St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE

Professional

Both

$575.54

Service Code	HCPCS 16030
Min. Negotiated Rate	$431.66
Max. Negotiated Rate	$431.66
Rate for Payer: Cash Price	$155.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$431.66
Rate for Payer: SOMOS Essential	$431.66

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM

Professional

Both

$474.36

Service Code	HCPCS 16025
Min. Negotiated Rate	$355.77
Max. Negotiated Rate	$355.77
Rate for Payer: Cash Price	$130.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$355.77
Rate for Payer: SOMOS Essential	$355.77

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL

Professional

Both

$239.65

Service Code	HCPCS 16020
Min. Negotiated Rate	$179.74
Max. Negotiated Rate	$179.74
Rate for Payer: Cash Price	$65.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$179.74
Rate for Payer: SOMOS Essential	$179.74

PR DRUGS UNCLASSIFIED INJECTION

Professional

Both

$10.85

Service Code	HCPCS J3490
Min. Negotiated Rate	$8.14
Max. Negotiated Rate	$8.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.14
Rate for Payer: SOMOS Essential	$8.14

PR DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS

Professional

Both

$5,077.17

Service Code	HCPCS 36838
Min. Negotiated Rate	$3,807.88
Max. Negotiated Rate	$3,807.88
Rate for Payer: Cash Price	$1,342.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,807.88
Rate for Payer: SOMOS Essential	$3,807.88

PR DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM

Professional

Both

$1,512.42

Service Code	HCPCS 17107
Min. Negotiated Rate	$1,134.32
Max. Negotiated Rate	$1,134.32
Rate for Payer: Cash Price	$415.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,134.32
Rate for Payer: SOMOS Essential	$1,134.32

PR DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM

Professional

Both

$2,235.49

Service Code	HCPCS 17108
Min. Negotiated Rate	$1,676.62
Max. Negotiated Rate	$1,676.62
Rate for Payer: Cash Price	$614.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,676.62
Rate for Payer: SOMOS Essential	$1,676.62

PR DSTRJ CYST/LESION IRIS/CILIARY BODY

Professional

Both

$1,980.37

Service Code	HCPCS 66770
Min. Negotiated Rate	$1,485.28
Max. Negotiated Rate	$1,485.28
Rate for Payer: Cash Price	$546.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,485.28
Rate for Payer: SOMOS Essential	$1,485.28

PR DSTRJ LESION ANUS EXTENSIVE

Professional

Both

$778.68

Service Code	HCPCS 46924
Min. Negotiated Rate	$584.01
Max. Negotiated Rate	$584.01
Rate for Payer: Cash Price	$212.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$584.01
Rate for Payer: SOMOS Essential	$584.01

PR DSTRJ LESION ANUS SIMPLE CHEMICAL

Professional

Both

$587.79

Service Code	HCPCS 46900
Min. Negotiated Rate	$440.84
Max. Negotiated Rate	$440.84
Rate for Payer: Cash Price	$160.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$440.84
Rate for Payer: SOMOS Essential	$440.84

PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY

Professional

Both

$597.28

Service Code	HCPCS 46916
Min. Negotiated Rate	$447.96
Max. Negotiated Rate	$447.96
Rate for Payer: Cash Price	$164.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$447.96
Rate for Payer: SOMOS Essential	$447.96

PR DSTRJ LESION ANUS SIMPLE LASER SURG

Professional

Both

$555.77

Service Code	HCPCS 46917
Min. Negotiated Rate	$416.83
Max. Negotiated Rate	$416.83
Rate for Payer: Cash Price	$151.78
Rate for Payer: SOMOS CHP/HARP/Medicaid	$416.83
Rate for Payer: SOMOS Essential	$416.83

PR DSTRJ LESION ANUS SIMPLE SURG EXCISION

Professional

Both

$603.79

Service Code	HCPCS 46922
Min. Negotiated Rate	$452.84
Max. Negotiated Rate	$452.84
Rate for Payer: Cash Price	$163.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$452.84
Rate for Payer: SOMOS Essential	$452.84

