St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP

Professional

Both

$137.59

Service Code	HCPCS 36575
Min. Negotiated Rate	$103.19
Max. Negotiated Rate	$103.19
Rate for Payer: Cash Price	$37.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.19
Rate for Payer: SOMOS Essential	$103.19

PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC

Professional

Both

$9,549.19

Service Code	HCPCS 33414
Min. Negotiated Rate	$7,161.89
Max. Negotiated Rate	$7,161.89
Rate for Payer: Cash Price	$2,536.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,161.89
Rate for Payer: SOMOS Essential	$7,161.89

PR RPR WND EXTRAOCULAR MUSCLE TENDON&/TENON CAPSU

Professional

Both

$2,016.98

Service Code	HCPCS 65290
Min. Negotiated Rate	$1,512.74
Max. Negotiated Rate	$1,512.74
Rate for Payer: Cash Price	$554.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,512.74
Rate for Payer: SOMOS Essential	$1,512.74

PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER

Professional

Both

$3,546.69

Service Code	HCPCS 26428
Min. Negotiated Rate	$2,660.02
Max. Negotiated Rate	$2,660.02
Rate for Payer: Cash Price	$954.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,660.02
Rate for Payer: SOMOS Essential	$2,660.02

PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR

Professional

Both

$2,234.26

Service Code	HCPCS 26426
Min. Negotiated Rate	$1,675.70
Max. Negotiated Rate	$1,675.70
Rate for Payer: Cash Price	$607.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,675.70
Rate for Payer: SOMOS Essential	$1,675.70

PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD

Professional

Both

$2,155.86

Service Code	HCPCS 33226
Min. Negotiated Rate	$1,616.90
Max. Negotiated Rate	$1,616.90
Rate for Payer: Cash Price	$572.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,616.90
Rate for Payer: SOMOS Essential	$1,616.90

PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE

Professional

Both

$1,372.74

Service Code	HCPCS 33215
Min. Negotiated Rate	$1,029.56
Max. Negotiated Rate	$1,029.56
Rate for Payer: Cash Price	$364.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,029.56
Rate for Payer: SOMOS Essential	$1,029.56

PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE

Professional

Both

$257.01

Service Code	HCPCS 36597
Min. Negotiated Rate	$192.76
Max. Negotiated Rate	$192.76
Rate for Payer: Cash Price	$67.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$192.76
Rate for Payer: SOMOS Essential	$192.76

PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE

Professional

Both

$94.87

Service Code	HCPCS 90380
Min. Negotiated Rate	$71.15
Max. Negotiated Rate	$71.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.15
Rate for Payer: SOMOS Essential	$71.15

PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE

Professional

Both

$94.47

Service Code	HCPCS 90381
Min. Negotiated Rate	$70.85
Max. Negotiated Rate	$70.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$70.85
Rate for Payer: SOMOS Essential	$70.85

PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I

Professional

Both

$1,448.93

Service Code	HCPCS 37193
Min. Negotiated Rate	$1,086.70
Max. Negotiated Rate	$1,086.70
Rate for Payer: Cash Price	$389.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,086.70
Rate for Payer: SOMOS Essential	$1,086.70

PR R-T SPCTRL ALYS PRST8 TISS FLUORESCENC SPCTRSCPY

Professional

Both

$68.60

Service Code	HCPCS 0443T
Min. Negotiated Rate	$51.45
Max. Negotiated Rate	$51.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$51.45
Rate for Payer: SOMOS Essential	$51.45

PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE

Professional

Both

$373.66

Service Code	HCPCS 90681
Min. Negotiated Rate	$280.24
Max. Negotiated Rate	$280.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$280.24
Rate for Payer: SOMOS Essential	$280.24

PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE

Professional

Both

$287.95

Service Code	HCPCS 90680
Min. Negotiated Rate	$215.96
Max. Negotiated Rate	$215.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$215.96
Rate for Payer: SOMOS Essential	$215.96

PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY

Professional

Both

$6,785.31

Service Code	HCPCS 33476
Min. Negotiated Rate	$5,088.98
Max. Negotiated Rate	$5,088.98
Rate for Payer: Cash Price	$1,807.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,088.98
Rate for Payer: SOMOS Essential	$5,088.98

PR RX&FITG C-LENS TECH CRNL LENS APHAKIA 1 EYE

Professional

Both

$82.11

Service Code	HCPCS 92315
Min. Negotiated Rate	$61.58
Max. Negotiated Rate	$61.58
Rate for Payer: Cash Price	$22.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.58
Rate for Payer: SOMOS Essential	$61.58

PR RX&FITG C-LENS TECH CRNL LENS APHAKIA BOTH EYES

Professional

Both

$122.40

Service Code	HCPCS 92316
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Cash Price	$33.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.80
Rate for Payer: SOMOS Essential	$91.80

PR RX&FITG CONTACT LENS CORNEAL LENS APHAKIA 1 EYE

Professional

Both

$201.25

Service Code	HCPCS 92311
Min. Negotiated Rate	$150.94
Max. Negotiated Rate	$150.94
Rate for Payer: Cash Price	$54.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$150.94
Rate for Payer: SOMOS Essential	$150.94

PR RX&FITG CONTACT LENS CORNEAL LENS APHAKIA OU

Professional

Both

$232.44

Service Code	HCPCS 92312
Min. Negotiated Rate	$174.33
Max. Negotiated Rate	$174.33
Rate for Payer: Cash Price	$65.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$174.33
Rate for Payer: SOMOS Essential	$174.33

PR RX&FITG CONTACT LENS CORNEOSCLERAL LENS

Professional

Both

$166.85

Service Code	HCPCS 92313
Min. Negotiated Rate	$125.14
Max. Negotiated Rate	$125.14
Rate for Payer: Cash Price	$45.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$125.14
Rate for Payer: SOMOS Essential	$125.14

PR RX&FITG CONTACT LENS TECH CORNEOSCLERAL LENS

Professional

Both

$82.11

Service Code	HCPCS 92317
Min. Negotiated Rate	$61.58
Max. Negotiated Rate	$61.58
Rate for Payer: Cash Price	$22.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$61.58
Rate for Payer: SOMOS Essential	$61.58

PR RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE

Professional

Both

$1,711.68

Service Code	HCPCS 95954
Min. Negotiated Rate	$1,283.76
Max. Negotiated Rate	$1,283.76
Rate for Payer: Cash Price	$457.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,283.76
Rate for Payer: SOMOS Essential	$1,283.76

PR RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE

Professional

Both

$426.09

Service Code	HCPCS 95954 26
Min. Negotiated Rate	$319.57
Max. Negotiated Rate	$319.57
Rate for Payer: Cash Price	$121.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$319.57
Rate for Payer: SOMOS Essential	$319.57

PR RX/PHYSICAL EEG ACTIVAJ PHYS/QHP ATTENDANCE

Professional

Both

$1,285.59

Service Code	HCPCS 95954 TC
Min. Negotiated Rate	$964.19
Max. Negotiated Rate	$964.19
Rate for Payer: Cash Price	$336.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$964.19
Rate for Payer: SOMOS Essential	$964.19

PR RX SP-GENRATJ AUGMNT&COMUNICAJ DEV 1ST HR

Professional

Both

$501.41

Service Code	HCPCS 92607
Min. Negotiated Rate	$376.06
Max. Negotiated Rate	$376.06
Rate for Payer: Cash Price	$139.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$376.06
Rate for Payer: SOMOS Essential	$376.06

Know your out-of-pocket cost for care.

All Charges