St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF

Professional

Both

$2,541.49

Service Code	HCPCS 26433
Min. Negotiated Rate	$1,906.12
Max. Negotiated Rate	$1,906.12
Rate for Payer: Cash Price	$684.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,906.12
Rate for Payer: SOMOS Essential	$1,906.12

PR REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH

Professional

Both

$3,289.44

Service Code	HCPCS 26420
Min. Negotiated Rate	$2,467.08
Max. Negotiated Rate	$2,467.08
Rate for Payer: Cash Price	$887.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,467.08
Rate for Payer: SOMOS Essential	$2,467.08

PR REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH

Professional

Both

$2,762.24

Service Code	HCPCS 26418
Min. Negotiated Rate	$2,071.68
Max. Negotiated Rate	$2,071.68
Rate for Payer: Cash Price	$748.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,071.68
Rate for Payer: SOMOS Essential	$2,071.68

PR REPAIR EXTENSOR TENDON HAND W/GRAFT EACH

Professional

Both

$3,176.88

Service Code	HCPCS 26412
Min. Negotiated Rate	$2,382.66
Max. Negotiated Rate	$2,382.66
Rate for Payer: Cash Price	$855.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,382.66
Rate for Payer: SOMOS Essential	$2,382.66

PR REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH

Professional

Both

$2,666.58

Service Code	HCPCS 26410
Min. Negotiated Rate	$1,999.94
Max. Negotiated Rate	$1,999.94
Rate for Payer: Cash Price	$719.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,999.94
Rate for Payer: SOMOS Essential	$1,999.94

PR REPAIR FASCIAL DEFECT LEG

Professional

Both

$1,493.70

Service Code	HCPCS 27656
Min. Negotiated Rate	$1,120.28
Max. Negotiated Rate	$1,120.28
Rate for Payer: Cash Price	$401.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,120.28
Rate for Payer: SOMOS Essential	$1,120.28

PR REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION

Professional

Both

$4,215.12

Service Code	HCPCS 27726
Min. Negotiated Rate	$3,161.34
Max. Negotiated Rate	$3,161.34
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,161.34
Rate for Payer: SOMOS Essential	$3,161.34

PR REPAIR FISTULA OROMAXILLARY

Professional

Both

$1,942.92

Service Code	HCPCS 30580
Min. Negotiated Rate	$1,457.19
Max. Negotiated Rate	$1,457.19
Rate for Payer: Cash Price	$530.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,457.19
Rate for Payer: SOMOS Essential	$1,457.19

PR REPAIR FISTULA ORONASAL

Professional

Both

$1,608.71

Service Code	HCPCS 30600
Min. Negotiated Rate	$1,206.53
Max. Negotiated Rate	$1,206.53
Rate for Payer: Cash Price	$440.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,206.53
Rate for Payer: SOMOS Essential	$1,206.53

PR REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH

Professional

Both

$1,597.12

Service Code	HCPCS 27658
Min. Negotiated Rate	$1,197.84
Max. Negotiated Rate	$1,197.84
Rate for Payer: Cash Price	$436.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,197.84
Rate for Payer: SOMOS Essential	$1,197.84

PR REPAIR INCOMPLETE CIRCUMCISION

Professional

Both

$923.44

Service Code	HCPCS 54163
Min. Negotiated Rate	$692.58
Max. Negotiated Rate	$692.58
Rate for Payer: Cash Price	$254.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$692.58
Rate for Payer: SOMOS Essential	$692.58

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM

Professional

Both

$1,308.37

Service Code	HCPCS 12055
Min. Negotiated Rate	$981.28
Max. Negotiated Rate	$981.28
Rate for Payer: Cash Price	$354.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$981.28
Rate for Payer: SOMOS Essential	$981.28

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM

Professional

Both

$1,674.12

Service Code	HCPCS 12056
Min. Negotiated Rate	$1,255.59
Max. Negotiated Rate	$1,255.59
Rate for Payer: Cash Price	$452.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,255.59
Rate for Payer: SOMOS Essential	$1,255.59

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<

Professional

Both

$720.34

Service Code	HCPCS 12051
Min. Negotiated Rate	$540.26
Max. Negotiated Rate	$540.26
Rate for Payer: Cash Price	$196.53
Rate for Payer: SOMOS CHP/HARP/Medicaid	$540.26
Rate for Payer: SOMOS Essential	$540.26

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM

Professional

Both

$844.80

Service Code	HCPCS 12052
Min. Negotiated Rate	$633.60
Max. Negotiated Rate	$633.60
Rate for Payer: Cash Price	$230.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$633.60
Rate for Payer: SOMOS Essential	$633.60

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM

Professional

Both

$1,826.13

Service Code	HCPCS 12057
Min. Negotiated Rate	$1,369.60
Max. Negotiated Rate	$1,369.60
Rate for Payer: Cash Price	$493.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,369.60
Rate for Payer: SOMOS Essential	$1,369.60

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM

Professional

Both

$914.59

Service Code	HCPCS 12053
Min. Negotiated Rate	$685.94
Max. Negotiated Rate	$685.94
Rate for Payer: Cash Price	$248.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$685.94
Rate for Payer: SOMOS Essential	$685.94

PR REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM

Professional

Both

$945.49

Service Code	HCPCS 12054
Min. Negotiated Rate	$709.12
Max. Negotiated Rate	$709.12
Rate for Payer: Cash Price	$255.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$709.12
Rate for Payer: SOMOS Essential	$709.12

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM

Professional

Both

$1,194.94

Service Code	HCPCS 12045
Min. Negotiated Rate	$896.20
Max. Negotiated Rate	$896.20
Rate for Payer: Cash Price	$322.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$896.20
Rate for Payer: SOMOS Essential	$896.20

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<

Professional

Both

$614.46

Service Code	HCPCS 12041
Min. Negotiated Rate	$460.84
Max. Negotiated Rate	$460.84
Rate for Payer: Cash Price	$167.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$460.84
Rate for Payer: SOMOS Essential	$460.84

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM

Professional

Both

$822.40

Service Code	HCPCS 12042
Min. Negotiated Rate	$616.80
Max. Negotiated Rate	$616.80
Rate for Payer: Cash Price	$225.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$616.80
Rate for Payer: SOMOS Essential	$616.80

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM

Professional

Both

$1,587.32

Service Code	HCPCS 12047
Min. Negotiated Rate	$1,190.49
Max. Negotiated Rate	$1,190.49
Rate for Payer: Cash Price	$424.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,190.49
Rate for Payer: SOMOS Essential	$1,190.49

PR REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM

Professional

Both

$910.95

Service Code	HCPCS 12044
Min. Negotiated Rate	$683.21
Max. Negotiated Rate	$683.21
Rate for Payer: Cash Price	$248.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$683.21
Rate for Payer: SOMOS Essential	$683.21

PR REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM

Professional

Both

$1,050.49

Service Code	HCPCS 12035
Min. Negotiated Rate	$787.87
Max. Negotiated Rate	$787.87
Rate for Payer: Cash Price	$283.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$787.87
Rate for Payer: SOMOS Essential	$787.87

PR REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM

Professional

Both

$1,235.47

Service Code	HCPCS 12036
Min. Negotiated Rate	$926.60
Max. Negotiated Rate	$926.60
Rate for Payer: Cash Price	$334.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$926.60
Rate for Payer: SOMOS Essential	$926.60

Know your out-of-pocket cost for care.

All Charges