St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE

Professional

Both

$116.43

Service Code	HCPCS 90714
Min. Negotiated Rate	$87.32
Max. Negotiated Rate	$87.32
Rate for Payer: Cash Price	$18.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$87.32
Rate for Payer: SOMOS Essential	$87.32

PR TEAEC W/GRAFT EA ADDL TIBIAL/PERONEAL ART

Professional

Both

$1,986.81

Service Code	HCPCS 35306
Min. Negotiated Rate	$1,490.11
Max. Negotiated Rate	$1,490.11
Rate for Payer: Cash Price	$522.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,490.11
Rate for Payer: SOMOS Essential	$1,490.11

PR TEAEC W/GRAFT POPLITEAL ARTERY

Professional

Both

$5,498.43

Service Code	HCPCS 35303
Min. Negotiated Rate	$4,123.82
Max. Negotiated Rate	$4,123.82
Rate for Payer: Cash Price	$1,441.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,123.82
Rate for Payer: SOMOS Essential	$4,123.82

PR TEAEC W/GRAFT SUPERFICIAL FEMORAL ARTERY

Professional

Both

$4,971.54

Service Code	HCPCS 35302
Min. Negotiated Rate	$3,728.66
Max. Negotiated Rate	$3,728.66
Rate for Payer: Cash Price	$1,314.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,728.66
Rate for Payer: SOMOS Essential	$3,728.66

PR TEAEC W/GRAFT TIBIAL/PERONEAL ART 1ST VESSEL

Professional

Both

$5,434.17

Service Code	HCPCS 35305
Min. Negotiated Rate	$4,075.63
Max. Negotiated Rate	$4,075.63
Rate for Payer: Cash Price	$1,444.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,075.63
Rate for Payer: SOMOS Essential	$4,075.63

PR TEAEC W/GRAFT TIBIOPERONEAL TRUNK ARTERY

Professional

Both

$5,651.98

Service Code	HCPCS 35304
Min. Negotiated Rate	$4,238.98
Max. Negotiated Rate	$4,238.98
Rate for Payer: Cash Price	$1,501.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,238.98
Rate for Payer: SOMOS Essential	$4,238.98

PR TEAEC W/PATCH GRF CAROTID VERTB SUBCLAV NECK INC

Professional

Both

$5,030.31

Service Code	HCPCS 35301
Min. Negotiated Rate	$3,772.73
Max. Negotiated Rate	$3,772.73
Rate for Payer: Cash Price	$1,331.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,772.73
Rate for Payer: SOMOS Essential	$3,772.73

PR TEAEC W/WO PATCH GRAFT ABDOMINAL AORTA

Professional

Both

$6,489.63

Service Code	HCPCS 35331
Min. Negotiated Rate	$4,867.22
Max. Negotiated Rate	$4,867.22
Rate for Payer: Cash Price	$1,712.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,867.22
Rate for Payer: SOMOS Essential	$4,867.22

PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIAC

Professional

Both

$6,774.81

Service Code	HCPCS 35361
Min. Negotiated Rate	$5,081.11
Max. Negotiated Rate	$5,081.11
Rate for Payer: Cash Price	$1,794.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,081.11
Rate for Payer: SOMOS Essential	$5,081.11

PR TEAEC W/WO PATCH GRAFT COMBINED AORTOILIOFEMORAL

Professional

Both

$7,220.57

Service Code	HCPCS 35363
Min. Negotiated Rate	$5,415.43
Max. Negotiated Rate	$5,415.43
Rate for Payer: Cash Price	$1,912.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,415.43
Rate for Payer: SOMOS Essential	$5,415.43

PR TEAEC W/WO PATCH GRAFT COMMON FEMORAL

Professional

Both

$3,619.95

Service Code	HCPCS 35371
Min. Negotiated Rate	$2,714.96
Max. Negotiated Rate	$2,714.96
Rate for Payer: Cash Price	$958.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,714.96
Rate for Payer: SOMOS Essential	$2,714.96

PR TEAEC W/WO PATCH GRAFT DEEP PROFUNDA FEMORAL

Professional

Both

$4,336.08

Service Code	HCPCS 35372
Min. Negotiated Rate	$3,252.06
Max. Negotiated Rate	$3,252.06
Rate for Payer: Cash Price	$1,148.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,252.06
Rate for Payer: SOMOS Essential	$3,252.06

