St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM SHRT

Professional

Both

$6,802.99

Service Code	HCPCS 27259
Min. Negotiated Rate	$5,102.24
Max. Negotiated Rate	$5,102.24
Rate for Payer: Cash Price	$1,832.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,102.24
Rate for Payer: SOMOS Essential	$5,102.24

PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF

Professional

Both

$2,789.36

Service Code	HCPCS 23532
Min. Negotiated Rate	$2,092.02
Max. Negotiated Rate	$2,092.02
Rate for Payer: Cash Price	$755.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,092.02
Rate for Payer: SOMOS Essential	$2,092.02

PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ

Professional

Both

$5,240.48

Service Code	HCPCS 27536
Min. Negotiated Rate	$3,930.36
Max. Negotiated Rate	$3,930.36
Rate for Payer: Cash Price	$1,414.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,930.36
Rate for Payer: SOMOS Essential	$3,930.36

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

Professional

Both

$3,962.67

Service Code	HCPCS 27758
Min. Negotiated Rate	$2,972.00
Max. Negotiated Rate	$2,972.00
Rate for Payer: Cash Price	$1,071.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,972.00
Rate for Payer: SOMOS Essential	$2,972.00

PROPYLTHIOURACIL 50 MG PO TABS [6662]

Facility

$0.90

Service Code	NDC 67253065110
Hospital Charge Code	67253065110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

PROPYLTHIOURACIL 50 MG PO TABS [6662]

Facility

$0.90

Service Code	NDC 00228234810
Hospital Charge Code	00228234810
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

PROPYLTHIOURACIL 50 MG TAB

Facility

$0.14

Hospital Charge Code	41654035
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

PROPYLTHIOURACIL 50 MG TAB

Facility

$0.14

Hospital Charge Code	41644035
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

PROQUAD VFC

Facility

$0.01

Service Code	HCPCS 94060 TC
Hospital Charge Code	41655883
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

PROQUAD VFC

Facility

$0.01

Service Code	HCPCS 94060 TC
Hospital Charge Code	41645883
Hospital Revenue Code	460
Rate for Payer: Cash Price	$362.98

PROQUAD VFC

Facility

$0.01

Service Code	HCPCS 94060 TC
Hospital Charge Code	41645883
Hospital Revenue Code	460
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$370.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

PROQUAD VFC

Facility

$0.01

Service Code	HCPCS 94060 TC
Hospital Charge Code	41655883
Hospital Revenue Code	460
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$370.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Affinity Essential Plan 1&2	$254.09
Rate for Payer: Affinity Essential Plan 3&4	$254.09
Rate for Payer: Affinity Medicaid/CHP/HARP	$254.09
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Humana Medicare	$370.24
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: United Healthcare Commercial	$0.01
Rate for Payer: United Healthcare Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST

Professional

Both

$349.20

Service Code	HCPCS 95933
Min. Negotiated Rate	$261.90
Max. Negotiated Rate	$261.90
Rate for Payer: Cash Price	$95.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$261.90
Rate for Payer: SOMOS Essential	$261.90

PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST

Professional

Both

$126.53

Service Code	HCPCS 95933 26
Min. Negotiated Rate	$94.90
Max. Negotiated Rate	$94.90
Rate for Payer: Cash Price	$34.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.90
Rate for Payer: SOMOS Essential	$94.90

PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST

Professional

Both

$222.67

Service Code	HCPCS 95933 TC
Min. Negotiated Rate	$167.00
Max. Negotiated Rate	$167.00
Rate for Payer: Cash Price	$61.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$167.00
Rate for Payer: SOMOS Essential	$167.00

PR ORBITAL IMPLANT INSERTION

Professional

Both

$4,557.07

Service Code	HCPCS 67550
Min. Negotiated Rate	$3,417.80
Max. Negotiated Rate	$3,417.80
Rate for Payer: Cash Price	$1,242.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,417.80
Rate for Payer: SOMOS Essential	$3,417.80

PR ORBITAL IMPLANT REMOVAL/REVISION

Professional

Both

$4,642.79

Service Code	HCPCS 67560
Min. Negotiated Rate	$3,482.09
Max. Negotiated Rate	$3,482.09
Rate for Payer: Cash Price	$1,270.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,482.09
Rate for Payer: SOMOS Essential	$3,482.09

PR ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL

Professional

Both

$6,995.84

Service Code	HCPCS 21267
Min. Negotiated Rate	$5,246.88
Max. Negotiated Rate	$5,246.88
Rate for Payer: Cash Price	$1,880.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,246.88
Rate for Payer: SOMOS Essential	$5,246.88

PR ORBITAL REPOSITIONING W/BONE GRAFTS ICRA & XTRC

Professional

Both

$8,773.84

Service Code	HCPCS 21268
Min. Negotiated Rate	$6,580.38
Max. Negotiated Rate	$6,580.38
Rate for Payer: Cash Price	$2,359.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,580.38
Rate for Payer: SOMOS Essential	$6,580.38

PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ

Professional

Both

$13,759.20

Service Code	HCPCS 61584
Min. Negotiated Rate	$10,319.40
Max. Negotiated Rate	$10,319.40
Rate for Payer: Cash Price	$3,601.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10,319.40
Rate for Payer: SOMOS Essential	$10,319.40

PR ORBITOCRANIAL ANT CRANIAL FOSSA W/ORBITAL EXNTJ

Professional

Both

$15,701.39

Service Code	HCPCS 61585
Min. Negotiated Rate	$11,776.04
Max. Negotiated Rate	$11,776.04
Rate for Payer: Cash Price	$4,130.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11,776.04
Rate for Payer: SOMOS Essential	$11,776.04

PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE

Professional

Both

$15,005.94

Service Code	HCPCS 61592
Min. Negotiated Rate	$11,254.46
Max. Negotiated Rate	$11,254.46
Rate for Payer: Cash Price	$3,973.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11,254.46
Rate for Payer: SOMOS Essential	$11,254.46

PR ORBITOTOMY BONE FLAP/WINDOW LATERAL RMVL FB

Professional

Both

$5,795.83

Service Code	HCPCS 67430
Min. Negotiated Rate	$4,346.87
Max. Negotiated Rate	$4,346.87
Rate for Payer: Cash Price	$1,584.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,346.87
Rate for Payer: SOMOS Essential	$4,346.87

PR ORBITOTOMY BONE FLAP/WINDOW LATERAL W/DRG

Professional

Both

$5,622.16

Service Code	HCPCS 67440
Min. Negotiated Rate	$4,216.62
Max. Negotiated Rate	$4,216.62
Rate for Payer: Cash Price	$1,537.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,216.62
Rate for Payer: SOMOS Essential	$4,216.62

PR ORBITOTOMY BONE FLAP/WINDOW LAT EXPL W/WO BX

Professional

Both

$5,825.12

Service Code	HCPCS 67450
Min. Negotiated Rate	$4,368.84
Max. Negotiated Rate	$4,368.84
Rate for Payer: Cash Price	$1,592.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,368.84
Rate for Payer: SOMOS Essential	$4,368.84

Know your out-of-pocket cost for care.

All Charges