St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR APPLICATION SHORT ARM SPLINT DYNAMIC

Professional

Both

$211.72

Service Code	HCPCS 29126
Min. Negotiated Rate	$158.79
Max. Negotiated Rate	$158.79
Rate for Payer: Cash Price	$57.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$158.79
Rate for Payer: SOMOS Essential	$158.79

PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC

Professional

Both

$177.66

Service Code	HCPCS 29125
Min. Negotiated Rate	$133.24
Max. Negotiated Rate	$133.24
Rate for Payer: Cash Price	$47.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$133.24
Rate for Payer: SOMOS Essential	$133.24

PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE

Professional

Both

$250.92

Service Code	HCPCS 29405
Min. Negotiated Rate	$188.19
Max. Negotiated Rate	$188.19
Rate for Payer: Cash Price	$69.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$188.19
Rate for Payer: SOMOS Essential	$188.19

PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY

Professional

Both

$229.64

Service Code	HCPCS 29425
Min. Negotiated Rate	$172.23
Max. Negotiated Rate	$172.23
Rate for Payer: Cash Price	$62.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$172.23
Rate for Payer: SOMOS Essential	$172.23

PR APPLICATION SHORT LEG SPLINT CALF FOOT

Professional

Both

$212.10

Service Code	HCPCS 29515
Min. Negotiated Rate	$159.08
Max. Negotiated Rate	$159.08
Rate for Payer: Cash Price	$58.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$159.08
Rate for Payer: SOMOS Essential	$159.08

PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM

Professional

Both

$2,626.12

Service Code	HCPCS 20690
Min. Negotiated Rate	$1,969.59
Max. Negotiated Rate	$1,969.59
Rate for Payer: Cash Price	$710.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,969.59
Rate for Payer: SOMOS Essential	$1,969.59

PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC

Professional

Both

$3,059.42

Service Code	HCPCS 21110
Min. Negotiated Rate	$2,294.56
Max. Negotiated Rate	$2,294.56
Rate for Payer: Cash Price	$824.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,294.56
Rate for Payer: SOMOS Essential	$2,294.56

PR APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT

Professional

Both

$103.78

Service Code	HCPCS 29581
Min. Negotiated Rate	$77.84
Max. Negotiated Rate	$77.84
Rate for Payer: Cash Price	$28.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.84
Rate for Payer: SOMOS Essential	$77.84

PR APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FING

Professional

Both

$62.37

Service Code	HCPCS 29584
Min. Negotiated Rate	$46.78
Max. Negotiated Rate	$46.78
Rate for Payer: Cash Price	$16.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$46.78
Rate for Payer: SOMOS Essential	$46.78

PR APPL MODALITY 1+ AREAS CONTRAST BATHS EA 15 MIN

Professional

Both

$59.22

Service Code	HCPCS 97034
Min. Negotiated Rate	$44.42
Max. Negotiated Rate	$44.42
Rate for Payer: Cash Price	$15.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.42
Rate for Payer: SOMOS Essential	$44.42

PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN

Professional

Both

$58.49

Service Code	HCPCS 97032
Min. Negotiated Rate	$43.87
Max. Negotiated Rate	$43.87
Rate for Payer: Cash Price	$16.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.87
Rate for Payer: SOMOS Essential	$43.87

PR APPL MODALITY 1+ AREAS HUBBARD TANK EA 15 MIN

Professional

Both

$145.64

Service Code	HCPCS 97036
Min. Negotiated Rate	$109.23
Max. Negotiated Rate	$109.23
Rate for Payer: Cash Price	$40.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$109.23
Rate for Payer: SOMOS Essential	$109.23

PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN

Professional

Both

$81.31

Service Code	HCPCS 97033
Min. Negotiated Rate	$60.98
Max. Negotiated Rate	$60.98
Rate for Payer: Cash Price	$21.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$60.98
Rate for Payer: SOMOS Essential	$60.98

