St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM

Professional

Both

$700.67

Service Code	HCPCS 17274
Min. Negotiated Rate	$525.50
Max. Negotiated Rate	$525.50
Rate for Payer: Cash Price	$191.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$525.50
Rate for Payer: SOMOS Essential	$525.50

PR DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<

Professional

Both

$297.12

Service Code	HCPCS 17260
Min. Negotiated Rate	$222.84
Max. Negotiated Rate	$222.84
Rate for Payer: Cash Price	$81.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$222.84
Rate for Payer: SOMOS Essential	$222.84

PR DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM

Professional

Both

$496.48

Service Code	HCPCS 17281
Min. Negotiated Rate	$372.36
Max. Negotiated Rate	$372.36
Rate for Payer: Cash Price	$135.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$372.36
Rate for Payer: SOMOS Essential	$372.36

PR DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM

Professional

Both

$572.08

Service Code	HCPCS 17282
Min. Negotiated Rate	$429.06
Max. Negotiated Rate	$429.06
Rate for Payer: Cash Price	$156.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$429.06
Rate for Payer: SOMOS Essential	$429.06

PR DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM

Professional

Both

$709.80

Service Code	HCPCS 17283
Min. Negotiated Rate	$532.35
Max. Negotiated Rate	$532.35
Rate for Payer: Cash Price	$195.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$532.35
Rate for Payer: SOMOS Essential	$532.35

PR DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM

Professional

Both

$831.64

Service Code	HCPCS 17284
Min. Negotiated Rate	$623.73
Max. Negotiated Rate	$623.73
Rate for Payer: Cash Price	$226.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$623.73
Rate for Payer: SOMOS Essential	$623.73

PR DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM

Professional

Both

$1,119.65

Service Code	HCPCS 17286
Min. Negotiated Rate	$839.74
Max. Negotiated Rate	$839.74
Rate for Payer: Cash Price	$307.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$839.74
Rate for Payer: SOMOS Essential	$839.74

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM

Professional

Both

$362.46

Service Code	HCPCS 17261
Min. Negotiated Rate	$271.84
Max. Negotiated Rate	$271.84
Rate for Payer: Cash Price	$100.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$271.84
Rate for Payer: SOMOS Essential	$271.84

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM

Professional

Both

$464.73

Service Code	HCPCS 17262
Min. Negotiated Rate	$348.55
Max. Negotiated Rate	$348.55
Rate for Payer: Cash Price	$126.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$348.55
Rate for Payer: SOMOS Essential	$348.55

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM

Professional

Both

$511.00

Service Code	HCPCS 17263
Min. Negotiated Rate	$383.25
Max. Negotiated Rate	$383.25
Rate for Payer: Cash Price	$140.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$383.25
Rate for Payer: SOMOS Essential	$383.25

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM

Professional

Both

$544.04

Service Code	HCPCS 17264
Min. Negotiated Rate	$408.03
Max. Negotiated Rate	$408.03
Rate for Payer: Cash Price	$149.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$408.03
Rate for Payer: SOMOS Essential	$408.03

PR DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM

Professional

Both

$642.32

Service Code	HCPCS 17266
Min. Negotiated Rate	$481.74
Max. Negotiated Rate	$481.74
Rate for Payer: Cash Price	$175.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$481.74
Rate for Payer: SOMOS Essential	$481.74

PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG

Professional

Both

$603.19

Service Code	HCPCS 64624
Min. Negotiated Rate	$452.39
Max. Negotiated Rate	$452.39
Rate for Payer: Cash Price	$165.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$452.39
Rate for Payer: SOMOS Essential	$452.39

PR DESTRUCTION PREMALIGNANT LESION 15/>

Professional

Both

$420.81

Service Code	HCPCS 17004
Min. Negotiated Rate	$315.61
Max. Negotiated Rate	$315.61
Rate for Payer: Cash Price	$113.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$315.61
Rate for Payer: SOMOS Essential	$315.61

PR DESTRUCTION PREMALIGNANT LESION 1ST

Professional

Both

$230.83

Service Code	HCPCS 17000
Min. Negotiated Rate	$173.12
Max. Negotiated Rate	$173.12
Rate for Payer: Cash Price	$63.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$173.12
Rate for Payer: SOMOS Essential	$173.12

PR DESTRUCTION PREMALIGNANT LESION 2-14 EA

Professional

Both

$7.88

Service Code	HCPCS 17003
Min. Negotiated Rate	$5.91
Max. Negotiated Rate	$5.91
Rate for Payer: Cash Price	$2.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.91
Rate for Payer: SOMOS Essential	$5.91

PR DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH

Professional

Both

$3,005.56

Service Code	HCPCS 45190
Min. Negotiated Rate	$2,254.17
Max. Negotiated Rate	$2,254.17
Rate for Payer: Cash Price	$814.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,254.17
Rate for Payer: SOMOS Essential	$2,254.17

PR DESTRUCTION RETINOPATHY CRYOTHERAPY DIATHERMY

Professional

Both

$1,044.12

Service Code	HCPCS 67227
Min. Negotiated Rate	$783.09
Max. Negotiated Rate	$783.09
Rate for Payer: Cash Price	$287.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$783.09
Rate for Payer: SOMOS Essential	$783.09

PR DESTRUCTION VAGINAL LESIONS EXTENSIVE

Professional

Both

$811.62

Service Code	HCPCS 57065
Min. Negotiated Rate	$608.72
Max. Negotiated Rate	$608.72
Rate for Payer: Cash Price	$219.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$608.72
Rate for Payer: SOMOS Essential	$608.72

PR DESTRUCTION VAGINAL LESIONS SIMPLE

Professional

Both

$504.77

Service Code	HCPCS 57061
Min. Negotiated Rate	$378.58
Max. Negotiated Rate	$378.58
Rate for Payer: Cash Price	$136.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$378.58
Rate for Payer: SOMOS Essential	$378.58

PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM

Professional

Both

$30.00

Service Code	HCPCS 96110
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$22.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22.50
Rate for Payer: SOMOS Essential	$22.50

PR DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR

Professional

Both

$502.71

Service Code	HCPCS 96112
Min. Negotiated Rate	$377.03
Max. Negotiated Rate	$377.03
Rate for Payer: Cash Price	$137.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$377.03
Rate for Payer: SOMOS Essential	$377.03

PR DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN

Professional

Both

$224.95

Service Code	HCPCS 96113
Min. Negotiated Rate	$168.71
Max. Negotiated Rate	$168.71
Rate for Payer: Cash Price	$62.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$168.71
Rate for Payer: SOMOS Essential	$168.71

PR DEV INTERR PRGRMG IO RTA ELTRD RA W/ADJ & REPRT

Professional

Both

$257.64

Service Code	HCPCS 0472T
Min. Negotiated Rate	$193.23
Max. Negotiated Rate	$193.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$193.23
Rate for Payer: SOMOS Essential	$193.23

PR DEV INTERR REPRGRMG IO RTA ELTRD RA W/REPRT

Professional

Both

$257.64

Service Code	HCPCS 0473T
Min. Negotiated Rate	$193.23
Max. Negotiated Rate	$193.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$193.23
Rate for Payer: SOMOS Essential	$193.23

Know your out-of-pocket cost for care.

All Charges