St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CLOSED TX CRANIOFACIAL SEPARATION

Professional

Both

$2,938.50

Service Code	HCPCS 21431
Min. Negotiated Rate	$2,203.88
Max. Negotiated Rate	$2,203.88
Rate for Payer: Cash Price	$798.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,203.88
Rate for Payer: SOMOS Essential	$2,203.88

PR CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ

Professional

Both

$1,852.34

Service Code	HCPCS 25675
Min. Negotiated Rate	$1,389.26
Max. Negotiated Rate	$1,389.26
Rate for Payer: Cash Price	$507.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,389.26
Rate for Payer: SOMOS Essential	$1,389.26

PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ

Professional

Both

$2,425.71

Service Code	HCPCS 27268
Min. Negotiated Rate	$1,819.28
Max. Negotiated Rate	$1,819.28
Rate for Payer: Cash Price	$657.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,819.28
Rate for Payer: SOMOS Essential	$1,819.28

PR CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ

Professional

Both

$1,959.27

Service Code	HCPCS 27267
Min. Negotiated Rate	$1,469.45
Max. Negotiated Rate	$1,469.45
Rate for Payer: Cash Price	$536.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,469.45
Rate for Payer: SOMOS Essential	$1,469.45

PR CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION

Professional

Both

$2,148.69

Service Code	HCPCS 27500
Min. Negotiated Rate	$1,611.52
Max. Negotiated Rate	$1,611.52
Rate for Payer: Cash Price	$581.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,611.52
Rate for Payer: SOMOS Essential	$1,611.52

PR CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION

Professional

Both

$1,439.31

Service Code	HCPCS 21401
Min. Negotiated Rate	$1,079.48
Max. Negotiated Rate	$1,079.48
Rate for Payer: Cash Price	$393.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,079.48
Rate for Payer: SOMOS Essential	$1,079.48

PR CLOSED TX KNEE DISLOCATION W/ANESTHESIA

Professional

Both

$2,813.30

Service Code	HCPCS 27552
Min. Negotiated Rate	$2,109.98
Max. Negotiated Rate	$2,109.98
Rate for Payer: Cash Price	$765.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,109.98
Rate for Payer: SOMOS Essential	$2,109.98

PR CLOSED TX KNEE DISLOCATION W/O ANESTHESIA

Professional

Both

$2,116.77

Service Code	HCPCS 27550
Min. Negotiated Rate	$1,587.58
Max. Negotiated Rate	$1,587.58
Rate for Payer: Cash Price	$572.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,587.58
Rate for Payer: SOMOS Essential	$1,587.58

PR CLOSED TX LUNATE DISLOCATION W/MANIPULATION

Professional

Both

$2,197.02

Service Code	HCPCS 25690
Min. Negotiated Rate	$1,647.76
Max. Negotiated Rate	$1,647.76
Rate for Payer: Cash Price	$600.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,647.76
Rate for Payer: SOMOS Essential	$1,647.76

PR CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION

Professional

Both

$2,739.98

Service Code	HCPCS 21451
Min. Negotiated Rate	$2,054.98
Max. Negotiated Rate	$2,054.98
Rate for Payer: Cash Price	$742.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,054.98
Rate for Payer: SOMOS Essential	$2,054.98

PR CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION

Professional

Both

$2,055.45

Service Code	HCPCS 21450
Min. Negotiated Rate	$1,541.59
Max. Negotiated Rate	$1,541.59
Rate for Payer: Cash Price	$558.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,541.59
Rate for Payer: SOMOS Essential	$1,541.59

PR CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION

Professional

Both

$4,023.46

Service Code	HCPCS 21453
Min. Negotiated Rate	$3,017.60
Max. Negotiated Rate	$3,017.60
Rate for Payer: Cash Price	$1,089.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,017.60
Rate for Payer: SOMOS Essential	$3,017.60

PR CLOSED TX METATARSAL FRACTURE W/O MANIPULATION

Professional

Both

$893.06

Service Code	HCPCS 28470
Min. Negotiated Rate	$669.80
Max. Negotiated Rate	$669.80
Rate for Payer: Cash Price	$248.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$669.80
Rate for Payer: SOMOS Essential	$669.80

