St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR SCROTAL EXPLORATION

Professional

Both

$1,641.47

Service Code	HCPCS 55110
Min. Negotiated Rate	$1,231.10
Max. Negotiated Rate	$1,231.10
Rate for Payer: Cash Price	$450.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,231.10
Rate for Payer: SOMOS Essential	$1,231.10

PR SCROTOPLASTY COMPLICATED

Professional

Both

$2,905.32

Service Code	HCPCS 55180
Min. Negotiated Rate	$2,178.99
Max. Negotiated Rate	$2,178.99
Rate for Payer: Cash Price	$793.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,178.99
Rate for Payer: SOMOS Essential	$2,178.99

PR SCROTOPLASTY SIMPLE

Professional

Both

$1,545.88

Service Code	HCPCS 55175
Min. Negotiated Rate	$1,159.41
Max. Negotiated Rate	$1,159.41
Rate for Payer: Cash Price	$423.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,159.41
Rate for Payer: SOMOS Essential	$1,159.41

PRSCVXCP TPDRNVO FLTLNR 19MM 3/4

Facility

$21.86

Service Code	HCPCS A5057
Hospital Charge Code	40005177
Hospital Revenue Code	274
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$22.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.84
Rate for Payer: Aetna Government	$5.84
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.57
Rate for Payer: EmblemHealth Commercial	$10.93
Rate for Payer: Fidelis Medicare Advantage	$22.95
Rate for Payer: Group Health Inc Commercial	$10.93
Rate for Payer: Group Health Inc Medicare	$7.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.21

PRSCVXCP TPDRNVO FLTLNR38MM 1-1/2

Facility

$21.86

Service Code	HCPCS A5057
Hospital Charge Code	40005176
Hospital Revenue Code	274
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$22.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.84
Rate for Payer: Aetna Government	$5.84
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.57
Rate for Payer: EmblemHealth Commercial	$10.93
Rate for Payer: Fidelis Medicare Advantage	$22.95
Rate for Payer: Group Health Inc Commercial	$10.93
Rate for Payer: Group Health Inc Medicare	$7.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.21

PRSCVXCP TPDRNVO FLTR LNR 25MM 1

Facility

$21.86

Service Code	HCPCS A5057
Hospital Charge Code	40005175
Hospital Revenue Code	274
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$22.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.84
Rate for Payer: Aetna Government	$5.84
Rate for Payer: Brighton Health Commercial	$13.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.57
Rate for Payer: EmblemHealth Commercial	$10.93
Rate for Payer: Fidelis Medicare Advantage	$22.95
Rate for Payer: Group Health Inc Commercial	$10.93
Rate for Payer: Group Health Inc Medicare	$7.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.93
Rate for Payer: Hamaspik Choice Inc Medicare	$10.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.21

PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN

Professional

Both

$3,673.74

Service Code	HCPCS 49900
Min. Negotiated Rate	$2,755.30
Max. Negotiated Rate	$2,755.30
Rate for Payer: Cash Price	$990.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,755.30
Rate for Payer: SOMOS Essential	$2,755.30

PR SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP

Professional

Both

$3,457.51

Service Code	HCPCS 13160
Min. Negotiated Rate	$2,593.13
Max. Negotiated Rate	$2,593.13
Rate for Payer: Cash Price	$933.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,593.13
Rate for Payer: SOMOS Essential	$2,593.13

PR SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ

Professional

Both

$3,689.14

Service Code	HCPCS 21275
Min. Negotiated Rate	$2,766.86
Max. Negotiated Rate	$2,766.86
Rate for Payer: Cash Price	$995.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,766.86
Rate for Payer: SOMOS Essential	$2,766.86

PR SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT

Professional

Both

$6,036.70

Service Code	HCPCS 61618
Min. Negotiated Rate	$4,527.52
Max. Negotiated Rate	$4,527.52
Rate for Payer: Cash Price	$1,596.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,527.52
Rate for Payer: SOMOS Essential	$4,527.52

PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL

Professional

Both

$1,049.97

Service Code	HCPCS 37186
Min. Negotiated Rate	$787.48
Max. Negotiated Rate	$787.48
Rate for Payer: Cash Price	$280.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$787.48
Rate for Payer: SOMOS Essential	$787.48

