St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR VISIT ESKETAMINE 56M OR LESS

Professional

Both

$145.64

Service Code	HCPCS G2082
Min. Negotiated Rate	$109.23
Max. Negotiated Rate	$109.23
Rate for Payer: Cash Price	$40.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109.23
Rate for Payer: SOMOS Essential	$109.23

PR VISIT TO DETERM LDCT ELIG

Professional

Both

$104.83

Service Code	HCPCS G0296
Min. Negotiated Rate	$78.62
Max. Negotiated Rate	$78.62
Rate for Payer: Cash Price	$27.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.62
Rate for Payer: SOMOS Essential	$78.62

PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R

Professional

Both

$72.45

Service Code	HCPCS 95930 26
Min. Negotiated Rate	$54.34
Max. Negotiated Rate	$54.34
Rate for Payer: Cash Price	$19.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$54.34
Rate for Payer: SOMOS Essential	$54.34

PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R

Professional

Both

$208.29

Service Code	HCPCS 95930 TC
Min. Negotiated Rate	$156.22
Max. Negotiated Rate	$156.22
Rate for Payer: Cash Price	$58.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$156.22
Rate for Payer: SOMOS Essential	$156.22

PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R

Professional

Both

$280.74

Service Code	HCPCS 95930
Min. Negotiated Rate	$210.56
Max. Negotiated Rate	$210.56
Rate for Payer: Cash Price	$78.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$210.56
Rate for Payer: SOMOS Essential	$210.56

PR VISUAL FIELD ASSESSMENT PHYS REVIEW AND REPORT

Professional

Both

$114.42

Service Code	HCPCS 0378T
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$85.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$85.82
Rate for Payer: SOMOS Essential	$85.82

PR VISUAL REINFORCEMENT AUDIOMETRY

Professional

Both

$147.77

Service Code	HCPCS 92579
Min. Negotiated Rate	$110.83
Max. Negotiated Rate	$110.83
Rate for Payer: Cash Price	$40.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$110.83
Rate for Payer: SOMOS Essential	$110.83

PR VITAMIN B12 INJECTION

Professional

Both

$9.52

Service Code	HCPCS J3420
Min. Negotiated Rate	$7.14
Max. Negotiated Rate	$7.14
Rate for Payer: Cash Price	$1.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.14
Rate for Payer: SOMOS Essential	$7.14

PR VITRECTOMY MCHNL PARS PLNA FOCAL ENDOLASER PC

Professional

Both

$3,934.91

Service Code	HCPCS 67039
Min. Negotiated Rate	$2,951.18
Max. Negotiated Rate	$2,951.18
Rate for Payer: Cash Price	$1,083.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,951.18
Rate for Payer: SOMOS Essential	$2,951.18

PR VITRECTOMY MECHANICAL PARS PLANA

Professional

Both

$3,674.37

Service Code	HCPCS 67036
Min. Negotiated Rate	$2,755.78
Max. Negotiated Rate	$2,755.78
Rate for Payer: Cash Price	$1,013.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,755.78
Rate for Payer: SOMOS Essential	$2,755.78

PR VITRECTOMY PARS PLANA REMOVE INT MEMB RETINA

Professional

Both

$4,679.99

Service Code	HCPCS 67042
Min. Negotiated Rate	$3,509.99
Max. Negotiated Rate	$3,509.99
Rate for Payer: Cash Price	$1,286.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,509.99
Rate for Payer: SOMOS Essential	$3,509.99

PR VITRECTOMY PARS PLANA REMOVE PRERETINAL MEMBRANE

Professional

Both

$4,681.43

Service Code	HCPCS 67041
Min. Negotiated Rate	$3,511.07
Max. Negotiated Rate	$3,511.07
Rate for Payer: Cash Price	$1,286.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,511.07
Rate for Payer: SOMOS Essential	$3,511.07

