St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR PROCTOSGMDSC RIGID W/DILATION

Professional

Both

$367.64

Service Code	HCPCS 45303
Min. Negotiated Rate	$275.73
Max. Negotiated Rate	$275.73
Rate for Payer: Cash Price	$99.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$275.73
Rate for Payer: SOMOS Essential	$275.73

PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY

Professional

Both

$450.73

Service Code	HCPCS 45307
Min. Negotiated Rate	$338.05
Max. Negotiated Rate	$338.05
Rate for Payer: Cash Price	$120.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$338.05
Rate for Payer: SOMOS Essential	$338.05

PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX

Professional

Both

$44.42

Service Code	HCPCS 95115
Min. Negotiated Rate	$33.32
Max. Negotiated Rate	$33.32
Rate for Payer: Cash Price	$12.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33.32
Rate for Payer: SOMOS Essential	$33.32

PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS

Professional

Both

$51.63

Service Code	HCPCS 95117
Min. Negotiated Rate	$38.72
Max. Negotiated Rate	$38.72
Rate for Payer: Cash Price	$14.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38.72
Rate for Payer: SOMOS Essential	$38.72

PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER

Professional

Both

$145.04

Service Code	HCPCS 93280 26
Min. Negotiated Rate	$108.78
Max. Negotiated Rate	$108.78
Rate for Payer: Cash Price	$39.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.78
Rate for Payer: SOMOS Essential	$108.78

PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER

Professional

Both

$186.73

Service Code	HCPCS 93280 TC
Min. Negotiated Rate	$140.05
Max. Negotiated Rate	$140.05
Rate for Payer: Cash Price	$50.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$140.05
Rate for Payer: SOMOS Essential	$140.05

PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER

Professional

Both

$331.77

Service Code	HCPCS 93280
Min. Negotiated Rate	$248.83
Max. Negotiated Rate	$248.83
Rate for Payer: Cash Price	$89.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$248.83
Rate for Payer: SOMOS Essential	$248.83

PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER

Professional

Both

$189.60

Service Code	HCPCS 93281 TC
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$142.20
Rate for Payer: Cash Price	$50.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$142.20
Rate for Payer: SOMOS Essential	$142.20

PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER

Professional

Both

$355.88

Service Code	HCPCS 93281
Min. Negotiated Rate	$266.91
Max. Negotiated Rate	$266.91
Rate for Payer: Cash Price	$95.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$266.91
Rate for Payer: SOMOS Essential	$266.91

PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER

Professional

Both

$166.29

Service Code	HCPCS 93281 26
Min. Negotiated Rate	$124.72
Max. Negotiated Rate	$124.72
Rate for Payer: Cash Price	$44.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$124.72
Rate for Payer: SOMOS Essential	$124.72

PR PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS

Professional

Both

$357.28

Service Code	HCPCS 93623 26
Min. Negotiated Rate	$267.96
Max. Negotiated Rate	$267.96
Rate for Payer: Cash Price	$77.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$267.96
Rate for Payer: SOMOS Essential	$267.96

PR PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS

Professional

Both

$3,211.04

Service Code	HCPCS 93623
Min. Negotiated Rate	$2,408.28
Max. Negotiated Rate	$2,408.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,408.28
Rate for Payer: SOMOS Essential	$2,408.28

PR PROGRAMMED STIMJ & PACG AFTER IV DRUG NFS

Professional

Both

$2,853.76

Service Code	HCPCS 93623 TC
Min. Negotiated Rate	$2,140.32
Max. Negotiated Rate	$2,140.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,140.32
Rate for Payer: SOMOS Essential	$2,140.32

PR PROLONGED CLINICAL STAFF SVC OFFICE/O/P 1ST HR

Professional

Both

$81.80

Service Code	HCPCS 99415
Min. Negotiated Rate	$61.35
Max. Negotiated Rate	$61.35
Rate for Payer: Cash Price	$24.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.35
Rate for Payer: SOMOS Essential	$61.35

PR PROLONGED CLINICAL STAFF SVC OFFICE/O/P EA ADDL

Professional

Both

$38.68

Service Code	HCPCS 99416
Min. Negotiated Rate	$29.01
Max. Negotiated Rate	$29.01
Rate for Payer: Cash Price	$11.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$29.01
Rate for Payer: SOMOS Essential	$29.01

PR PROLONGED OUTPATIENT E/M SERVICE EACH 15 MINUTES

Professional

Both

$65.00

Service Code	HCPCS 99417
Min. Negotiated Rate	$48.75
Max. Negotiated Rate	$48.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48.75
Rate for Payer: SOMOS Essential	$48.75

PR PROLONG HOME EVAL ADD 15M

Professional

Both

$120.40

Service Code	HCPCS G0318
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$90.30
Rate for Payer: Cash Price	$33.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$90.30
Rate for Payer: SOMOS Essential	$90.30

PR PROLONG INPT EVAL ADD15 M

Professional

Both

$123.27

Service Code	HCPCS G0316
Min. Negotiated Rate	$92.45
Max. Negotiated Rate	$92.45
Rate for Payer: Cash Price	$33.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.45
Rate for Payer: SOMOS Essential	$92.45

PR PROLONG NURSIN FAC EVAL 15M

Professional

Both

$123.27

Service Code	HCPCS G0317
Min. Negotiated Rate	$92.45
Max. Negotiated Rate	$92.45
Rate for Payer: Cash Price	$33.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$92.45
Rate for Payer: SOMOS Essential	$92.45

PR PROLONG OUTPT/OFFICE VIS

Professional

Both

$126.18

Service Code	HCPCS G2212
Min. Negotiated Rate	$94.64
Max. Negotiated Rate	$94.64
Rate for Payer: Cash Price	$35.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$94.64
Rate for Payer: SOMOS Essential	$94.64

PR PROLONG PREV SVCS, ADDL 30M

Professional

Both

$241.75

Service Code	HCPCS G0514
Min. Negotiated Rate	$181.31
Max. Negotiated Rate	$181.31
Rate for Payer: Cash Price	$66.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.31
Rate for Payer: SOMOS Essential	$181.31

PR PROLONG PREV SVCS, FIRST 30M

Professional

Both

$240.31

Service Code	HCPCS G0513
Min. Negotiated Rate	$180.23
Max. Negotiated Rate	$180.23
Rate for Payer: Cash Price	$65.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$180.23
Rate for Payer: SOMOS Essential	$180.23

PR PROPH RETINAL DTCHMNT W/O DRG CRTX DIATHERMY

Professional

Both

$893.55

Service Code	HCPCS 67141
Min. Negotiated Rate	$670.16
Max. Negotiated Rate	$670.16
Rate for Payer: Cash Price	$246.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$670.16
Rate for Payer: SOMOS Essential	$670.16

PR PROPH RETINAL DTCHMNT W/O DRG PHOTOCOAGULATION

Professional

Both

$893.55

Service Code	HCPCS 67145
Min. Negotiated Rate	$670.16
Max. Negotiated Rate	$670.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$670.16
Rate for Payer: SOMOS Essential	$670.16

PR PROPH TX N/P/PLTWR W/WO METHYLACRYLATE RADIUS

Professional

Both

$3,195.33

Service Code	HCPCS 25490
Min. Negotiated Rate	$2,396.50
Max. Negotiated Rate	$2,396.50
Rate for Payer: Cash Price	$864.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,396.50
Rate for Payer: SOMOS Essential	$2,396.50

Know your out-of-pocket cost for care.

All Charges