St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY

Professional

Both

$1,621.17

Service Code	HCPCS 52353
Min. Negotiated Rate	$1,215.88
Max. Negotiated Rate	$1,215.88
Rate for Payer: Cash Price	$441.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,215.88
Rate for Payer: SOMOS Essential	$1,215.88

PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES

Professional

Both

$1,463.95

Service Code	HCPCS 52352
Min. Negotiated Rate	$1,097.96
Max. Negotiated Rate	$1,097.96
Rate for Payer: Cash Price	$399.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,097.96
Rate for Payer: SOMOS Essential	$1,097.96

PR CYSTO W/URTRL CATHJ BRUSH BX URTR&/RENAL PELVIS

Professional

Both

$689.36

Service Code	HCPCS 52007
Min. Negotiated Rate	$517.02
Max. Negotiated Rate	$517.02
Rate for Payer: Cash Price	$189.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$517.02
Rate for Payer: SOMOS Essential	$517.02

PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX

Professional

Both

$1,248.49

Service Code	HCPCS 52351
Min. Negotiated Rate	$936.37
Max. Negotiated Rate	$936.37
Rate for Payer: Cash Price	$342.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$936.37
Rate for Payer: SOMOS Essential	$936.37

PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE

Professional

Both

$1,842.47

Service Code	HCPCS 52346
Min. Negotiated Rate	$1,381.85
Max. Negotiated Rate	$1,381.85
Rate for Payer: Cash Price	$503.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,381.85
Rate for Payer: SOMOS Essential	$1,381.85

PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE

Professional

Both

$1,522.68

Service Code	HCPCS 52344
Min. Negotiated Rate	$1,142.01
Max. Negotiated Rate	$1,142.01
Rate for Payer: Cash Price	$416.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,142.01
Rate for Payer: SOMOS Essential	$1,142.01

PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX

Professional

Both

$1,628.87

Service Code	HCPCS 52345
Min. Negotiated Rate	$1,221.65
Max. Negotiated Rate	$1,221.65
Rate for Payer: Cash Price	$444.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,221.65
Rate for Payer: SOMOS Essential	$1,221.65

PR CYTO/MOLECULAR REPORT

Professional

Both

$130.97

Service Code	HCPCS 88291
Min. Negotiated Rate	$98.23
Max. Negotiated Rate	$98.23
Rate for Payer: Cash Price	$37.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$98.23
Rate for Payer: SOMOS Essential	$98.23

PR DACRYOCSTORHINOSTOMY

Professional

Both

$3,369.59

Service Code	HCPCS 68720
Min. Negotiated Rate	$2,527.19
Max. Negotiated Rate	$2,527.19
Rate for Payer: Cash Price	$923.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,527.19
Rate for Payer: SOMOS Essential	$2,527.19

PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF

Professional

Both

$109.10

Service Code	HCPCS 11000
Min. Negotiated Rate	$81.82
Max. Negotiated Rate	$81.82
Rate for Payer: Cash Price	$30.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.82
Rate for Payer: SOMOS Essential	$81.82

PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%

Professional

Both

$62.90

Service Code	HCPCS 11001
Min. Negotiated Rate	$47.18
Max. Negotiated Rate	$47.18
Rate for Payer: Cash Price	$16.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$47.18
Rate for Payer: SOMOS Essential	$47.18

PR DBRDMT FX&/DISLC SUBQ T/M/F BONE

Professional

Both

$1,818.32

Service Code	HCPCS 11012
Min. Negotiated Rate	$1,363.74
Max. Negotiated Rate	$1,363.74
Rate for Payer: Cash Price	$488.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,363.74
Rate for Payer: SOMOS Essential	$1,363.74

PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER

Professional

Both

$2,480.10

Service Code	HCPCS 11004
Min. Negotiated Rate	$1,860.08
Max. Negotiated Rate	$1,860.08
Rate for Payer: Cash Price	$662.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,860.08
Rate for Payer: SOMOS Essential	$1,860.08

PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL

Professional

Both

$3,456.85

Service Code	HCPCS 11005
Min. Negotiated Rate	$2,592.64
Max. Negotiated Rate	$2,592.64
Rate for Payer: Cash Price	$918.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,592.64
Rate for Payer: SOMOS Essential	$2,592.64

PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL

Professional

Both

$3,090.54

Service Code	HCPCS 11006
Min. Negotiated Rate	$2,317.90
Max. Negotiated Rate	$2,317.90
Rate for Payer: Cash Price	$823.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,317.90
Rate for Payer: SOMOS Essential	$2,317.90

PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS

Professional

Both

$1,201.66

Service Code	HCPCS 11010
Min. Negotiated Rate	$901.24
Max. Negotiated Rate	$901.24
Rate for Payer: Cash Price	$323.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$901.24
Rate for Payer: SOMOS Essential	$901.24

PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC

Professional

Both

$1,295.53

Service Code	HCPCS 11011
Min. Negotiated Rate	$971.65
Max. Negotiated Rate	$971.65
Rate for Payer: Cash Price	$349.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$971.65
Rate for Payer: SOMOS Essential	$971.65

PR DCMPRN FACIAL NRV INTRATEMPORAL LAT GANGLION

Professional

Both

$5,186.69

Service Code	HCPCS 69720
Min. Negotiated Rate	$3,890.02
Max. Negotiated Rate	$3,890.02
Rate for Payer: Cash Price	$1,379.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,890.02
Rate for Payer: SOMOS Essential	$3,890.02

PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI

Professional

Both

$4,460.72

Service Code	HCPCS 27057
Min. Negotiated Rate	$3,345.54
Max. Negotiated Rate	$3,345.54
Rate for Payer: Cash Price	$1,200.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,345.54
Rate for Payer: SOMOS Essential	$3,345.54

PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS

Professional

Both

$2,919.18

Service Code	HCPCS 27498
Min. Negotiated Rate	$2,189.38
Max. Negotiated Rate	$2,189.38
Rate for Payer: Cash Price	$790.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,189.38
Rate for Payer: SOMOS Essential	$2,189.38

PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT

Professional

Both

$5,421.29

Service Code	HCPCS 25025
Min. Negotiated Rate	$4,065.97
Max. Negotiated Rate	$4,065.97
Rate for Payer: Cash Price	$1,462.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,065.97
Rate for Payer: SOMOS Essential	$4,065.97

PR DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT

Professional

Both

$5,776.23

Service Code	HCPCS 25023
Min. Negotiated Rate	$4,332.17
Max. Negotiated Rate	$4,332.17
Rate for Payer: Cash Price	$1,558.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,332.17
Rate for Payer: SOMOS Essential	$4,332.17

PR DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB

Professional

Both

$3,425.35

Service Code	HCPCS 25024
Min. Negotiated Rate	$2,569.01
Max. Negotiated Rate	$2,569.01
Rate for Payer: Cash Price	$933.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,569.01
Rate for Payer: SOMOS Essential	$2,569.01

PR DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT

Professional

Both

$3,273.31

Service Code	HCPCS 25020
Min. Negotiated Rate	$2,454.98
Max. Negotiated Rate	$2,454.98
Rate for Payer: Cash Price	$881.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,454.98
Rate for Payer: SOMOS Essential	$2,454.98

PR DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY

Professional

Both

$1,776.32

Service Code	HCPCS 27600
Min. Negotiated Rate	$1,332.24
Max. Negotiated Rate	$1,332.24
Rate for Payer: Cash Price	$476.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,332.24
Rate for Payer: SOMOS Essential	$1,332.24

Know your out-of-pocket cost for care.

All Charges