St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR APPLICATION CAST PLASTER VELPEAU

Professional

Both

$410.59

Service Code	HCPCS 29058
Min. Negotiated Rate	$307.94
Max. Negotiated Rate	$307.94
Rate for Payer: Cash Price	$111.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.94
Rate for Payer: SOMOS Essential	$307.94

PR APPLICATION CAST SHOULDER HAND LONG ARM

Professional

Both

$300.55

Service Code	HCPCS 29065
Min. Negotiated Rate	$225.41
Max. Negotiated Rate	$225.41
Rate for Payer: Cash Price	$81.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$225.41
Rate for Payer: SOMOS Essential	$225.41

PR APPLICATION CAST SHOULDER SPICA

Professional

Both

$603.19

Service Code	HCPCS 29055
Min. Negotiated Rate	$452.39
Max. Negotiated Rate	$452.39
Rate for Payer: Cash Price	$164.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$452.39
Rate for Payer: SOMOS Essential	$452.39

PR APPLICATION CYLINDER CAST THIGH ANKLE

Professional

Both

$381.78

Service Code	HCPCS 29365
Min. Negotiated Rate	$286.34
Max. Negotiated Rate	$286.34
Rate for Payer: Cash Price	$104.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$286.34
Rate for Payer: SOMOS Essential	$286.34

PR APPLICATION FINGER SPLINT DYNAMIC

Professional

Both

$152.32

Service Code	HCPCS 29131
Min. Negotiated Rate	$114.24
Max. Negotiated Rate	$114.24
Rate for Payer: Cash Price	$40.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$114.24
Rate for Payer: SOMOS Essential	$114.24

PR APPLICATION FINGER SPLINT STATIC

Professional

Both

$130.24

Service Code	HCPCS 29130
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$97.68
Rate for Payer: Cash Price	$34.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$97.68
Rate for Payer: SOMOS Essential	$97.68

PR APPLICATION HALO CRANIAL INCLUDING REMOVAL

Professional

Both

$2,384.69

Service Code	HCPCS 20661
Min. Negotiated Rate	$1,788.52
Max. Negotiated Rate	$1,788.52
Rate for Payer: Cash Price	$651.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,788.52
Rate for Payer: SOMOS Essential	$1,788.52

PR APPLICATION HALO FEMORAL INCLUDING REMOVAL

Professional

Both

$2,126.08

Service Code	HCPCS 20663
Min. Negotiated Rate	$1,594.56
Max. Negotiated Rate	$1,594.56
Rate for Payer: Cash Price	$580.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,594.56
Rate for Payer: SOMOS Essential	$1,594.56

PR APPLICATION HALO PELVIC INCLUDING REMOVAL

Professional

Both

$2,307.94

Service Code	HCPCS 20662
Min. Negotiated Rate	$1,730.96
Max. Negotiated Rate	$1,730.96
Rate for Payer: Cash Price	$627.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,730.96
Rate for Payer: SOMOS Essential	$1,730.96

PR APPLICATION HALO TYPE BODY CAST

Professional

Both

$929.01

Service Code	HCPCS 29000
Min. Negotiated Rate	$696.76
Max. Negotiated Rate	$696.76
Rate for Payer: Cash Price	$249.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$696.76
Rate for Payer: SOMOS Essential	$696.76

PR APPLICATION HIP SPICA CAST 1 LEG

Professional

Both

$694.19

Service Code	HCPCS 29305
Min. Negotiated Rate	$520.64
Max. Negotiated Rate	$520.64
Rate for Payer: Cash Price	$188.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$520.64
Rate for Payer: SOMOS Essential	$520.64

PR APPLICATION LONG ARM SPLINT SHOULDER HAND

Professional

Both

$188.41

Service Code	HCPCS 29105
Min. Negotiated Rate	$141.31
Max. Negotiated Rate	$141.31
Rate for Payer: Cash Price	$49.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.31
Rate for Payer: SOMOS Essential	$141.31

