St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR TC99M MEBROFENIN

Professional

Both

$209.09

Service Code	HCPCS A9537
Min. Negotiated Rate	$156.82
Max. Negotiated Rate	$156.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.82
Rate for Payer: SOMOS Essential	$156.82

PR TC99M MEDRONATE

Professional

Both

$326.59

Service Code	HCPCS A9503
Min. Negotiated Rate	$244.94
Max. Negotiated Rate	$244.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$244.94
Rate for Payer: SOMOS Essential	$244.94

PR TC99M OXIDRONATE

Professional

Both

$203.74

Service Code	HCPCS A9561
Min. Negotiated Rate	$152.80
Max. Negotiated Rate	$152.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$152.80
Rate for Payer: SOMOS Essential	$152.80

PR TC99M PERTECHNETATE

Professional

Both

$76.93

Service Code	HCPCS A9512
Min. Negotiated Rate	$57.70
Max. Negotiated Rate	$57.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57.70
Rate for Payer: SOMOS Essential	$57.70

PR TC99M PYROPHOSPHATE

Professional

Both

$96.04

Service Code	HCPCS A9538
Min. Negotiated Rate	$72.03
Max. Negotiated Rate	$72.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$72.03
Rate for Payer: SOMOS Essential	$72.03

PR TC99M SESTAMIBI

Professional

Both

$406.98

Service Code	HCPCS A9500
Min. Negotiated Rate	$305.24
Max. Negotiated Rate	$305.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$305.24
Rate for Payer: SOMOS Essential	$305.24

PR TC99M SULFUR COLLOID

Professional

Both

$2,498.41

Service Code	HCPCS A9541
Min. Negotiated Rate	$1,873.81
Max. Negotiated Rate	$1,873.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,873.81
Rate for Payer: SOMOS Essential	$1,873.81

PR TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE

Professional

Both

$3,642.52

Service Code	HCPCS 37218
Min. Negotiated Rate	$2,731.89
Max. Negotiated Rate	$2,731.89
Rate for Payer: Cash Price	$972.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,731.89
Rate for Payer: SOMOS Essential	$2,731.89

PR TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE

Professional

Both

$4,811.14

Service Code	HCPCS 37217
Min. Negotiated Rate	$3,608.36
Max. Negotiated Rate	$3,608.36
Rate for Payer: Cash Price	$1,266.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,608.36
Rate for Payer: SOMOS Essential	$3,608.36

PR TCAT IMPL WRLS P-ART PRS SNR L-T HEMODYN MNTR

Professional

Both

$1,463.42

Service Code	HCPCS 33289
Min. Negotiated Rate	$1,097.56
Max. Negotiated Rate	$1,097.56
Rate for Payer: Cash Price	$389.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,097.56
Rate for Payer: SOMOS Essential	$1,097.56

PR TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG

Professional

Both

$2,118.73

Service Code	HCPCS 33274
Min. Negotiated Rate	$1,589.05
Max. Negotiated Rate	$1,589.05
Rate for Payer: Cash Price	$559.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,589.05
Rate for Payer: SOMOS Essential	$1,589.05

PR TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ

Professional

Both

$4,417.11

Service Code	HCPCS 37215
Min. Negotiated Rate	$3,312.83
Max. Negotiated Rate	$3,312.83
Rate for Payer: Cash Price	$1,169.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,312.83
Rate for Payer: SOMOS Essential	$3,312.83

PR TCAT MITRAL VALVE REPAIR ADDL PROSTHESIS

Professional

Both

$1,857.17

Service Code	HCPCS 33419
Min. Negotiated Rate	$1,392.88
Max. Negotiated Rate	$1,392.88
Rate for Payer: Cash Price	$493.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,392.88
Rate for Payer: SOMOS Essential	$1,392.88

PR TCAT MITRAL VALVE REPAIR INITIAL PROSTHESIS

Professional

Both

$7,886.94

Service Code	HCPCS 33418
Min. Negotiated Rate	$5,915.20
Max. Negotiated Rate	$5,915.20
Rate for Payer: Cash Price	$2,106.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,915.20
Rate for Payer: SOMOS Essential	$5,915.20

