St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX

Professional

Both

$7,666.96

Service Code	HCPCS 45112
Min. Negotiated Rate	$5,750.22
Max. Negotiated Rate	$5,750.22
Rate for Payer: Cash Price	$2,073.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,750.22
Rate for Payer: SOMOS Essential	$5,750.22

PR PRCTECT CMBN PULL-THRU W/RSVR W/NTRSTM

Professional

Both

$7,946.93

Service Code	HCPCS 45119
Min. Negotiated Rate	$5,960.20
Max. Negotiated Rate	$5,960.20
Rate for Payer: Cash Price	$2,148.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,960.20
Rate for Payer: SOMOS Essential	$5,960.20

PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST

Professional

Both

$7,913.12

Service Code	HCPCS 45110
Min. Negotiated Rate	$5,934.84
Max. Negotiated Rate	$5,934.84
Rate for Payer: Cash Price	$2,117.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,934.84
Rate for Payer: SOMOS Essential	$5,934.84

PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS

Professional

Both

$7,239.65

Service Code	HCPCS 45120
Min. Negotiated Rate	$5,429.74
Max. Negotiated Rate	$5,429.74
Rate for Payer: Cash Price	$1,927.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,429.74
Rate for Payer: SOMOS Essential	$5,429.74

PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS

Professional

Both

$7,902.37

Service Code	HCPCS 45121
Min. Negotiated Rate	$5,926.78
Max. Negotiated Rate	$5,926.78
Rate for Payer: Cash Price	$2,104.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,926.78
Rate for Payer: SOMOS Essential	$5,926.78

PR PRCTECT PRTL RESCJ RECTUM TABDL APPR

Professional

Both

$4,752.06

Service Code	HCPCS 45111
Min. Negotiated Rate	$3,564.04
Max. Negotiated Rate	$3,564.04
Rate for Payer: Cash Price	$1,283.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,564.04
Rate for Payer: SOMOS Essential	$3,564.04

PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH

Professional

Both

$8,221.15

Service Code	HCPCS 45114
Min. Negotiated Rate	$6,165.86
Max. Negotiated Rate	$6,165.86
Rate for Payer: Cash Price	$2,186.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,165.86
Rate for Payer: SOMOS Essential	$6,165.86

PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY

Professional

Both

$6,531.81

Service Code	HCPCS 45116
Min. Negotiated Rate	$4,898.86
Max. Negotiated Rate	$4,898.86
Rate for Payer: Cash Price	$1,768.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,898.86
Rate for Payer: SOMOS Essential	$4,898.86

PR PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR

Professional

Both

$7,889.04

Service Code	HCPCS 45113
Min. Negotiated Rate	$5,916.78
Max. Negotiated Rate	$5,916.78
Rate for Payer: Cash Price	$2,132.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,916.78
Rate for Payer: SOMOS Essential	$5,916.78

PR PRCTECT PRTL W/O ANAST PRNL APPR

Professional

Both

$4,854.57

Service Code	HCPCS 45123
Min. Negotiated Rate	$3,640.93
Max. Negotiated Rate	$3,640.93
Rate for Payer: Cash Price	$1,296.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,640.93
Rate for Payer: SOMOS Essential	$3,640.93

PR PREDNISOLONE ORAL PER 5 MG

Professional

Both

$35.00

Service Code	HCPCS J7510
Min. Negotiated Rate	$26.25
Max. Negotiated Rate	$26.25
Rate for Payer: Cash Price	$0.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.25
Rate for Payer: SOMOS Essential	$26.25

PR PREPARATION MOULAGE CUSTOM BREAST IMPLANT

Professional

Both

$618.70

Service Code	HCPCS 19396
Min. Negotiated Rate	$464.02
Max. Negotiated Rate	$464.02
Rate for Payer: Cash Price	$167.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$464.02
Rate for Payer: SOMOS Essential	$464.02

PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA

Professional

Both

$2,057.69

Service Code	HCPCS 49013
Min. Negotiated Rate	$1,543.27
Max. Negotiated Rate	$1,543.27
Rate for Payer: Cash Price	$545.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,543.27
Rate for Payer: SOMOS Essential	$1,543.27

PR PREPJ& ALLERGEN IMMUNOTHERAPY 1/MLT ANTIGEN

Professional

Both

$14.56

Service Code	HCPCS 95165
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$10.92
Rate for Payer: Cash Price	$3.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.92
Rate for Payer: SOMOS Essential	$10.92

PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 1 INSECT

Professional

Both

$13.13

Service Code	HCPCS 95145
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Cash Price	$3.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.85
Rate for Payer: SOMOS Essential	$9.85

PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 2 INSECT

Professional

Both

$13.13

Service Code	HCPCS 95146
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Cash Price	$3.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.85
Rate for Payer: SOMOS Essential	$9.85

PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 3 INSECT

Professional

Both

$13.13

Service Code	HCPCS 95147
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Cash Price	$3.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.85
Rate for Payer: SOMOS Essential	$9.85

PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 4 INSECT

Professional

Both

$13.13

Service Code	HCPCS 95148
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Cash Price	$3.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.85
Rate for Payer: SOMOS Essential	$9.85

PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY 5 INSECT

Professional

Both

$13.13

Service Code	HCPCS 95149
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Cash Price	$3.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.85
Rate for Payer: SOMOS Essential	$9.85

PR PREPJ& ANTIGEN ALLERGEN IMMUNOTHERAPY WHL INSE

Professional

Both

$13.13

Service Code	HCPCS 95170
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Cash Price	$3.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.85
Rate for Payer: SOMOS Essential	$9.85

PR PREPJ& ANTIGEN PRV ALLERGEN IMMUNOTHERAPY 1 DO

Professional

Both

$14.56

Service Code	HCPCS 95144
Min. Negotiated Rate	$10.92
Max. Negotiated Rate	$10.92
Rate for Payer: Cash Price	$3.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.92
Rate for Payer: SOMOS Essential	$10.92

PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT

Professional

Both

$1,106.70

Service Code	HCPCS 15004
Min. Negotiated Rate	$830.02
Max. Negotiated Rate	$830.02
Rate for Payer: Cash Price	$297.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$830.02
Rate for Payer: SOMOS Essential	$830.02

PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT

Professional

Both

$391.58

Service Code	HCPCS 15005
Min. Negotiated Rate	$293.68
Max. Negotiated Rate	$293.68
Rate for Payer: Cash Price	$105.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$293.68
Rate for Payer: SOMOS Essential	$293.68

PR PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT

Professional

Both

$951.27

Service Code	HCPCS 15002
Min. Negotiated Rate	$713.45
Max. Negotiated Rate	$713.45
Rate for Payer: Cash Price	$255.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$713.45
Rate for Payer: SOMOS Essential	$713.45

PR PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT

Professional

Both

$201.22

Service Code	HCPCS 15003
Min. Negotiated Rate	$150.92
Max. Negotiated Rate	$150.92
Rate for Payer: Cash Price	$53.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.92
Rate for Payer: SOMOS Essential	$150.92

Know your out-of-pocket cost for care.

All Charges