St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION

Professional

Both

$1,156.89

Service Code	HCPCS 25500
Min. Negotiated Rate	$867.67
Max. Negotiated Rate	$867.67
Rate for Payer: Cash Price	$318.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$867.67
Rate for Payer: SOMOS Essential	$867.67

PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ

Professional

Both

$2,096.33

Service Code	HCPCS 25565
Min. Negotiated Rate	$1,572.25
Max. Negotiated Rate	$1,572.25
Rate for Payer: Cash Price	$568.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,572.25
Rate for Payer: SOMOS Essential	$1,572.25

PR CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN

Professional

Both

$1,165.57

Service Code	HCPCS 25560
Min. Negotiated Rate	$874.18
Max. Negotiated Rate	$874.18
Rate for Payer: Cash Price	$320.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$874.18
Rate for Payer: SOMOS Essential	$874.18

PR CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION

Professional

Both

$1,085.84

Service Code	HCPCS 23570
Min. Negotiated Rate	$814.38
Max. Negotiated Rate	$814.38
Rate for Payer: Cash Price	$299.92
Rate for Payer: SOMOS CHP/HARP/Medicaid	$814.38
Rate for Payer: SOMOS Essential	$814.38

PR CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION

Professional

Both

$1,628.66

Service Code	HCPCS 23525
Min. Negotiated Rate	$1,221.50
Max. Negotiated Rate	$1,221.50
Rate for Payer: Cash Price	$446.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,221.50
Rate for Payer: SOMOS Essential	$1,221.50

PR CLOSED TX TALOTARSAL JOINT DISLC W/O ANES

Professional

Both

$878.26

Service Code	HCPCS 28570
Min. Negotiated Rate	$658.70
Max. Negotiated Rate	$658.70
Rate for Payer: Cash Price	$243.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$658.70
Rate for Payer: SOMOS Essential	$658.70

PR CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES

Professional

Both

$1,518.34

Service Code	HCPCS 28575
Min. Negotiated Rate	$1,138.76
Max. Negotiated Rate	$1,138.76
Rate for Payer: Cash Price	$415.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,138.76
Rate for Payer: SOMOS Essential	$1,138.76

PR CLOSED TX TALUS FRACTURE W/MANIPULATION

Professional

Both

$1,469.83

Service Code	HCPCS 28435
Min. Negotiated Rate	$1,102.37
Max. Negotiated Rate	$1,102.37
Rate for Payer: Cash Price	$402.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,102.37
Rate for Payer: SOMOS Essential	$1,102.37

PR CLOSED TX TALUS FRACTURE W/O MANIPULATION

Professional

Both

$928.69

Service Code	HCPCS 28430
Min. Negotiated Rate	$696.52
Max. Negotiated Rate	$696.52
Rate for Payer: Cash Price	$255.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$696.52
Rate for Payer: SOMOS Essential	$696.52

PR CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES

Professional

Both

$1,361.61

Service Code	HCPCS 28605
Min. Negotiated Rate	$1,021.21
Max. Negotiated Rate	$1,021.21
Rate for Payer: Cash Price	$374.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,021.21
Rate for Payer: SOMOS Essential	$1,021.21

PR CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES

Professional

Both

$808.57

Service Code	HCPCS 28600
Min. Negotiated Rate	$606.43
Max. Negotiated Rate	$606.43
Rate for Payer: Cash Price	$189.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$606.43
Rate for Payer: SOMOS Essential	$606.43

PR CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ

Professional

Both

$3,402.63

Service Code	HCPCS 21485
Min. Negotiated Rate	$2,551.97
Max. Negotiated Rate	$2,551.97
Rate for Payer: Cash Price	$912.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,551.97
Rate for Payer: SOMOS Essential	$2,551.97

PR CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ

Professional

Both

$137.97

Service Code	HCPCS 21480
Min. Negotiated Rate	$103.48
Max. Negotiated Rate	$103.48
Rate for Payer: Cash Price	$36.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$103.48
Rate for Payer: SOMOS Essential	$103.48

PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ

Professional

Both

$1,868.34

Service Code	HCPCS 24675
Min. Negotiated Rate	$1,401.26
Max. Negotiated Rate	$1,401.26
Rate for Payer: Cash Price	$510.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,401.26
Rate for Payer: SOMOS Essential	$1,401.26

PR CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ

Professional

Both

$1,206.42

Service Code	HCPCS 24670
Min. Negotiated Rate	$904.82
Max. Negotiated Rate	$904.82
Rate for Payer: Cash Price	$330.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$904.82
Rate for Payer: SOMOS Essential	$904.82

PR CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION

Professional

Both

$2,044.35

Service Code	HCPCS 25535
Min. Negotiated Rate	$1,533.26
Max. Negotiated Rate	$1,533.26
Rate for Payer: Cash Price	$559.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,533.26
Rate for Payer: SOMOS Essential	$1,533.26

PR CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION

Professional

Both

$1,091.09

Service Code	HCPCS 25530
Min. Negotiated Rate	$818.32
Max. Negotiated Rate	$818.32
Rate for Payer: Cash Price	$300.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$818.32
Rate for Payer: SOMOS Essential	$818.32

PR CLOSE MEDIAN STERNOTOMY SEP W/WO DEBRIDEMENT SPX

Professional

Both

$3,021.17

Service Code	HCPCS 21750
Min. Negotiated Rate	$2,265.88
Max. Negotiated Rate	$2,265.88
Rate for Payer: Cash Price	$806.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,265.88
Rate for Payer: SOMOS Essential	$2,265.88

PR CLOSURE ATRIOVENTRICULAR VALVE SUTURE/PATCH

Professional

Both

$7,651.07

Service Code	HCPCS 33600
Min. Negotiated Rate	$5,738.30
Max. Negotiated Rate	$5,738.30
Rate for Payer: Cash Price	$2,037.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,738.30
Rate for Payer: SOMOS Essential	$5,738.30

PR CLOSURE CYSTOSTOMY SEPARATE PROCEDURE

Professional

Both

$1,962.10

Service Code	HCPCS 51880
Min. Negotiated Rate	$1,471.58
Max. Negotiated Rate	$1,471.58
Rate for Payer: Cash Price	$540.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,471.58
Rate for Payer: SOMOS Essential	$1,471.58

PR CLOSURE ENTEROSTOMY LG/SMALL INTESTINE

Professional

Both

$3,829.53

Service Code	HCPCS 44620
Min. Negotiated Rate	$2,872.15
Max. Negotiated Rate	$2,872.15
Rate for Payer: Cash Price	$1,023.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,872.15
Rate for Payer: SOMOS Essential	$2,872.15

PR CLOSURE EXSTROPHY BLADDER

Professional

Both

$6,829.73

Service Code	HCPCS 51940
Min. Negotiated Rate	$5,122.30
Max. Negotiated Rate	$5,122.30
Rate for Payer: Cash Price	$1,863.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,122.30
Rate for Payer: SOMOS Essential	$5,122.30

PR CLOSURE GASTROCOLIC FISTULA

Professional

Both

$7,105.56

Service Code	HCPCS 43880
Min. Negotiated Rate	$5,329.17
Max. Negotiated Rate	$5,329.17
Rate for Payer: Cash Price	$1,935.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,329.17
Rate for Payer: SOMOS Essential	$5,329.17

PR CLOSURE GASTROSTOMY SURG

Professional

Both

$3,191.20

Service Code	HCPCS 43870
Min. Negotiated Rate	$2,393.40
Max. Negotiated Rate	$2,393.40
Rate for Payer: Cash Price	$851.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,393.40
Rate for Payer: SOMOS Essential	$2,393.40

PR CLOSURE INTESTINAL CUTANEOUS FISTULA

Professional

Both

$6,201.72

Service Code	HCPCS 44640
Min. Negotiated Rate	$4,651.29
Max. Negotiated Rate	$4,651.29
Rate for Payer: Cash Price	$1,655.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,651.29
Rate for Payer: SOMOS Essential	$4,651.29

Know your out-of-pocket cost for care.

All Charges