3,993.31
Max. Negotiated Rate	$3,993.31
Rate for Payer: Cash Price	$1,454.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,993.31
Rate for Payer: SOMOS Essential	$3,993.31

PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC

Professional

Both

$56.67

Service Code	HCPCS 92544 26
Min. Negotiated Rate	$42.50
Max. Negotiated Rate	$42.50
Rate for Payer: Cash Price	$15.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$42.50
Rate for Payer: SOMOS Essential	$42.50

PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC

Professional

Both

$17.12

Service Code	HCPCS 92544 TC
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$12.84
Rate for Payer: Cash Price	$4.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$12.84
Rate for Payer: SOMOS Essential	$12.84

PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC

Professional

Both

$73.78

Service Code	HCPCS 92544
Min. Negotiated Rate	$55.34
Max. Negotiated Rate	$55.34
Rate for Payer: Cash Price	$20.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.34
Rate for Payer: SOMOS Essential	$55.34

PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF

Professional

Both

$2,866.89

Service Code	HCPCS 23552
Min. Negotiated Rate	$2,150.17
Max. Negotiated Rate	$2,150.17
Rate for Payer: Cash Price	$778.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,150.17
Rate for Payer: SOMOS Essential	$2,150.17

PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT

Professional

Both

$8,277.57

Service Code	HCPCS 27228
Min. Negotiated Rate	$6,208.18
Max. Negotiated Rate	$6,208.18
Rate for Payer: Cash Price	$2,224.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,208.18
Rate for Payer: SOMOS Essential	$6,208.18

PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT

Professional

Both

$7,273.18

Service Code	HCPCS 27227
Min. Negotiated Rate	$5,454.88
Max. Negotiated Rate	$5,454.88
Rate for Payer: Cash Price	$1,957.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,454.88
Rate for Payer: SOMOS Essential	$5,454.88

PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ

Professional

Both

$3,152.73

Service Code	HCPCS 27846
Min. Negotiated Rate	$2,364.55
Max. Negotiated Rate	$2,364.55
Rate for Payer: Cash Price	$868.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,364.55
Rate for Payer: SOMOS Essential	$2,364.55

PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ

Professional

Both

$3,437.14

Service Code	HCPCS 27848
Min. Negotiated Rate	$2,577.86
Max. Negotiated Rate	$2,577.86
Rate for Payer: Cash Price	$935.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,577.86
Rate for Payer: SOMOS Essential	$2,577.86

PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR

Professional

Both

$1,425.00

Service Code	HCPCS 27217
Min. Negotiated Rate	$1,068.75
Max. Negotiated Rate	$1,068.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,068.75
Rate for Payer: SOMOS Essential	$1,068.75

PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ

Professional

Both

$2,772.81

Service Code	HCPCS 26686
Min. Negotiated Rate	$2,079.61
Max. Negotiated Rate	$2,079.61
Rate for Payer: Cash Price	$750.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,079.61
Rate for Payer: SOMOS Essential	$2,079.61

PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION

Professional

Both

$4,949.63

Service Code	HCPCS 21470
Min. Negotiated Rate	$3,712.22
Max. Negotiated Rate	$3,712.22
Rate for Payer: Cash Price	$1,352.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,712.22
Rate for Payer: SOMOS Essential	$3,712.22

PR OPTX CRNFCL SEP LFT III TYP COMP INT FIXJ W/BONE

Professional

Both

$8,891.33

Service Code	HCPCS 21436
Min. Negotiated Rate	$6,668.50
Max. Negotiated Rate	$6,668.50
Rate for Payer: Cash Price	$2,393.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,668.50
Rate for Payer: SOMOS Essential	$6,668.50

PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG

Professional

Both

$3,661.25

Service Code	HCPCS 25608
Min. Negotiated Rate	$2,745.94
Max. Negotiated Rate	$2,745.94
Rate for Payer: Cash Price	$993.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,745.94
Rate for Payer: SOMOS Essential	$2,745.94

PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG

Professional

Both

$4,639.60

Service Code	HCPCS 25609
Min. Negotiated Rate	$3,479.70
Max. Negotiated Rate	$3,479.70
Rate for Payer: Cash Price	$1,256.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,479.70
Rate for Payer: SOMOS Essential	$3,479.70

PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP

Professional

Both

$3,279.05

Service Code	HCPCS 25607
Min. Negotiated Rate	$2,459.29
Max. Negotiated Rate	$2,459.29
Rate for Payer: Cash Price	$889.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,459.29
Rate for Payer: SOMOS Essential	$2,459.29

PR OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT

Professional

Both

$5,259.28

Service Code	HCPCS 27236
Min. Negotiated Rate	$3,944.46
Max. Negotiated Rate	$3,944.46
Rate for Payer: Cash Price	$1,420.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,944.46
Rate for Payer: SOMOS Essential	$3,944.46

PR OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW

Professional

Both

$5,904.01

Service Code	HCPCS 27506
Min. Negotiated Rate	$4,428.01
Max. Negotiated Rate	$4,428.01
Rate for Payer: Cash Price	$1,591.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,428.01
Rate for Payer: SOMOS Essential	$4,428.01

PR OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE

Professional

Both

$4,274.73

Service Code	HCPCS 27507
Min. Negotiated Rate	$3,206.05
Max. Negotiated Rate	$3,206.05
Rate for Payer: Cash Price	$1,150.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,206.05
Rate for Payer: SOMOS Essential	$3,206.05

PR OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD

Professional

Both

$5,611.45

Service Code	HCPCS 27254
Min. Negotiated Rate	$4,208.59
Max. Negotiated Rate	$4,208.59
Rate for Payer: Cash Price	$1,512.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,208.59
Rate for Payer: SOMOS Essential	$4,208.59

Know your out-of-pocket cost for care.

All Charges