St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ

Professional

Both

$4,157.30

Service Code	HCPCS 27253
Min. Negotiated Rate	$3,117.98
Max. Negotiated Rate	$3,117.98
Rate for Payer: Cash Price	$1,120.85
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,117.98
Rate for Payer: SOMOS Essential	$3,117.98

PR OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE

Professional

Both

$3,899.67

Service Code	HCPCS 24515
Min. Negotiated Rate	$2,924.75
Max. Negotiated Rate	$2,924.75
Rate for Payer: Cash Price	$1,053.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,924.75
Rate for Payer: SOMOS Essential	$2,924.75

PR OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX

Professional

Both

$2,715.65

Service Code	HCPCS 21445
Min. Negotiated Rate	$2,036.74
Max. Negotiated Rate	$2,036.74
Rate for Payer: Cash Price	$730.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,036.74
Rate for Payer: SOMOS Essential	$2,036.74

PR OPTX NASOMAX CPLX FX LEFT II TYPE REQ MLT OPN

Professional

Both

$4,495.37

Service Code	HCPCS 21347
Min. Negotiated Rate	$3,371.53
Max. Negotiated Rate	$3,371.53
Rate for Payer: Cash Price	$1,212.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,371.53
Rate for Payer: SOMOS Essential	$3,371.53

PR OPTX NASOMAX CPLX FX LEFT II TYPE W/BONE GRAFT

Professional

Both

$4,712.89

Service Code	HCPCS 21348
Min. Negotiated Rate	$3,534.67
Max. Negotiated Rate	$3,534.67
Rate for Payer: Cash Price	$1,276.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,534.67
Rate for Payer: SOMOS Essential	$3,534.67

PR OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ

Professional

Both

$4,436.08

Service Code	HCPCS 21346
Min. Negotiated Rate	$3,327.06
Max. Negotiated Rate	$3,327.06
Rate for Payer: Cash Price	$1,195.74
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,327.06
Rate for Payer: SOMOS Essential	$3,327.06

PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC

Professional

Both

$3,442.64

Service Code	HCPCS 21390
Min. Negotiated Rate	$2,581.98
Max. Negotiated Rate	$2,581.98
Rate for Payer: Cash Price	$934.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,581.98
Rate for Payer: SOMOS Essential	$2,581.98

PR OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF

Professional

Both

$4,411.96

Service Code	HCPCS 21395
Min. Negotiated Rate	$3,308.97
Max. Negotiated Rate	$3,308.97
Rate for Payer: Cash Price	$1,185.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,308.97
Rate for Payer: SOMOS Essential	$3,308.97

PR OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY

Professional

Both

$3,951.36

Service Code	HCPCS 27566
Min. Negotiated Rate	$2,963.52
Max. Negotiated Rate	$2,963.52
Rate for Payer: Cash Price	$1,068.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,963.52
Rate for Payer: SOMOS Essential	$2,963.52

PR OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR

Professional

Both

$3,337.50

Service Code	HCPCS 27524
Min. Negotiated Rate	$2,503.12
Max. Negotiated Rate	$2,503.12
Rate for Payer: Cash Price	$902.70
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,503.12
Rate for Payer: SOMOS Essential	$2,503.12

PR OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO

Professional

Both

$4,795.56

Service Code	HCPCS 24586
Min. Negotiated Rate	$3,596.67
Max. Negotiated Rate	$3,596.67
Rate for Payer: Cash Price	$1,293.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,596.67
Rate for Payer: SOMOS Essential	$3,596.67

PR OPTX POST PEL BONE FX&/DISLC INT FIXJ IF PFRMD

Professional

Both

$4,120.00

Service Code	HCPCS 27218
Min. Negotiated Rate	$3,090.00
Max. Negotiated Rate	$3,090.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,090.00
Rate for Payer: SOMOS Essential	$3,090.00

