St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN

Professional

Both

$6,366.85

Service Code	HCPCS 67445
Min. Negotiated Rate	$4,775.14
Max. Negotiated Rate	$4,775.14
Rate for Payer: Cash Price	$1,742.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,775.14
Rate for Payer: SOMOS Essential	$4,775.14

PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL LESION

Professional

Both

$7,364.25

Service Code	HCPCS 67420
Min. Negotiated Rate	$5,523.19
Max. Negotiated Rate	$5,523.19
Rate for Payer: Cash Price	$1,984.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,523.19
Rate for Payer: SOMOS Essential	$5,523.19

PR ORBITOTOMY W/O BONE FLAP EXPL W/DRAINAGE ONLY

Professional

Both

$3,814.65

Service Code	HCPCS 67405
Min. Negotiated Rate	$2,860.99
Max. Negotiated Rate	$2,860.99
Rate for Payer: Cash Price	$1,039.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,860.99
Rate for Payer: SOMOS Essential	$2,860.99

PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY

Professional

Both

$4,347.35

Service Code	HCPCS 67400
Min. Negotiated Rate	$3,260.51
Max. Negotiated Rate	$3,260.51
Rate for Payer: Cash Price	$1,187.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,260.51
Rate for Payer: SOMOS Essential	$3,260.51

PR ORBITOTOMY W/O BONE FLAP W/REMOVAL LESION

Professional

Both

$4,166.47

Service Code	HCPCS 67412
Min. Negotiated Rate	$3,124.85
Max. Negotiated Rate	$3,124.85
Rate for Payer: Cash Price	$1,134.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,124.85
Rate for Payer: SOMOS Essential	$3,124.85

PR ORBITOTOMY W/O BONE FLAP W/RMVL BONE DCMPRN

Professional

Both

$6,098.09

Service Code	HCPCS 67414
Min. Negotiated Rate	$4,573.57
Max. Negotiated Rate	$4,573.57
Rate for Payer: Cash Price	$1,661.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,573.57
Rate for Payer: SOMOS Essential	$4,573.57

PR ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY

Professional

Both

$4,071.45

Service Code	HCPCS 67413
Min. Negotiated Rate	$3,053.59
Max. Negotiated Rate	$3,053.59
Rate for Payer: Cash Price	$1,104.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,053.59
Rate for Payer: SOMOS Essential	$3,053.59

PR ORCHIECTOMY PARTIAL

Professional

Both

$2,464.42

Service Code	HCPCS 54522
Min. Negotiated Rate	$1,848.32
Max. Negotiated Rate	$1,848.32
Rate for Payer: Cash Price	$675.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,848.32
Rate for Payer: SOMOS Essential	$1,848.32

PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH

Professional

Both

$2,148.86

Service Code	HCPCS 54530
Min. Negotiated Rate	$1,611.64
Max. Negotiated Rate	$1,611.64
Rate for Payer: Cash Price	$588.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,611.64
Rate for Payer: SOMOS Essential	$1,611.64

PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL

Professional

Both

$3,116.72

Service Code	HCPCS 54535
Min. Negotiated Rate	$2,337.54
Max. Negotiated Rate	$2,337.54
Rate for Payer: Cash Price	$853.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,337.54
Rate for Payer: SOMOS Essential	$2,337.54

PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH

Professional

Both

$1,390.24

Service Code	HCPCS 54520
Min. Negotiated Rate	$1,042.68
Max. Negotiated Rate	$1,042.68
Rate for Payer: Cash Price	$381.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,042.68
Rate for Payer: SOMOS Essential	$1,042.68

PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS

Professional

Both

$2,988.90

Service Code	HCPCS 54650
Min. Negotiated Rate	$2,241.68
Max. Negotiated Rate	$2,241.68
Rate for Payer: Cash Price	$819.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,241.68
Rate for Payer: SOMOS Essential	$2,241.68

PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH

Professional

Both

$1,818.50

Service Code	HCPCS 54640
Min. Negotiated Rate	$1,363.88
Max. Negotiated Rate	$1,363.88
Rate for Payer: Cash Price	$497.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,363.88
Rate for Payer: SOMOS Essential	$1,363.88

PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP

Professional

Both

$127.61

Service Code	HCPCS 92065 26
Min. Negotiated Rate	$95.71
Max. Negotiated Rate	$95.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$95.71
Rate for Payer: SOMOS Essential	$95.71

PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP

Professional

Both

$37.24

Service Code	HCPCS 92065 TC
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$27.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.93
Rate for Payer: SOMOS Essential	$27.93

PR ORTHOPTIC TRAINING PERFORMED BY PHYS/OTHER QHP

Professional

Both

$164.85

Service Code	HCPCS 92065
Min. Negotiated Rate	$123.64
Max. Negotiated Rate	$123.64
Rate for Payer: Cash Price	$35.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.64
Rate for Payer: SOMOS Essential	$123.64

PR ORTHOPTIC TRAINING UNDER SUPERVISION OF PHYS/QHP

Professional

Both

$112.00

Service Code	HCPCS 92066
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$84.00
Rate for Payer: Cash Price	$31.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.00
Rate for Payer: SOMOS Essential	$84.00

PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS

Professional

Both

$200.48

Service Code	HCPCS 97760
Min. Negotiated Rate	$150.36
Max. Negotiated Rate	$150.36
Rate for Payer: Cash Price	$54.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.36
Rate for Payer: SOMOS Essential	$150.36

PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN

Professional

Both

$220.99

Service Code	HCPCS 97763
Min. Negotiated Rate	$165.74
Max. Negotiated Rate	$165.74
Rate for Payer: Cash Price	$59.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.74
Rate for Payer: SOMOS Essential	$165.74

PR OSCILLATING TRACKING TEST W/RECORDING

Professional

Both

$52.75

Service Code	HCPCS 92545 26
Min. Negotiated Rate	$39.56
Max. Negotiated Rate	$39.56
Rate for Payer: Cash Price	$14.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.56
Rate for Payer: SOMOS Essential	$39.56

PR OSCILLATING TRACKING TEST W/RECORDING

Professional

Both

$69.86

Service Code	HCPCS 92545
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$52.40
Rate for Payer: Cash Price	$19.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$52.40
Rate for Payer: SOMOS Essential	$52.40

PR OSCILLATING TRACKING TEST W/RECORDING

Professional

Both

$17.12

Service Code	HCPCS 92545 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

PRO SERVIC ALLER IMMUNOTH, INCLUD

Facility

$39.65

Service Code	HCPCS 95120
Hospital Charge Code	30301421
Hospital Revenue Code	940
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$31.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.10
Rate for Payer: Aetna Government	$9.10
Rate for Payer: Brighton Health Commercial	$29.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.96
Rate for Payer: Group Health Inc Commercial	$19.82
Rate for Payer: Group Health Inc Medicare	$13.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.82
Rate for Payer: Hamaspik Choice Inc Medicare	$19.82
Rate for Payer: United Healthcare Commercial	$19.82

PROS PENILE INFLAT 15CM

Facility

$11,170.00

Service Code	HCPCS C1813
Hospital Charge Code	40201117
Hospital Revenue Code	278
Min. Negotiated Rate	$5,585.00
Max. Negotiated Rate	$5,585.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,585.00

PROS PENILE INFLAT 15CM

Facility

$11,170.00

Service Code	HCPCS C1813
Hospital Charge Code	40201117
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$11,728.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,143.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$6,702.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,585.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,422.75
Rate for Payer: EmblemHealth Commercial	$5,585.00
Rate for Payer: Fidelis Medicare Advantage	$11,728.50
Rate for Payer: Group Health Inc Commercial	$5,585.00
Rate for Payer: Group Health Inc Medicare	$3,909.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,585.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,260.50

Know your out-of-pocket cost for care.

All Charges