St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DCMPRN FASCT LEG ANT&/LAT&PST CMPRT

Professional

Both

$2,135.95

Service Code	HCPCS 27602
Min. Negotiated Rate	$1,601.96
Max. Negotiated Rate	$1,601.96
Rate for Payer: Cash Price	$569.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,601.96
Rate for Payer: SOMOS Essential	$1,601.96

PR DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS

Professional

Both

$3,596.92

Service Code	HCPCS 27894
Min. Negotiated Rate	$2,697.69
Max. Negotiated Rate	$2,697.69
Rate for Payer: Cash Price	$970.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,697.69
Rate for Payer: SOMOS Essential	$2,697.69

PR DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE

Professional

Both

$2,365.62

Service Code	HCPCS 27892
Min. Negotiated Rate	$1,774.22
Max. Negotiated Rate	$1,774.22
Rate for Payer: Cash Price	$639.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,774.22
Rate for Payer: SOMOS Essential	$1,774.22

PR DCMPRN FASCT LEG POST COMPARTMENT ONLY

Professional

Both

$1,947.58

Service Code	HCPCS 27601
Min. Negotiated Rate	$1,460.68
Max. Negotiated Rate	$1,460.68
Rate for Payer: Cash Price	$528.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,460.68
Rate for Payer: SOMOS Essential	$1,460.68

PR DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV

Professional

Both

$2,726.89

Service Code	HCPCS 27893
Min. Negotiated Rate	$2,045.17
Max. Negotiated Rate	$2,045.17
Rate for Payer: Cash Price	$739.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,045.17
Rate for Payer: SOMOS Essential	$2,045.17

PR DCMPRN FASCT THIGH&/KNEE DBRDMT MUSCLE&/NERVE

Professional

Both

$2,579.85

Service Code	HCPCS 27497
Min. Negotiated Rate	$1,934.89
Max. Negotiated Rate	$1,934.89
Rate for Payer: Cash Price	$699.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,934.89
Rate for Payer: SOMOS Essential	$1,934.89

PR DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&NRVE

Professional

Both

$3,121.06

Service Code	HCPCS 27499
Min. Negotiated Rate	$2,340.80
Max. Negotiated Rate	$2,340.80
Rate for Payer: Cash Price	$844.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,340.80
Rate for Payer: SOMOS Essential	$2,340.80

PR DCMPRN NRV INTRATEMPORAL MEDIAL GENICULATE

Professional

Both

$8,077.58

Service Code	HCPCS 69725
Min. Negotiated Rate	$6,058.18
Max. Negotiated Rate	$6,058.18
Rate for Payer: Cash Price	$2,178.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,058.18
Rate for Payer: SOMOS Essential	$6,058.18

PR DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR

Professional

Both

$2,363.38

Service Code	HCPCS 62287
Min. Negotiated Rate	$1,772.54
Max. Negotiated Rate	$1,772.54
Rate for Payer: Cash Price	$693.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,772.54
Rate for Payer: SOMOS Essential	$1,772.54

PR DEBRIDEMENT BONE 1ST 20 SQ CM/<

Professional

Both

$967.37

Service Code	HCPCS 11044
Min. Negotiated Rate	$725.53
Max. Negotiated Rate	$725.53
Rate for Payer: Cash Price	$261.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$725.53
Rate for Payer: SOMOS Essential	$725.53

PR DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM

Professional

Both

$424.73

Service Code	HCPCS 11047
Min. Negotiated Rate	$318.55
Max. Negotiated Rate	$318.55
Rate for Payer: Cash Price	$113.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$318.55
Rate for Payer: SOMOS Essential	$318.55

PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX

Professional

Both

$589.96

Service Code	HCPCS 69222
Min. Negotiated Rate	$442.47
Max. Negotiated Rate	$442.47
Rate for Payer: Cash Price	$161.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$442.47
Rate for Payer: SOMOS Essential	$442.47

PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE

Professional

Both

$220.15

Service Code	HCPCS 69220
Min. Negotiated Rate	$165.11
Max. Negotiated Rate	$165.11
Rate for Payer: Cash Price	$59.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$165.11
Rate for Payer: SOMOS Essential	$165.11

PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<

Professional

Both

$656.04

Service Code	HCPCS 11043
Min. Negotiated Rate	$492.03
Max. Negotiated Rate	$492.03
Rate for Payer: Cash Price	$177.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$492.03
Rate for Payer: SOMOS Essential	$492.03

PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM

Professional

Both

$238.49

Service Code	HCPCS 11046
Min. Negotiated Rate	$178.87
Max. Negotiated Rate	$178.87
Rate for Payer: Cash Price	$63.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$178.87
Rate for Payer: SOMOS Essential	$178.87

PR DEBRIDEMENT NAIL ANY METHOD 1-5

Professional

Both

$61.08

Service Code	HCPCS 11720
Min. Negotiated Rate	$45.81
Max. Negotiated Rate	$45.81
Rate for Payer: Cash Price	$15.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45.81
Rate for Payer: SOMOS Essential	$45.81

PR DEBRIDEMENT NAIL ANY METHOD 6/>

Professional

Both

$95.83

Service Code	HCPCS 11721
Min. Negotiated Rate	$71.87
Max. Negotiated Rate	$71.87
Rate for Payer: Cash Price	$26.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.87
Rate for Payer: SOMOS Essential	$71.87

PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<

Professional

Both

$144.48

Service Code	HCPCS 97597
Min. Negotiated Rate	$108.36
Max. Negotiated Rate	$108.36
Rate for Payer: Cash Price	$39.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$108.36
Rate for Payer: SOMOS Essential	$108.36

PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF

Professional

Both

$103.50

Service Code	HCPCS 97598
Min. Negotiated Rate	$77.62
Max. Negotiated Rate	$77.62
Rate for Payer: Cash Price	$27.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.62
Rate for Payer: SOMOS Essential	$77.62

PR DEBRIDEMENT PRMLG HYPERKERATOTIC LES W/PDT

Professional

Both

$1,198.33

Service Code	HCPCS 96574
Min. Negotiated Rate	$898.75
Max. Negotiated Rate	$898.75
Rate for Payer: Cash Price	$324.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$898.75
Rate for Payer: SOMOS Essential	$898.75

PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<

Professional

Both

$251.34

Service Code	HCPCS 11042
Min. Negotiated Rate	$188.50
Max. Negotiated Rate	$188.50
Rate for Payer: Cash Price	$69.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$188.50
Rate for Payer: SOMOS Essential	$188.50

PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM

Professional

Both

$108.96

Service Code	HCPCS 11045
Min. Negotiated Rate	$81.72
Max. Negotiated Rate	$81.72
Rate for Payer: Cash Price	$29.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$81.72
Rate for Payer: SOMOS Essential	$81.72

PR DECALCIFY TISSUE

Professional

Both

$85.86

Service Code	HCPCS 88311
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$64.40
Rate for Payer: Cash Price	$23.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$64.40
Rate for Payer: SOMOS Essential	$64.40

PR DECALCIFY TISSUE

Professional

Both

$48.62

Service Code	HCPCS 88311 26
Min. Negotiated Rate	$36.46
Max. Negotiated Rate	$36.46
Rate for Payer: Cash Price	$12.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.46
Rate for Payer: SOMOS Essential	$36.46

PR DECALCIFY TISSUE

Professional

Both

$37.24

Service Code	HCPCS 88311 TC
Min. Negotiated Rate	$27.93
Max. Negotiated Rate	$27.93
Rate for Payer: Cash Price	$10.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.93
Rate for Payer: SOMOS Essential	$27.93

Know your out-of-pocket cost for care.

All Charges