PR OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR

Professional

Both

$4,815.69

Service Code	HCPCS 24587
Min. Negotiated Rate	$3,611.77
Max. Negotiated Rate	$3,611.77
Rate for Payer: Cash Price	$1,299.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,611.77
Rate for Payer: SOMOS Essential	$3,611.77

PR OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ

Professional

Both

$4,670.68

Service Code	HCPCS 27226
Min. Negotiated Rate	$3,503.01
Max. Negotiated Rate	$3,503.01
Rate for Payer: Cash Price	$1,260.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,503.01
Rate for Payer: SOMOS Essential	$3,503.01

PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT

Professional

Both

$7,888.41

Service Code	HCPCS 22318
Min. Negotiated Rate	$5,916.31
Max. Negotiated Rate	$5,916.31
Rate for Payer: Cash Price	$2,092.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,916.31
Rate for Payer: SOMOS Essential	$5,916.31

PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ

Professional

Both

$8,817.62

Service Code	HCPCS 22319
Min. Negotiated Rate	$6,613.22
Max. Negotiated Rate	$6,613.22
Rate for Payer: Cash Price	$2,330.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,613.22
Rate for Payer: SOMOS Essential	$6,613.22

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR

Professional

Both

$7,107.94

Service Code	HCPCS 22326
Min. Negotiated Rate	$5,330.96
Max. Negotiated Rate	$5,330.96
Rate for Payer: Cash Price	$1,888.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,330.96
Rate for Payer: SOMOS Essential	$5,330.96

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA

Professional

Both

$1,328.01

Service Code	HCPCS 22328
Min. Negotiated Rate	$996.01
Max. Negotiated Rate	$996.01
Rate for Payer: Cash Price	$346.83
Rate for Payer: SOMOS CHP/HARP/Medicaid	$996.01
Rate for Payer: SOMOS Essential	$996.01

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM

Professional

Both

$6,885.83

Service Code	HCPCS 22325
Min. Negotiated Rate	$5,164.37
Max. Negotiated Rate	$5,164.37
Rate for Payer: Cash Price	$1,836.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,164.37
Rate for Payer: SOMOS Essential	$5,164.37

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH

Professional

Both

$7,192.54

Service Code	HCPCS 22327
Min. Negotiated Rate	$5,394.40
Max. Negotiated Rate	$5,394.40
Rate for Payer: Cash Price	$1,918.16
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,394.40
Rate for Payer: SOMOS Essential	$5,394.40

PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN

Professional

Both

$4,086.08

Service Code	HCPCS 27178
Min. Negotiated Rate	$3,064.56
Max. Negotiated Rate	$3,064.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,064.56
Rate for Payer: SOMOS Essential	$3,064.56

PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ

Professional

Both

$4,948.41

Service Code	HCPCS 27181
Min. Negotiated Rate	$3,711.31
Max. Negotiated Rate	$3,711.31
Rate for Payer: Cash Price	$1,336.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,711.31
Rate for Payer: SOMOS Essential	$3,711.31

PR OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX

Professional

Both

$4,334.02

Service Code	HCPCS 27179
Min. Negotiated Rate	$3,250.52
Max. Negotiated Rate	$3,250.52
Rate for Payer: Cash Price	$1,168.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,250.52
Rate for Payer: SOMOS Essential	$3,250.52

PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT

Professional

Both

$4,932.94

Service Code	HCPCS 27177
Min. Negotiated Rate	$3,699.70
Max. Negotiated Rate	$3,699.70
Rate for Payer: Cash Price	$1,330.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,699.70
Rate for Payer: SOMOS Essential	$3,699.70

PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM

Professional

Both

$4,912.46

Service Code	HCPCS 27258
Min. Negotiated Rate	$3,684.34
Max. Negotiated Rate	$3,684.34
Rate for Payer: Cash Price	$1,325.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,684.34
Rate for Payer: SOMOS Essential	$3,684.34

Know your out-of-pocket cost for care.

All Charges