St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DENOSUMAB INJECTION

Professional

Both

$33.00

Service Code	HCPCS J0897
Min. Negotiated Rate	$24.75
Max. Negotiated Rate	$24.75
Rate for Payer: Cash Price	$25.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24.75
Rate for Payer: SOMOS Essential	$24.75

PR DEPRESSION SCREEN ANNUAL

Professional

Both

$36.79

Service Code	HCPCS G0444
Min. Negotiated Rate	$27.59
Max. Negotiated Rate	$27.59
Rate for Payer: Cash Price	$10.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27.59
Rate for Payer: SOMOS Essential	$27.59

PR DERMABRASION REGIONAL OTHER THAN FACE

Professional

Both

$1,553.37

Service Code	HCPCS 15782
Min. Negotiated Rate	$1,165.03
Max. Negotiated Rate	$1,165.03
Rate for Payer: Cash Price	$428.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,165.03
Rate for Payer: SOMOS Essential	$1,165.03

PR DERMABRASION SEGMENTAL FACE

Professional

Both

$1,852.59

Service Code	HCPCS 15781
Min. Negotiated Rate	$1,389.44
Max. Negotiated Rate	$1,389.44
Rate for Payer: Cash Price	$500.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,389.44
Rate for Payer: SOMOS Essential	$1,389.44

PR DERMABRASION SUPERFICIAL ANY SITE

Professional

Both

$1,490.69

Service Code	HCPCS 15783
Min. Negotiated Rate	$1,118.02
Max. Negotiated Rate	$1,118.02
Rate for Payer: Cash Price	$411.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,118.02
Rate for Payer: SOMOS Essential	$1,118.02

PR DERMABRASION TOTAL FACE

Professional

Both

$2,788.66

Service Code	HCPCS 15780
Min. Negotiated Rate	$2,091.50
Max. Negotiated Rate	$2,091.50
Rate for Payer: Cash Price	$765.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,091.50
Rate for Payer: SOMOS Essential	$2,091.50

PR DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA

Professional

Both

$389.69

Service Code	HCPCS 15136
Min. Negotiated Rate	$292.27
Max. Negotiated Rate	$292.27
Rate for Payer: Cash Price	$103.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$292.27
Rate for Payer: SOMOS Essential	$292.27

PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100

Professional

Both

$3,268.86

Service Code	HCPCS 15135
Min. Negotiated Rate	$2,451.64
Max. Negotiated Rate	$2,451.64
Rate for Payer: Cash Price	$880.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,451.64
Rate for Payer: SOMOS Essential	$2,451.64

PR DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM

Professional

Both

$2,599.21

Service Code	HCPCS 15130
Min. Negotiated Rate	$1,949.41
Max. Negotiated Rate	$1,949.41
Rate for Payer: Cash Price	$705.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,949.41
Rate for Payer: SOMOS Essential	$1,949.41

PR DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA

Professional

Both

$389.69

Service Code	HCPCS 15131
Min. Negotiated Rate	$292.27
Max. Negotiated Rate	$292.27
Rate for Payer: Cash Price	$103.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$292.27
Rate for Payer: SOMOS Essential	$292.27

PR DERMAL FILLER INJECTION(S)

Professional

Both

$282.52

Service Code	HCPCS G0429
Min. Negotiated Rate	$211.89
Max. Negotiated Rate	$211.89
Rate for Payer: Cash Price	$78.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$211.89
Rate for Payer: SOMOS Essential	$211.89

PR DESCENDING THORACIC AORTA GRAFT W/WO BYPASS

Professional

Both

$12,129.39

Service Code	HCPCS 33875
Min. Negotiated Rate	$9,097.04
Max. Negotiated Rate	$9,097.04
Rate for Payer: Cash Price	$3,225.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,097.04
Rate for Payer: SOMOS Essential	$9,097.04