PR APPL MODALITY 1/> AREAS PARAFFIN BATH

Professional

Both

$24.64

Service Code	HCPCS 97018
Min. Negotiated Rate	$18.48
Max. Negotiated Rate	$18.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.48
Rate for Payer: SOMOS Essential	$18.48

PR APPL MODALITY 1/> AREAS TRACTION MECHANICAL

Professional

Both

$58.49

Service Code	HCPCS 97012
Min. Negotiated Rate	$43.87
Max. Negotiated Rate	$43.87
Rate for Payer: Cash Price	$15.63
Rate for Payer: SOMOS CHP/HARP/Medicaid	$43.87
Rate for Payer: SOMOS Essential	$43.87

PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN

Professional

Both

$59.22

Service Code	HCPCS 97035
Min. Negotiated Rate	$44.42
Max. Negotiated Rate	$44.42
Rate for Payer: Cash Price	$15.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$44.42
Rate for Payer: SOMOS Essential	$44.42

PR APPL MODALITY 1/> AREAS ULTRAVIOLET

Professional

Both

$35.77

Service Code	HCPCS 97028
Min. Negotiated Rate	$26.83
Max. Negotiated Rate	$26.83
Rate for Payer: Cash Price	$9.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26.83
Rate for Payer: SOMOS Essential	$26.83

PR APPL MODALITY 1/> AREAS VASOPNEUMATIC DEVICES

Professional

Both

$48.27

Service Code	HCPCS 97016
Min. Negotiated Rate	$36.20
Max. Negotiated Rate	$36.20
Rate for Payer: Cash Price	$13.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$36.20
Rate for Payer: SOMOS Essential	$36.20

PR APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION

Professional

Both

$77.21

Service Code	HCPCS 96377
Min. Negotiated Rate	$57.91
Max. Negotiated Rate	$57.91
Rate for Payer: Cash Price	$21.09
Rate for Payer: SOMOS CHP/HARP/Medicaid	$57.91
Rate for Payer: SOMOS Essential	$57.91

PR APPL STRTCTC HEADFRAME STEREOTACTIC RADIOSURGERY

Professional

Both

$726.29

Service Code	HCPCS 61800
Min. Negotiated Rate	$544.72
Max. Negotiated Rate	$544.72
Rate for Payer: Cash Price	$190.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$544.72
Rate for Payer: SOMOS Essential	$544.72

PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT 1ST&SUBSQ

Professional

Both

$5,103.00

Service Code	HCPCS 20696
Min. Negotiated Rate	$3,827.25
Max. Negotiated Rate	$3,827.25
Rate for Payer: Cash Price	$1,372.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,827.25
Rate for Payer: SOMOS Essential	$3,827.25

PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE

Professional

Both

$7,897.05

Service Code	HCPCS 20697
Min. Negotiated Rate	$5,922.79
Max. Negotiated Rate	$5,922.79
Rate for Payer: Cash Price	$2,087.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,922.79
Rate for Payer: SOMOS Essential	$5,922.79

PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM

Professional

Both

$199.75

Service Code	HCPCS 15274
Min. Negotiated Rate	$149.81
Max. Negotiated Rate	$149.81
Rate for Payer: Cash Price	$52.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$149.81
Rate for Payer: SOMOS Essential	$149.81

PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM

Professional

Both

$853.41

Service Code	HCPCS 15273
Min. Negotiated Rate	$640.06
Max. Negotiated Rate	$640.06
Rate for Payer: Cash Price	$227.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$640.06
Rate for Payer: SOMOS Essential	$640.06

PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25

Professional

Both

$355.88

Service Code	HCPCS 15271
Min. Negotiated Rate	$266.91
Max. Negotiated Rate	$266.91
Rate for Payer: Cash Price	$96.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$266.91
Rate for Payer: SOMOS Essential	$266.91

Know your out-of-pocket cost for care.

All Charges