St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION

Professional

Both

$2,753.66

Service Code	HCPCS 21336
Min. Negotiated Rate	$2,065.24
Max. Negotiated Rate	$2,065.24
Rate for Payer: Cash Price	$748.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,065.24
Rate for Payer: SOMOS Essential	$2,065.24

PR OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION

Professional

Both

$3,287.55

Service Code	HCPCS 21339
Min. Negotiated Rate	$2,465.66
Max. Negotiated Rate	$2,465.66
Rate for Payer: Cash Price	$889.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,465.66
Rate for Payer: SOMOS Essential	$2,465.66

PR OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION

Professional

Both

$2,909.80

Service Code	HCPCS 21338
Min. Negotiated Rate	$2,182.35
Max. Negotiated Rate	$2,182.35
Rate for Payer: Cash Price	$788.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,182.35
Rate for Payer: SOMOS Essential	$2,182.35

PR OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR

Professional

Both

$3,348.49

Service Code	HCPCS 21387
Min. Negotiated Rate	$2,511.37
Max. Negotiated Rate	$2,511.37
Rate for Payer: Cash Price	$903.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,511.37
Rate for Payer: SOMOS Essential	$2,511.37

PR OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL

Professional

Both

$3,027.68

Service Code	HCPCS 21386
Min. Negotiated Rate	$2,270.76
Max. Negotiated Rate	$2,270.76
Rate for Payer: Cash Price	$817.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,270.76
Rate for Payer: SOMOS Essential	$2,270.76

PR OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL

Professional

Both

$3,208.80

Service Code	HCPCS 21385
Min. Negotiated Rate	$2,406.60
Max. Negotiated Rate	$2,406.60
Rate for Payer: Cash Price	$865.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,406.60
Rate for Payer: SOMOS Essential	$2,406.60

PR OPEN TX PALATAL/MAXILLARY FX COMP MULTIPLE APPR

Professional

Both

$3,493.74

Service Code	HCPCS 21423
Min. Negotiated Rate	$2,620.30
Max. Negotiated Rate	$2,620.30
Rate for Payer: Cash Price	$939.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,620.30
Rate for Payer: SOMOS Essential	$2,620.30

PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA

Professional

Both

$2,630.88

Service Code	HCPCS 26735
Min. Negotiated Rate	$1,973.16
Max. Negotiated Rate	$1,973.16
Rate for Payer: Cash Price	$716.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,973.16
Rate for Payer: SOMOS Essential	$1,973.16

PR OPEN TX POST PELVIC FXCTURE

Professional

Both

$6,068.97

Service Code	HCPCS G0415
Min. Negotiated Rate	$4,551.73
Max. Negotiated Rate	$4,551.73
Rate for Payer: Cash Price	$1,628.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,551.73
Rate for Payer: SOMOS Essential	$4,551.73

PR OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB

Professional

Both

$3,360.00

Service Code	HCPCS 27832
Min. Negotiated Rate	$2,520.00
Max. Negotiated Rate	$2,520.00
Rate for Payer: Cash Price	$910.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,520.00
Rate for Payer: SOMOS Essential	$2,520.00

PR OPEN TX RADIAL HEAD/NECK FRACTURE

Professional

Both

$2,909.41

Service Code	HCPCS 24665
Min. Negotiated Rate	$2,182.06
Max. Negotiated Rate	$2,182.06
Rate for Payer: Cash Price	$790.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,182.06
Rate for Payer: SOMOS Essential	$2,182.06

PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC

Professional

Both

$3,245.24

Service Code	HCPCS 24666
Min. Negotiated Rate	$2,433.93
Max. Negotiated Rate	$2,433.93
Rate for Payer: Cash Price	$877.89
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,433.93
Rate for Payer: SOMOS Essential	$2,433.93

PR OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA

Professional

Both

$4,002.64

Service Code	HCPCS 25575
Min. Negotiated Rate	$3,001.98
Max. Negotiated Rate	$3,001.98
Rate for Payer: Cash Price	$1,082.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,001.98
Rate for Payer: SOMOS Essential	$3,001.98

PR OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA

Professional

Both

$2,997.51

Service Code	HCPCS 25574
Min. Negotiated Rate	$2,248.13
Max. Negotiated Rate	$2,248.13
Rate for Payer: Cash Price	$812.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,248.13
Rate for Payer: SOMOS Essential	$2,248.13

PR OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES

Professional

Both

$2,700.64

Service Code	HCPCS 25670
Min. Negotiated Rate	$2,025.48
Max. Negotiated Rate	$2,025.48
Rate for Payer: Cash Price	$730.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,025.48
Rate for Payer: SOMOS Essential	$2,025.48

PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS

Professional

Both

$2,656.05

Service Code	HCPCS 21811
Min. Negotiated Rate	$1,992.04
Max. Negotiated Rate	$1,992.04
Rate for Payer: Cash Price	$706.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,992.04
Rate for Payer: SOMOS Essential	$1,992.04

PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS

Professional

Both

$3,217.59

Service Code	HCPCS 21812
Min. Negotiated Rate	$2,413.19
Max. Negotiated Rate	$2,413.19
Rate for Payer: Cash Price	$851.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,413.19
Rate for Payer: SOMOS Essential	$2,413.19

PR OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS

Professional

Both

$4,434.33

Service Code	HCPCS 21813
Min. Negotiated Rate	$3,325.75
Max. Negotiated Rate	$3,325.75
Rate for Payer: Cash Price	$1,174.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,325.75
Rate for Payer: SOMOS Essential	$3,325.75

PR OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD

Professional

Both

$4,309.90

Service Code	HCPCS 23585
Min. Negotiated Rate	$3,232.42
Max. Negotiated Rate	$3,232.42
Rate for Payer: Cash Price	$1,161.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,232.42
Rate for Payer: SOMOS Essential	$3,232.42

PR OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION

Professional

Both

$751.94

Service Code	HCPCS 28531
Min. Negotiated Rate	$563.96
Max. Negotiated Rate	$563.96
Rate for Payer: Cash Price	$210.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$563.96
Rate for Payer: SOMOS Essential	$563.96

PR OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX

Professional

Both

$3,846.68

Service Code	HCPCS 23670
Min. Negotiated Rate	$2,885.01
Max. Negotiated Rate	$2,885.01
Rate for Payer: Cash Price	$1,043.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,885.01
Rate for Payer: SOMOS Essential	$2,885.01

PR OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE

Professional

Both

$4,116.07

Service Code	HCPCS 23680
Min. Negotiated Rate	$3,087.05
Max. Negotiated Rate	$3,087.05
Rate for Payer: Cash Price	$1,097.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,087.05
Rate for Payer: SOMOS Essential	$3,087.05

PR OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC

Professional

Both

$2,567.43

Service Code	HCPCS 23530
Min. Negotiated Rate	$1,925.57
Max. Negotiated Rate	$1,925.57
Rate for Payer: Cash Price	$694.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,925.57
Rate for Payer: SOMOS Essential	$1,925.57

PR OPEN TX STERNUM FRACTURE W/WO SKELETAL FIXATION

Professional

Both

$2,455.15

Service Code	HCPCS 21825
Min. Negotiated Rate	$1,841.36
Max. Negotiated Rate	$1,841.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,841.36
Rate for Payer: SOMOS Essential	$1,841.36

PR OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA

Professional

Both

$2,732.91

Service Code	HCPCS 28465
Min. Negotiated Rate	$2,049.68
Max. Negotiated Rate	$2,049.68
Rate for Payer: Cash Price	$756.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,049.68
Rate for Payer: SOMOS Essential	$2,049.68

Know your out-of-pocket cost for care.

All Charges