PR SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP

Professional

Both

$6,547.80

Service Code	HCPCS 61619
Min. Negotiated Rate	$4,910.85
Max. Negotiated Rate	$4,910.85
Rate for Payer: Cash Price	$1,749.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,910.85
Rate for Payer: SOMOS Essential	$4,910.85

PR SELECT PICTURE AUDIOMETRY

Professional

Both

$234.19

Service Code	HCPCS 92583
Min. Negotiated Rate	$175.64
Max. Negotiated Rate	$175.64
Rate for Payer: Cash Price	$67.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.64
Rate for Payer: SOMOS Essential	$175.64

PR SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES

Professional

Both

$133.84

Service Code	HCPCS 97535
Min. Negotiated Rate	$100.38
Max. Negotiated Rate	$100.38
Rate for Payer: Cash Price	$36.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$100.38
Rate for Payer: SOMOS Essential	$100.38

PR SELF-MEAS BP 2 READG 1 MIN APART BID 30 DAY PD

Professional

Both

$35.35

Service Code	HCPCS 99474
Min. Negotiated Rate	$26.51
Max. Negotiated Rate	$26.51
Rate for Payer: Cash Price	$9.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.51
Rate for Payer: SOMOS Essential	$26.51

PR SELF-MEAS BP PT EDUCAJ/TRAING & DEV CALIBRATION

Professional

Both

$55.93

Service Code	HCPCS 99473
Min. Negotiated Rate	$41.95
Max. Negotiated Rate	$41.95
Rate for Payer: Cash Price	$17.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$41.95
Rate for Payer: SOMOS Essential	$41.95

PR SENSORINEURAL ACUITY LEVEL

Professional

Both

$323.16

Service Code	HCPCS 92575
Min. Negotiated Rate	$242.37
Max. Negotiated Rate	$242.37
Rate for Payer: Cash Price	$87.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$242.37
Rate for Payer: SOMOS Essential	$242.37

PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX

Professional

Both

$116.31

Service Code	HCPCS 92060 TC
Min. Negotiated Rate	$87.23
Max. Negotiated Rate	$87.23
Rate for Payer: Cash Price	$32.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$87.23
Rate for Payer: SOMOS Essential	$87.23

PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX

Professional

Both

$143.78

Service Code	HCPCS 92060 26
Min. Negotiated Rate	$107.84
Max. Negotiated Rate	$107.84
Rate for Payer: Cash Price	$40.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$107.84
Rate for Payer: SOMOS Essential	$107.84

PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX

Professional

Both

$260.09

Service Code	HCPCS 92060
Min. Negotiated Rate	$195.07
Max. Negotiated Rate	$195.07
Rate for Payer: Cash Price	$72.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$195.07
Rate for Payer: SOMOS Essential	$195.07

PR SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES

Professional

Both

$265.55

Service Code	HCPCS 97533
Min. Negotiated Rate	$199.16
Max. Negotiated Rate	$199.16
Rate for Payer: Cash Price	$71.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$199.16
Rate for Payer: SOMOS Essential	$199.16

PR SEPTAL/OTHER INTRANASAL DERMATOPLASTY

Professional

Both

$2,952.92

Service Code	HCPCS 30620
Min. Negotiated Rate	$2,214.69
Max. Negotiated Rate	$2,214.69
Rate for Payer: Cash Price	$796.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,214.69
Rate for Payer: SOMOS Essential	$2,214.69

PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF

Professional

Both

$2,941.30

Service Code	HCPCS 30520
Min. Negotiated Rate	$2,205.98
Max. Negotiated Rate	$2,205.98
Rate for Payer: Cash Price	$795.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,205.98
Rate for Payer: SOMOS Essential	$2,205.98

PR SEQUESTRECTOMY CLAVICLE

Professional

Both

$2,511.60

Service Code	HCPCS 23170
Min. Negotiated Rate	$1,883.70
Max. Negotiated Rate	$1,883.70
Rate for Payer: Cash Price	$682.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,883.70
Rate for Payer: SOMOS Essential	$1,883.70

PR SEQUESTRECTOMY FOREARM &/WRIST

Professional

Both

$2,321.80

Service Code	HCPCS 25145
Min. Negotiated Rate	$1,741.35
Max. Negotiated Rate	$1,741.35
Rate for Payer: Cash Price	$630.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,741.35
Rate for Payer: SOMOS Essential	$1,741.35

Know your out-of-pocket cost for care.

All Charges