PR DESTRUCTION BENIGN LESIONS 15/>

Professional

Both

$347.24

Service Code	HCPCS 17111
Min. Negotiated Rate	$260.43
Max. Negotiated Rate	$260.43
Rate for Payer: Cash Price	$96.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$260.43
Rate for Payer: SOMOS Essential	$260.43

PR DESTRUCTION BENIGN LESIONS UP TO 14

Professional

Both

$283.64

Service Code	HCPCS 17110
Min. Negotiated Rate	$212.73
Max. Negotiated Rate	$212.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$212.73
Rate for Payer: SOMOS Essential	$212.73

PR DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM

Professional

Both

$1,166.45

Service Code	HCPCS 17106
Min. Negotiated Rate	$874.84
Max. Negotiated Rate	$874.84
Rate for Payer: Cash Price	$320.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$874.84
Rate for Payer: SOMOS Essential	$874.84

PR DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY

Professional

Both

$651.42

Service Code	HCPCS 46930
Min. Negotiated Rate	$488.56
Max. Negotiated Rate	$488.56
Rate for Payer: Cash Price	$178.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$488.56
Rate for Payer: SOMOS Essential	$488.56

PR DESTRUCTION LESION CONJUNCTIVA

Professional

Both

$622.48

Service Code	HCPCS 68135
Min. Negotiated Rate	$466.86
Max. Negotiated Rate	$466.86
Rate for Payer: Cash Price	$169.99
Rate for Payer: SOMOS CHP/HARP/Medicaid	$466.86
Rate for Payer: SOMOS Essential	$466.86

PR DESTRUCTION LESION LID MARGIN < 1 CM

Professional

Both

$549.08

Service Code	HCPCS 67850
Min. Negotiated Rate	$411.81
Max. Negotiated Rate	$411.81
Rate for Payer: Cash Price	$149.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$411.81
Rate for Payer: SOMOS Essential	$411.81

PR DESTRUCTION LESIONS VULVA EXTENSIVE

Professional

Both

$927.96

Service Code	HCPCS 56515
Min. Negotiated Rate	$695.97
Max. Negotiated Rate	$695.97
Rate for Payer: Cash Price	$250.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$695.97
Rate for Payer: SOMOS Essential	$695.97

PR DESTRUCTION LESIONS VULVA SIMPLE

Professional

Both

$582.54

Service Code	HCPCS 56501
Min. Negotiated Rate	$436.90
Max. Negotiated Rate	$436.90
Rate for Payer: Cash Price	$157.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$436.90
Rate for Payer: SOMOS Essential	$436.90

PR DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<

Professional

Both

$361.03

Service Code	HCPCS 17280
Min. Negotiated Rate	$270.77
Max. Negotiated Rate	$270.77
Rate for Payer: Cash Price	$100.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$270.77
Rate for Payer: SOMOS Essential	$270.77

PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<

Professional

Both

$404.99

Service Code	HCPCS 17270
Min. Negotiated Rate	$303.74
Max. Negotiated Rate	$303.74
Rate for Payer: Cash Price	$110.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$303.74
Rate for Payer: SOMOS Essential	$303.74

PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM

Professional

Both

$443.52

Service Code	HCPCS 17271
Min. Negotiated Rate	$332.64
Max. Negotiated Rate	$332.64
Rate for Payer: Cash Price	$120.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$332.64
Rate for Payer: SOMOS Essential	$332.64

PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM

Professional

Both

$507.05

Service Code	HCPCS 17272
Min. Negotiated Rate	$380.29
Max. Negotiated Rate	$380.29
Rate for Payer: Cash Price	$139.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$380.29
Rate for Payer: SOMOS Essential	$380.29

PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM

Professional

Both

$573.34

Service Code	HCPCS 17273
Min. Negotiated Rate	$430.00
Max. Negotiated Rate	$430.00
Rate for Payer: Cash Price	$156.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$430.00
Rate for Payer: SOMOS Essential	$430.00

Know your out-of-pocket cost for care.

All Charges