PR VITRECTOMY PARS PLANA REMOVE SUBRETINAL MEMBRANE

Professional

Both

$4,928.18

Service Code	HCPCS 67043
Min. Negotiated Rate	$3,696.14
Max. Negotiated Rate	$3,696.14
Rate for Payer: Cash Price	$1,355.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,696.14
Rate for Payer: SOMOS Essential	$3,696.14

PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING

Professional

Both

$10,742.94

Service Code	HCPCS 33427
Min. Negotiated Rate	$8,057.20
Max. Negotiated Rate	$8,057.20
Rate for Payer: Cash Price	$2,861.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,057.20
Rate for Payer: SOMOS Essential	$8,057.20

PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING

Professional

Both

$10,539.31

Service Code	HCPCS 33426
Min. Negotiated Rate	$7,904.48
Max. Negotiated Rate	$7,904.48
Rate for Payer: Cash Price	$2,804.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,904.48
Rate for Payer: SOMOS Essential	$7,904.48

PR VNPNXR <3 YEARS PHY/QHP SKILL FEMRAL/JUGLAR VEIN

Professional

Both

$78.68

Service Code	HCPCS 36400
Min. Negotiated Rate	$59.01
Max. Negotiated Rate	$59.01
Rate for Payer: Cash Price	$20.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$59.01
Rate for Payer: SOMOS Essential	$59.01

PR VNPNXR 3 YEARS/> PHYS/QHP SKILL

Professional

Both

$38.08

Service Code	HCPCS 36410
Min. Negotiated Rate	$28.56
Max. Negotiated Rate	$28.56
Rate for Payer: Cash Price	$10.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$28.56
Rate for Payer: SOMOS Essential	$28.56

PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN

Professional

Both

$35.35

Service Code	HCPCS 36406
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 VNPNXR <3 YEARS PHYS/QHP SKILL SCALP VEIN

Professional

Both

$60.10

Service Code	HCPCS 36405
Min. Negotiated Rate	$45.08
Max. Negotiated Rate	$45.08
Rate for Payer: Cash Price	$16.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.08
Rate for Payer: SOMOS Essential	$45.08

PR VOID PRESSURE STUDIES INTRAABDOMINAL

Professional

Both

$163.77

Service Code	HCPCS 51797 26
Min. Negotiated Rate	$122.83
Max. Negotiated Rate	$122.83
Rate for Payer: Cash Price	$44.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$122.83
Rate for Payer: SOMOS Essential	$122.83

PR VOID PRESSURE STUDIES INTRAABDOMINAL

Professional

Both

$826.46

Service Code	HCPCS 51797
Min. Negotiated Rate	$619.84
Max. Negotiated Rate	$619.84
Rate for Payer: Cash Price	$221.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$619.84
Rate for Payer: SOMOS Essential	$619.84

PR VOID PRESSURE STUDIES INTRAABDOMINAL

Professional

Both

$662.69

Service Code	HCPCS 51797 TC
Min. Negotiated Rate	$497.02
Max. Negotiated Rate	$497.02
Rate for Payer: Cash Price	$176.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$497.02
Rate for Payer: SOMOS Essential	$497.02

PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK

Professional

Both

$444.50

Service Code	HCPCS 92540
Min. Negotiated Rate	$333.38
Max. Negotiated Rate	$333.38
Rate for Payer: Cash Price	$119.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$333.38
Rate for Payer: SOMOS Essential	$333.38

PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK

Professional

Both

$137.87

Service Code	HCPCS 92540 TC
Min. Negotiated Rate	$103.40
Max. Negotiated Rate	$103.40
Rate for Payer: Cash Price	$36.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.40
Rate for Payer: SOMOS Essential	$103.40

PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK

Professional

Both

$306.64

Service Code	HCPCS 92540 26
Min. Negotiated Rate	$229.98
Max. Negotiated Rate	$229.98
Rate for Payer: Cash Price	$83.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$229.98
Rate for Payer: SOMOS Essential	$229.98

Know your out-of-pocket cost for care.

All Charges