St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR DSTRJ LESION RETINA 1/> SESS RADJ IMPLTJ

Professional

Both

$5,703.81

Service Code	HCPCS 67218
Min. Negotiated Rate	$4,277.86
Max. Negotiated Rate	$4,277.86
Rate for Payer: Cash Price	$1,563.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,277.86
Rate for Payer: SOMOS Essential	$4,277.86

PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS

Professional

Both

$709.28

Service Code	HCPCS 40820
Min. Negotiated Rate	$531.96
Max. Negotiated Rate	$531.96
Rate for Payer: Cash Price	$194.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$531.96
Rate for Payer: SOMOS Essential	$531.96

PR DSTRJ LOCLZD LESION RETINA 1/> SESS CRTX DTHRM

Professional

Both

$2,368.91

Service Code	HCPCS 67208
Min. Negotiated Rate	$1,776.68
Max. Negotiated Rate	$1,776.68
Rate for Payer: Cash Price	$653.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,776.68
Rate for Payer: SOMOS Essential	$1,776.68

PR DSTRJ LOCLZD LESION RETINA 1/> SESS PC

Professional

Both

$2,054.64

Service Code	HCPCS 67210
Min. Negotiated Rate	$1,540.98
Max. Negotiated Rate	$1,540.98
Rate for Payer: Cash Price	$565.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,540.98
Rate for Payer: SOMOS Essential	$1,540.98

PR DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM

Professional

Both

$846.37

Service Code	HCPCS 17276
Min. Negotiated Rate	$634.78
Max. Negotiated Rate	$634.78
Rate for Payer: Cash Price	$230.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$634.78
Rate for Payer: SOMOS Essential	$634.78

PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR

Professional

Both

$2,259.99

Service Code	HCPCS 64610
Min. Negotiated Rate	$1,694.99
Max. Negotiated Rate	$1,694.99
Rate for Payer: Cash Price	$593.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,694.99
Rate for Payer: SOMOS Essential	$1,694.99

PR DSTRJ NEUROFIBROMA XTNSV FACE HEAD NECK >50

Professional

Both

$644.14

Service Code	HCPCS 0419T
Min. Negotiated Rate	$483.10
Max. Negotiated Rate	$483.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$483.10
Rate for Payer: SOMOS Essential	$483.10

PR DSTRJ NEUROFIBROMA XTNSV TRNK EXTREMITIES >100

Professional

Both

$2,047.08

Service Code	HCPCS 0420T
Min. Negotiated Rate	$1,535.31
Max. Negotiated Rate	$1,535.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,535.31
Rate for Payer: SOMOS Essential	$1,535.31

PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE

Professional

Both

$746.80

Service Code	HCPCS 64620
Min. Negotiated Rate	$560.10
Max. Negotiated Rate	$560.10
Rate for Payer: Cash Price	$204.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$560.10
Rate for Payer: SOMOS Essential	$560.10

PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE

Professional

Both

$491.16

Service Code	HCPCS 64640
Min. Negotiated Rate	$368.37
Max. Negotiated Rate	$368.37
Rate for Payer: Cash Price	$136.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$368.37
Rate for Payer: SOMOS Essential	$368.37

PR DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE

Professional

Both

$829.19

Service Code	HCPCS 64630
Min. Negotiated Rate	$621.89
Max. Negotiated Rate	$621.89
Rate for Payer: Cash Price	$223.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$621.89
Rate for Payer: SOMOS Essential	$621.89

PR DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE

Professional

Both

$274.86

Service Code	HCPCS 64632
Min. Negotiated Rate	$206.14
Max. Negotiated Rate	$206.14
Rate for Payer: Cash Price	$75.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$206.14
Rate for Payer: SOMOS Essential	$206.14

PR DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH

Professional

Both

$1,550.15

Service Code	HCPCS 64605
Min. Negotiated Rate	$1,162.61
Max. Negotiated Rate	$1,162.61
Rate for Payer: Cash Price	$537.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,162.61
Rate for Payer: SOMOS Essential	$1,162.61

PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS

Professional

Both

$672.91

Service Code	HCPCS 64680
Min. Negotiated Rate	$504.68
Max. Negotiated Rate	$504.68
Rate for Payer: Cash Price	$182.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$504.68
Rate for Payer: SOMOS Essential	$504.68

PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS

Professional

Both

$926.73

Service Code	HCPCS 64681
Min. Negotiated Rate	$695.05
Max. Negotiated Rate	$695.05
Rate for Payer: Cash Price	$247.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$695.05
Rate for Payer: SOMOS Essential	$695.05

PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH

Professional

Both

$1,022.25

Service Code	HCPCS 64600
Min. Negotiated Rate	$766.69
Max. Negotiated Rate	$766.69
Rate for Payer: Cash Price	$284.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$766.69
Rate for Payer: SOMOS Essential	$766.69

PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA

Professional

Both

$274.37

Service Code	HCPCS 64634
Min. Negotiated Rate	$205.78
Max. Negotiated Rate	$205.78
Rate for Payer: Cash Price	$75.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$205.78
Rate for Payer: SOMOS Essential	$205.78

PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL

Professional

Both

$242.94

Service Code	HCPCS 64636
Min. Negotiated Rate	$182.20
Max. Negotiated Rate	$182.20
Rate for Payer: Cash Price	$65.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$182.20
Rate for Payer: SOMOS Essential	$182.20

PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA

Professional

Both

$789.71

Service Code	HCPCS 64633
Min. Negotiated Rate	$592.28
Max. Negotiated Rate	$592.28
Rate for Payer: Cash Price	$218.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$592.28
Rate for Payer: SOMOS Essential	$592.28

PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL

Professional

Both

$791.14

Service Code	HCPCS 64635
Min. Negotiated Rate	$593.36
Max. Negotiated Rate	$593.36
Rate for Payer: Cash Price	$218.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$593.36
Rate for Payer: SOMOS Essential	$593.36

PR DSTRY EYE LESN,FDR VSSL TECH

Professional

Both

$2,177.56

Service Code	HCPCS G0186
Min. Negotiated Rate	$1,633.17
Max. Negotiated Rate	$1,633.17
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,633.17
Rate for Payer: SOMOS Essential	$1,633.17

PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR

Professional

Both

$213.90

Service Code	HCPCS 90723
Min. Negotiated Rate	$160.42
Max. Negotiated Rate	$160.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$160.42
Rate for Payer: SOMOS Essential	$160.42

PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR

Professional

Both

$337.66

Service Code	HCPCS 90697
Min. Negotiated Rate	$253.24
Max. Negotiated Rate	$253.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$253.24
Rate for Payer: SOMOS Essential	$253.24

PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE

Professional

Both

$241.85

Service Code	HCPCS 90698
Min. Negotiated Rate	$181.39
Max. Negotiated Rate	$181.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$181.39
Rate for Payer: SOMOS Essential	$181.39

PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE

Professional

Both

$155.95

Service Code	HCPCS 90696
Min. Negotiated Rate	$116.96
Max. Negotiated Rate	$116.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$116.96
Rate for Payer: SOMOS Essential	$116.96

Know your out-of-pocket cost for care.

All Charges