St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY

Professional

Both

$1,365.39

Service Code	HCPCS 61864
Min. Negotiated Rate	$1,024.04
Max. Negotiated Rate	$1,024.04
Rate for Payer: Cash Price	$356.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,024.04
Rate for Payer: SOMOS Essential	$1,024.04

PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY

Professional

Both

$11,017.97

Service Code	HCPCS 61867
Min. Negotiated Rate	$8,263.48
Max. Negotiated Rate	$8,263.48
Rate for Payer: Cash Price	$2,900.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,263.48
Rate for Payer: SOMOS Essential	$8,263.48

PR STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY

Professional

Both

$2,411.26

Service Code	HCPCS 61868
Min. Negotiated Rate	$1,808.44
Max. Negotiated Rate	$1,808.44
Rate for Payer: Cash Price	$631.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,808.44
Rate for Payer: SOMOS Essential	$1,808.44

PR STRTCTC LOCLZJ INSJ CATH/PRB PLMT RADJ SRC

Professional

Both

$7,834.30

Service Code	HCPCS 61770
Min. Negotiated Rate	$5,875.72
Max. Negotiated Rate	$5,875.72
Rate for Payer: Cash Price	$2,065.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,875.72
Rate for Payer: SOMOS Essential	$5,875.72

PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX

Professional

Both

$1,462.58

Service Code	HCPCS 61799
Min. Negotiated Rate	$1,096.94
Max. Negotiated Rate	$1,096.94
Rate for Payer: Cash Price	$383.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,096.94
Rate for Payer: SOMOS Essential	$1,096.94

PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE

Professional

Both

$1,056.27

Service Code	HCPCS 61797
Min. Negotiated Rate	$792.20
Max. Negotiated Rate	$792.20
Rate for Payer: Cash Price	$277.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$792.20
Rate for Payer: SOMOS Essential	$792.20

PR STRTCTC STIMJ SPI CORD PRQ SPX N/FLWD OTH SURG

Professional

Both

$2,796.92

Service Code	HCPCS 63610
Min. Negotiated Rate	$2,097.69
Max. Negotiated Rate	$2,097.69
Rate for Payer: Cash Price	$734.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,097.69
Rate for Payer: SOMOS Essential	$2,097.69

PR STUMP ELONGATION UPPER EXTREMITY

Professional

Both

$5,409.74

Service Code	HCPCS 24935
Min. Negotiated Rate	$4,057.30
Max. Negotiated Rate	$4,057.30
Rate for Payer: Cash Price	$1,457.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,057.30
Rate for Payer: SOMOS Essential	$4,057.30

PR SUBCONJUNCTIVAL INJECTION

Professional

Both

$139.90

Service Code	HCPCS 68200
Min. Negotiated Rate	$104.92
Max. Negotiated Rate	$104.92
Rate for Payer: Cash Price	$38.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$104.92
Rate for Payer: SOMOS Essential	$104.92

PR SUBCUTANEOUS HORMONE PELLET IMPLANTATION

Professional

Both

$240.35

Service Code	HCPCS 11980
Min. Negotiated Rate	$180.26
Max. Negotiated Rate	$180.26
Rate for Payer: Cash Price	$63.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$180.26
Rate for Payer: SOMOS Essential	$180.26

PR SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR

Professional

Both

$64.09

Service Code	HCPCS 96370
Min. Negotiated Rate	$48.07
Max. Negotiated Rate	$48.07
Rate for Payer: Cash Price	$18.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$48.07
Rate for Payer: SOMOS Essential	$48.07

PR SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP

Professional

Both

$602.18

Service Code	HCPCS 96369
Min. Negotiated Rate	$451.64
Max. Negotiated Rate	$451.64
Rate for Payer: Cash Price	$166.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$451.64
Rate for Payer: SOMOS Essential	$451.64

PR SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/<

Professional

Both

$230.79

Service Code	HCPCS 11950
Min. Negotiated Rate	$173.09
Max. Negotiated Rate	$173.09
Rate for Payer: Cash Price	$60.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$173.09
Rate for Payer: SOMOS Essential	$173.09

PR SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC

Professional

Both

$488.60

Service Code	HCPCS 11954
Min. Negotiated Rate	$366.45
Max. Negotiated Rate	$366.45
Rate for Payer: Cash Price	$130.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$366.45
Rate for Payer: SOMOS Essential	$366.45

PR SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC

Professional

Both

$318.50

Service Code	HCPCS 11951
Min. Negotiated Rate	$238.88
Max. Negotiated Rate	$238.88
Rate for Payer: Cash Price	$85.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$238.88
Rate for Payer: SOMOS Essential	$238.88

PR SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC

Professional

Both

$444.68

Service Code	HCPCS 11952
Min. Negotiated Rate	$333.51
Max. Negotiated Rate	$333.51
Rate for Payer: Cash Price	$119.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$333.51
Rate for Payer: SOMOS Essential	$333.51

PR SUBDURAL IMPLTJ ELECTRODES SEIZURE MONITORING

Professional

Both

$5,899.04

Service Code	HCPCS 61531
Min. Negotiated Rate	$4,424.28
Max. Negotiated Rate	$4,424.28
Rate for Payer: Cash Price	$1,561.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,424.28
Rate for Payer: SOMOS Essential	$4,424.28

PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT

Professional

Both

$545.37

Service Code	HCPCS 61000
Min. Negotiated Rate	$409.03
Max. Negotiated Rate	$409.03
Rate for Payer: Cash Price	$143.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$409.03
Rate for Payer: SOMOS Essential	$409.03

PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI SBSQ

Professional

Both

$511.95

Service Code	HCPCS 61001
Min. Negotiated Rate	$383.96
Max. Negotiated Rate	$383.96
Rate for Payer: Cash Price	$136.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$383.96
Rate for Payer: SOMOS Essential	$383.96

PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM

Professional

Both

$975.45

Service Code	HCPCS 15277
Min. Negotiated Rate	$731.59
Max. Negotiated Rate	$731.59
Rate for Payer: Cash Price	$258.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$731.59
Rate for Payer: SOMOS Essential	$731.59

PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM

Professional

Both

$243.36

Service Code	HCPCS 15278
Min. Negotiated Rate	$182.52
Max. Negotiated Rate	$182.52
Rate for Payer: Cash Price	$65.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$182.52
Rate for Payer: SOMOS Essential	$182.52

PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM

Professional

Both

$386.12

Service Code	HCPCS 15275
Min. Negotiated Rate	$289.59
Max. Negotiated Rate	$289.59
Rate for Payer: Cash Price	$105.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$289.59
Rate for Payer: SOMOS Essential	$289.59

PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM

Professional

Both

$106.23

Service Code	HCPCS 15276
Min. Negotiated Rate	$79.67
Max. Negotiated Rate	$79.67
Rate for Payer: Cash Price	$28.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$79.67
Rate for Payer: SOMOS Essential	$79.67

PR SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION

Professional

Both

$1,629.29

Service Code	HCPCS 41530
Min. Negotiated Rate	$1,221.97
Max. Negotiated Rate	$1,221.97
Rate for Payer: Cash Price	$441.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,221.97
Rate for Payer: SOMOS Essential	$1,221.97

PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL

Professional

Both

$765.10

Service Code	HCPCS 30140
Min. Negotiated Rate	$573.82
Max. Negotiated Rate	$573.82
Rate for Payer: Cash Price	$206.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$573.82
Rate for Payer: SOMOS Essential	$573.82

Know your out-of-pocket cost for care.

All Charges