St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP

Professional

Both

$2,233.98

Service Code	HCPCS 66984
Min. Negotiated Rate	$1,675.48
Max. Negotiated Rate	$1,675.48
Rate for Payer: Cash Price	$614.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,675.48
Rate for Payer: SOMOS Essential	$1,675.48

PR XCAPSL CTRC RMVL INSJ IO LENS PRSTH CPLX INSJ 1+

Professional

Both

$3,501.86

Service Code	HCPCS 66989
Min. Negotiated Rate	$2,626.40
Max. Negotiated Rate	$2,626.40
Rate for Payer: Cash Price	$965.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,626.40
Rate for Payer: SOMOS Essential	$2,626.40

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG

Professional

Both

$122.05

Service Code	HCPCS 94617 26
Min. Negotiated Rate	$91.54
Max. Negotiated Rate	$91.54
Rate for Payer: Cash Price	$33.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$91.54
Rate for Payer: SOMOS Essential	$91.54

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG

Professional

Both

$242.66

Service Code	HCPCS 94617 TC
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$182.00
Rate for Payer: Cash Price	$69.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$182.00
Rate for Payer: SOMOS Essential	$182.00

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG

Professional

Both

$364.70

Service Code	HCPCS 94617
Min. Negotiated Rate	$273.52
Max. Negotiated Rate	$273.52
Rate for Payer: Cash Price	$102.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$273.52
Rate for Payer: SOMOS Essential	$273.52

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG

Professional

Both

$323.89

Service Code	HCPCS 94619
Min. Negotiated Rate	$242.92
Max. Negotiated Rate	$242.92
Rate for Payer: Cash Price	$75.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$242.92
Rate for Payer: SOMOS Essential	$242.92

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG

Professional

Both

$88.41

Service Code	HCPCS 94619 26
Min. Negotiated Rate	$66.31
Max. Negotiated Rate	$66.31
Rate for Payer: Cash Price	$22.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$66.31
Rate for Payer: SOMOS Essential	$66.31

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG

Professional

Both

$235.48

Service Code	HCPCS 94619 TC
Min. Negotiated Rate	$176.61
Max. Negotiated Rate	$176.61
Rate for Payer: Cash Price	$52.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$176.61
Rate for Payer: SOMOS Essential	$176.61

PR XTN CRANIECT MULTIPLE SUTURE CRANIOSYNOSTOSIS

Professional

Both

$9,086.60

Service Code	HCPCS 61558
Min. Negotiated Rate	$6,814.95
Max. Negotiated Rate	$6,814.95
Rate for Payer: Cash Price	$2,397.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,814.95
Rate for Payer: SOMOS Essential	$6,814.95

PR XTN CRNEC MLT SUTR CRANIOSYNOSTOSIS W/BONE GRAFT

Professional

Both

$11,572.12

Service Code	HCPCS 61559
Min. Negotiated Rate	$8,679.09
Max. Negotiated Rate	$8,679.09
Rate for Payer: Cash Price	$3,050.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,679.09
Rate for Payer: SOMOS Essential	$8,679.09

PR XTRNL CANNULA DECLTNG SPX W/BALO CATH

Professional

Both

$628.60

Service Code	HCPCS 36861
Min. Negotiated Rate	$471.45
Max. Negotiated Rate	$471.45
Rate for Payer: Cash Price	$164.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$471.45
Rate for Payer: SOMOS Essential	$471.45

PR XTRNL CANNULA DECLTNG SPX W/O BALO CATH

Professional

Both

$499.10

Service Code	HCPCS 36860
Min. Negotiated Rate	$374.32
Max. Negotiated Rate	$374.32
Rate for Payer: Cash Price	$131.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$374.32
Rate for Payer: SOMOS Essential	$374.32

PR XTRNL ECG & 48 HR RECORDING

Professional

Both

$80.36

Service Code	HCPCS 93225
Min. Negotiated Rate	$60.27
Max. Negotiated Rate	$60.27
Rate for Payer: Cash Price	$21.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60.27
Rate for Payer: SOMOS Essential	$60.27

PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I

Professional

Both

$244.00

Service Code	HCPCS 93224 26
Min. Negotiated Rate	$183.00
Max. Negotiated Rate	$183.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$183.00
Rate for Payer: SOMOS Essential	$183.00

PR XTRNL ECG & 48 HR RECORD SCAN STOR W/R&I

Professional

Both

$308.63

Service Code	HCPCS 93224
Min. Negotiated Rate	$231.47
Max. Negotiated Rate	$231.47
Rate for Payer: Cash Price	$83.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$231.47
Rate for Payer: SOMOS Essential	$231.47

PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS

Professional

Both

$52.00

Service Code	HCPCS 93227 26
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.00
Rate for Payer: SOMOS Essential	$39.00

PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS

Professional

Both

$71.72

Service Code	HCPCS 93227
Min. Negotiated Rate	$53.79
Max. Negotiated Rate	$53.79
Rate for Payer: Cash Price	$19.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.79
Rate for Payer: SOMOS Essential	$53.79

PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS

Professional

Both

$104.13

Service Code	HCPCS 93228
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$78.10
Rate for Payer: Cash Price	$27.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.10
Rate for Payer: SOMOS Essential	$78.10

PR XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT

Professional

Both

$3,616.80

Service Code	HCPCS 93229
Min. Negotiated Rate	$2,712.60
Max. Negotiated Rate	$2,712.60
Rate for Payer: Cash Price	$961.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,712.60
Rate for Payer: SOMOS Essential	$2,712.60

PR XTRNL OCULAR PHOTOG W/I&R DOCMT MED PROGRESS

Professional

Both

$100.87

Service Code	HCPCS 92285
Min. Negotiated Rate	$75.65
Max. Negotiated Rate	$75.65
Rate for Payer: Cash Price	$27.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$75.65
Rate for Payer: SOMOS Essential	$75.65

PR XTRNL OCULAR PHOTOG W/I&R DOCMT MED PROGRESS

Professional

Both

$87.54

Service Code	HCPCS 92285 TC
Min. Negotiated Rate	$65.66
Max. Negotiated Rate	$65.66
Rate for Payer: Cash Price	$24.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$65.66
Rate for Payer: SOMOS Essential	$65.66

PR XTRNL OCULAR PHOTOG W/I&R DOCMT MED PROGRESS

Professional

Both

$13.30

Service Code	HCPCS 92285 26
Min. Negotiated Rate	$9.98
Max. Negotiated Rate	$9.98
Rate for Payer: Cash Price	$3.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9.98
Rate for Payer: SOMOS Essential	$9.98

PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS

Professional

Both

$629.48

Service Code	HCPCS 93271
Min. Negotiated Rate	$472.11
Max. Negotiated Rate	$472.11
Rate for Payer: Cash Price	$168.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$472.11
Rate for Payer: SOMOS Essential	$472.11

PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS

Professional

Both

$37.24

Service Code	HCPCS 93270
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$27.93
Rate for Payer: Cash Price	$10.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.93
Rate for Payer: SOMOS Essential	$27.93

PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS

Professional

Both

$761.78

Service Code	HCPCS 93268
Min. Negotiated Rate	$571.34
Max. Negotiated Rate	$571.34
Rate for Payer: Cash Price	$204.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$571.34
Rate for Payer: SOMOS Essential	$571.34

Know your out-of-pocket cost for care.

All Charges