PR TCAT MV ANN RCNSTJ W/IMPL ADJST ANN RCNSTJ DEV

Professional

Both

$5,882.42

Service Code	HCPCS 0544T
Min. Negotiated Rate	$4,411.82
Max. Negotiated Rate	$4,411.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,411.82
Rate for Payer: SOMOS Essential	$4,411.82

PR TCAT PERMANENT OCCLUSION/EMBOLIZATION PRQ CNS

Professional

Both

$5,381.32

Service Code	HCPCS 61624
Min. Negotiated Rate	$4,035.99
Max. Negotiated Rate	$4,035.99
Rate for Payer: Cash Price	$1,423.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,035.99
Rate for Payer: SOMOS Essential	$4,035.99

PR TCAT PERMANT OCCLUSION/EMBOLIZATION PRQ NON-CNS

Professional

Both

$4,011.84

Service Code	HCPCS 61626
Min. Negotiated Rate	$3,008.88
Max. Negotiated Rate	$3,008.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,008.88
Rate for Payer: SOMOS Essential	$3,008.88

PR TCAT PLACEMENT RADJ DLVR DEV SBSQ C IV BRACHYTX

Professional

Both

$704.41

Service Code	HCPCS 92974
Min. Negotiated Rate	$528.31
Max. Negotiated Rate	$528.31
Rate for Payer: Cash Price	$188.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$528.31
Rate for Payer: SOMOS Essential	$528.31

PR TCAT PLMT IV STENT ICRA W/BALO ANGIOP IF PFRMD

Professional

Both

$6,787.55

Service Code	HCPCS 61635
Min. Negotiated Rate	$5,090.66
Max. Negotiated Rate	$5,090.66
Rate for Payer: Cash Price	$1,806.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,090.66
Rate for Payer: SOMOS Essential	$5,090.66

PR TCAT PULMONARY VALVE IMPLANTATION PRQ APPROACH

Professional

Both

$5,943.84

Service Code	HCPCS 33477
Min. Negotiated Rate	$4,457.88
Max. Negotiated Rate	$4,457.88
Rate for Payer: Cash Price	$1,497.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,457.88
Rate for Payer: SOMOS Essential	$4,457.88

PR TCAT REMOVAL PERM LEADLESS PM RIGHT VENTR W/IMG

Professional

Both

$2,219.07

Service Code	HCPCS 33275
Min. Negotiated Rate	$1,664.30
Max. Negotiated Rate	$1,664.30
Rate for Payer: Cash Price	$593.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,664.30
Rate for Payer: SOMOS Essential	$1,664.30

PR TCAT RMVL/DEBULK ICAR MASS SUCTION DEVICE PERQ

Professional

Both

$1,332.42

Service Code	HCPCS 0644T
Min. Negotiated Rate	$999.32
Max. Negotiated Rate	$999.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$999.32
Rate for Payer: SOMOS Essential	$999.32

PR TDAP VACCINE 7 YRS/> IM

Professional

Both

$152.46

Service Code	HCPCS 90715
Min. Negotiated Rate	$114.34
Max. Negotiated Rate	$114.34
Rate for Payer: Cash Price	$39.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$114.34
Rate for Payer: SOMOS Essential	$114.34

PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN

Professional

Both

$2,749.25

Service Code	HCPCS 25310
Min. Negotiated Rate	$2,061.94
Max. Negotiated Rate	$2,061.94
Rate for Payer: Cash Price	$745.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,061.94
Rate for Payer: SOMOS Essential	$2,061.94

PR TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR

Professional

Both

$3,173.63

Service Code	HCPCS 25312
Min. Negotiated Rate	$2,380.22
Max. Negotiated Rate	$2,380.22
Rate for Payer: Cash Price	$858.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,380.22
Rate for Payer: SOMOS Essential	$2,380.22

Know your out-of-pocket cost for care.

All Charges