PR CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ

Professional

Both

$2,620.66

Service Code	HCPCS 24620
Min. Negotiated Rate	$1,965.50
Max. Negotiated Rate	$1,965.50
Rate for Payer: Cash Price	$713.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,965.50
Rate for Payer: SOMOS Essential	$1,965.50

PR CLOSED TX NASAL BONE FX W/MNPJ W/O STABILIZATION

Professional

Both

$263.06

Service Code	HCPCS 21315
Min. Negotiated Rate	$197.30
Max. Negotiated Rate	$197.30
Rate for Payer: Cash Price	$69.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$197.30
Rate for Payer: SOMOS Essential	$197.30

PR CLOSED TX NASAL BONE FX W/MNPJ W/STABILIZATION

Professional

Both

$407.26

Service Code	HCPCS 21320
Min. Negotiated Rate	$305.44
Max. Negotiated Rate	$305.44
Rate for Payer: Cash Price	$110.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$305.44
Rate for Payer: SOMOS Essential	$305.44

PR CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION

Professional

Both

$1,304.45

Service Code	HCPCS 21337
Min. Negotiated Rate	$978.34
Max. Negotiated Rate	$978.34
Rate for Payer: Cash Price	$356.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$978.34
Rate for Payer: SOMOS Essential	$978.34

PR CLOSED TX NASOMAXILLARY COMPLEX FRACTURE

Professional

Both

$2,762.90

Service Code	HCPCS 21345
Min. Negotiated Rate	$2,072.18
Max. Negotiated Rate	$2,072.18
Rate for Payer: Cash Price	$752.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,072.18
Rate for Payer: SOMOS Essential	$2,072.18

PR CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT

Professional

Both

$2,305.91

Service Code	HCPCS 21421
Min. Negotiated Rate	$1,729.43
Max. Negotiated Rate	$1,729.43
Rate for Payer: Cash Price	$629.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,729.43
Rate for Payer: SOMOS Essential	$1,729.43

PR CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA

Professional

Both

$2,188.52

Service Code	HCPCS 27562
Min. Negotiated Rate	$1,641.39
Max. Negotiated Rate	$1,641.39
Rate for Payer: Cash Price	$595.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,641.39
Rate for Payer: SOMOS Essential	$1,641.39

PR CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA

Professional

Both

$1,539.58

Service Code	HCPCS 27560
Min. Negotiated Rate	$1,154.68
Max. Negotiated Rate	$1,154.68
Rate for Payer: Cash Price	$419.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,154.68
Rate for Payer: SOMOS Essential	$1,154.68

PR CLOSED TX PATELLAR FRACTURE W/O MANIPULATION

Professional

Both

$1,352.93

Service Code	HCPCS 27520
Min. Negotiated Rate	$1,014.70
Max. Negotiated Rate	$1,014.70
Rate for Payer: Cash Price	$370.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,014.70
Rate for Payer: SOMOS Essential	$1,014.70

PR CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION

Professional

Both

$1,813.77

Service Code	HCPCS 24655
Min. Negotiated Rate	$1,360.33
Max. Negotiated Rate	$1,360.33
Rate for Payer: Cash Price	$499.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,360.33
Rate for Payer: SOMOS Essential	$1,360.33

PR CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION

Professional

Both

$1,104.04

Service Code	HCPCS 24650
Min. Negotiated Rate	$828.03
Max. Negotiated Rate	$828.03
Rate for Payer: Cash Price	$304.39
Rate for Payer: SOMOS CHP/HARP/Medicaid	$828.03
Rate for Payer: SOMOS Essential	$828.03

PR CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION

Professional

Both

$2,065.14

Service Code	HCPCS 25505
Min. Negotiated Rate	$1,548.86
Max. Negotiated Rate	$1,548.86
Rate for Payer: Cash Price	$565.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,548.86
Rate for Payer: SOMOS Essential	$1,548.86

Know your out-of-pocket cost for care.

All Charges