PR DSTRJ LESION ANUS SMPL ELTRDSICCATION

Professional

Both

$581.49

Service Code	HCPCS 46910
Min. Negotiated Rate	$436.12
Max. Negotiated Rate	$436.12
Rate for Payer: Cash Price	$159.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$436.12
Rate for Payer: SOMOS Essential	$436.12

PR DSTRJ LESION CHOROID PC 1/> SESS

Professional

Both

$2,051.88

Service Code	HCPCS 67220
Min. Negotiated Rate	$1,538.91
Max. Negotiated Rate	$1,538.91
Rate for Payer: Cash Price	$565.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,538.91
Rate for Payer: SOMOS Essential	$1,538.91

PR DSTRJ LESION CHOROID PDT 2ND EYE 1 SESSION

Professional

Both

$112.95

Service Code	HCPCS 67225
Min. Negotiated Rate	$84.71
Max. Negotiated Rate	$84.71
Rate for Payer: Cash Price	$30.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.71
Rate for Payer: SOMOS Essential	$84.71

PR DSTRJ LESION CHOROID PHOTODYNAMIC THERAPY

Professional

Both

$848.26

Service Code	HCPCS 67221
Min. Negotiated Rate	$636.20
Max. Negotiated Rate	$636.20
Rate for Payer: Cash Price	$232.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$636.20
Rate for Payer: SOMOS Essential	$636.20

PR DSTRJ LESION CRYOTHER PHOTO/THERMOCAUTZATION

Professional

Both

$1,336.62

Service Code	HCPCS 65450
Min. Negotiated Rate	$1,002.46
Max. Negotiated Rate	$1,002.46
Rate for Payer: Cash Price	$370.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,002.46
Rate for Payer: SOMOS Essential	$1,002.46

PR DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM

Professional

Both

$616.35

Service Code	HCPCS 42160
Min. Negotiated Rate	$462.26
Max. Negotiated Rate	$462.26
Rate for Payer: Cash Price	$164.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$462.26
Rate for Payer: SOMOS Essential	$462.26

PR DSTRJ LESION PENIS EXTENSIVE

Professional

Both

$721.18

Service Code	HCPCS 54065
Min. Negotiated Rate	$540.88
Max. Negotiated Rate	$540.88
Rate for Payer: Cash Price	$198.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$540.88
Rate for Payer: SOMOS Essential	$540.88

PR DSTRJ LESION PENIS SIMPLE CHEMICAL

Professional

Both

$456.79

Service Code	HCPCS 54050
Min. Negotiated Rate	$342.59
Max. Negotiated Rate	$342.59
Rate for Payer: Cash Price	$124.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$342.59
Rate for Payer: SOMOS Essential	$342.59

PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY

Professional

Both

$471.56

Service Code	HCPCS 54056
Min. Negotiated Rate	$353.67
Max. Negotiated Rate	$353.67
Rate for Payer: Cash Price	$130.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$353.67
Rate for Payer: SOMOS Essential	$353.67

PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION

Professional

Both

$410.06

Service Code	HCPCS 54055
Min. Negotiated Rate	$307.54
Max. Negotiated Rate	$307.54
Rate for Payer: Cash Price	$111.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.54
Rate for Payer: SOMOS Essential	$307.54

PR DSTRJ LESION PENIS SIMPLE LASER

Professional

Both

$417.97

Service Code	HCPCS 54057
Min. Negotiated Rate	$313.48
Max. Negotiated Rate	$313.48
Rate for Payer: Cash Price	$114.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$313.48
Rate for Payer: SOMOS Essential	$313.48

PR DSTRJ LESION PENIS SIMPLE SURG EXCISION

Professional

Both

$552.41

Service Code	HCPCS 54060
Min. Negotiated Rate	$414.31
Max. Negotiated Rate	$414.31
Rate for Payer: Cash Price	$152.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$414.31
Rate for Payer: SOMOS Essential	$414.31

Know your out-of-pocket cost for care.

All Charges