PR APPLICATION LONG LEG CAST BRACE

Professional

Both

$452.52

Service Code	HCPCS 29358
Min. Negotiated Rate	$339.39
Max. Negotiated Rate	$339.39
Rate for Payer: Cash Price	$122.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$339.39
Rate for Payer: SOMOS Essential	$339.39

PR APPLICATION LONG LEG CAST THIGH-TOE

Professional

Both

$436.10

Service Code	HCPCS 29345
Min. Negotiated Rate	$327.08
Max. Negotiated Rate	$327.08
Rate for Payer: Cash Price	$116.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$327.08
Rate for Payer: SOMOS Essential	$327.08

PR APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE

Professional

Both

$465.05

Service Code	HCPCS 29355
Min. Negotiated Rate	$348.79
Max. Negotiated Rate	$348.79
Rate for Payer: Cash Price	$125.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$348.79
Rate for Payer: SOMOS Essential	$348.79

PR APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES

Professional

Both

$225.65

Service Code	HCPCS 29505
Min. Negotiated Rate	$169.24
Max. Negotiated Rate	$169.24
Rate for Payer: Cash Price	$61.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$169.24
Rate for Payer: SOMOS Essential	$169.24

PR APPLICATION MODALITY 1/> AREAS DIATHERMY

Professional

Both

$31.82

Service Code	HCPCS 97024
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$23.86
Rate for Payer: Cash Price	$8.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.86
Rate for Payer: SOMOS Essential	$23.86

PR APPLICATION MODALITY 1/> AREAS INFRARED

Professional

Both

$28.95

Service Code	HCPCS 97026
Min. Negotiated Rate	$21.71
Max. Negotiated Rate	$21.71
Rate for Payer: Cash Price	$7.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21.71
Rate for Payer: SOMOS Essential	$21.71

PR APPLICATION MODALITY 1/> AREAS WHIRLPOOL

Professional

Both

$71.47

Service Code	HCPCS 97022
Min. Negotiated Rate	$53.60
Max. Negotiated Rate	$53.60
Rate for Payer: Cash Price	$19.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$53.60
Rate for Payer: SOMOS Essential	$53.60

PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM

Professional

Both

$4,899.51

Service Code	HCPCS 20692
Min. Negotiated Rate	$3,674.63
Max. Negotiated Rate	$3,674.63
Rate for Payer: Cash Price	$1,334.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,674.63
Rate for Payer: SOMOS Essential	$3,674.63

PR APPLICATION PATELLAR TENDON BEARING CAST

Professional

Both

$350.60

Service Code	HCPCS 29435
Min. Negotiated Rate	$262.95
Max. Negotiated Rate	$262.95
Rate for Payer: Cash Price	$102.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$262.95
Rate for Payer: SOMOS Essential	$262.95

PR APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND

Professional

Both

$7,332.89

Service Code	HCPCS 33620
Min. Negotiated Rate	$5,499.67
Max. Negotiated Rate	$5,499.67
Rate for Payer: Cash Price	$1,947.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,499.67
Rate for Payer: SOMOS Essential	$5,499.67

PR APPLICATION RIGID TOTAL CONTACT LEG CAST

Professional

Both

$410.06

Service Code	HCPCS 29445
Min. Negotiated Rate	$307.54
Max. Negotiated Rate	$307.54
Rate for Payer: Cash Price	$112.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$307.54
Rate for Payer: SOMOS Essential	$307.54

PR APPLICATION RISSER JACKET LOCALIZER BODY ONLY

Professional

Both

$703.57

Service Code	HCPCS 29010
Min. Negotiated Rate	$527.68
Max. Negotiated Rate	$527.68
Rate for Payer: Cash Price	$190.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$527.68
Rate for Payer: SOMOS Essential	$527.68

PR APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD

Professional

Both

$792.44

Service Code	HCPCS 29015
Min. Negotiated Rate	$594.33
Max. Negotiated Rate	$594.33
Rate for Payer: Cash Price	$214.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$594.33
Rate for Payer: SOMOS Essential	$594.33

Know your out-of-pocket cost for care.

All Charges