PR TEAEC W/WO PATCH GRAFT ILIAC

Professional

Both

$5,701.22

Service Code	HCPCS 35351
Min. Negotiated Rate	$4,275.92
Max. Negotiated Rate	$4,275.92
Rate for Payer: Cash Price	$1,512.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,275.92
Rate for Payer: SOMOS Essential	$4,275.92

PR TEAEC W/WO PATCH GRAFT ILIOFEMORAL

Professional

Both

$4,569.85

Service Code	HCPCS 35355
Min. Negotiated Rate	$3,427.39
Max. Negotiated Rate	$3,427.39
Rate for Payer: Cash Price	$1,209.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,427.39
Rate for Payer: SOMOS Essential	$3,427.39

PR TEAEC W/WO PATCH GRAFT MESENTERIC CELIAC/RENAL

Professional

Both

$6,141.49

Service Code	HCPCS 35341
Min. Negotiated Rate	$4,606.12
Max. Negotiated Rate	$4,606.12
Rate for Payer: Cash Price	$1,631.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,606.12
Rate for Payer: SOMOS Essential	$4,606.12

PR TEAEC W/WO PATCH GRF AXILLARY-BRACHIAL

Professional

Both

$3,978.77

Service Code	HCPCS 35321
Min. Negotiated Rate	$2,984.08
Max. Negotiated Rate	$2,984.08
Rate for Payer: Cash Price	$1,059.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,984.08
Rate for Payer: SOMOS Essential	$2,984.08

PR TEAEC W/WO PATCH GRF SUBCLAV INNOM THORACIC INC

Professional

Both

$6,851.99

Service Code	HCPCS 35311
Min. Negotiated Rate	$5,138.99
Max. Negotiated Rate	$5,138.99
Rate for Payer: Cash Price	$1,817.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,138.99
Rate for Payer: SOMOS Essential	$5,138.99

PR TEAR FILM IMAGING UNILATERAL OR BILATERAL W/I&R

Professional

Both

$82.81

Service Code	HCPCS 0330T
Min. Negotiated Rate	$62.11
Max. Negotiated Rate	$62.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$62.11
Rate for Payer: SOMOS Essential	$62.11

PR TELEHEALTH INPT PHARM MGMT

Professional

Both

$164.43

Service Code	HCPCS G0459
Min. Negotiated Rate	$123.32
Max. Negotiated Rate	$123.32
Rate for Payer: Cash Price	$46.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.32
Rate for Payer: SOMOS Essential	$123.32

PR TELHEALTH INPT CONSULT 15MIN

Professional

Both

$175.74

Service Code	HCPCS G0406
Min. Negotiated Rate	$131.80
Max. Negotiated Rate	$131.80
Rate for Payer: Cash Price	$47.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$131.80
Rate for Payer: SOMOS Essential	$131.80

PR TELHEALTH INPT CONSULT 35MIN

Professional

Both

$434.88

Service Code	HCPCS G0408
Min. Negotiated Rate	$326.16
Max. Negotiated Rate	$326.16
Rate for Payer: Cash Price	$117.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$326.16
Rate for Payer: SOMOS Essential	$326.16

PR TELHEATH INPT CONSULT 25MIN

Professional

Both

$297.50

Service Code	HCPCS G0407
Min. Negotiated Rate	$223.12
Max. Negotiated Rate	$223.12
Rate for Payer: Cash Price	$80.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$223.12
Rate for Payer: SOMOS Essential	$223.12

PR TEMP FEMALE INTRAURETHRAL VALVE-PUMP 1ST INSJ

Professional

Both

$107.14

Service Code	HCPCS 0596T
Min. Negotiated Rate	$80.36
Max. Negotiated Rate	$80.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$80.36
Rate for Payer: SOMOS Essential	$80.36

PR TEMPORARY CLOSURE EYELIDS SUTURE

Professional

Both

$393.12

Service Code	HCPCS 67875
Min. Negotiated Rate	$294.84
Max. Negotiated Rate	$294.84
Rate for Payer: Cash Price	$108.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$294.84
Rate for Payer: SOMOS Essential	$294.84

PR TEMPORARY TRANSCUTANEOUS PACING

Professional

Both

$5.43

Service Code	HCPCS 92953
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$4.07
Rate for Payer: Cash Price	$1.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4.07
Rate for Payer: SOMOS Essential	$4.07

Know your out-of-pocket cost for care.

All Charges