St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT

Professional

Both

$4,763.40

Service Code	HCPCS 24435
Min. Negotiated Rate	$3,572.55
Max. Negotiated Rate	$3,572.55
Rate for Payer: Cash Price	$1,290.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,572.55
Rate for Payer: SOMOS Essential	$3,572.55

PR REPAIR NON/MALUNION HUMERUS W/O GRAFT

Professional

Both

$4,660.15

Service Code	HCPCS 24430
Min. Negotiated Rate	$3,495.11
Max. Negotiated Rate	$3,495.11
Rate for Payer: Cash Price	$1,257.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,495.11
Rate for Payer: SOMOS Essential	$3,495.11

PR REPAIR NONUNION CARPAL BONE EACH BONE

Professional

Both

$3,496.99

Service Code	HCPCS 25431
Min. Negotiated Rate	$2,622.74
Max. Negotiated Rate	$2,622.74
Rate for Payer: Cash Price	$945.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,622.74
Rate for Payer: SOMOS Essential	$2,622.74

PR REPAIR NONUNION/MALUNION TARSAL BONES

Professional

Both

$2,634.17

Service Code	HCPCS 28320
Min. Negotiated Rate	$1,975.63
Max. Negotiated Rate	$1,975.63
Rate for Payer: Cash Price	$725.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,975.63
Rate for Payer: SOMOS Essential	$1,975.63

PR REPAIR NONUNION/MALUNION TIBIA W/O GRAFT

Professional

Both

$3,848.36

Service Code	HCPCS 27720
Min. Negotiated Rate	$2,886.27
Max. Negotiated Rate	$2,886.27
Rate for Payer: Cash Price	$1,039.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,886.27
Rate for Payer: SOMOS Essential	$2,886.27

PR REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT

Professional

Both

$3,957.17

Service Code	HCPCS 27722
Min. Negotiated Rate	$2,967.88
Max. Negotiated Rate	$2,967.88
Rate for Payer: Cash Price	$1,071.21
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,967.88
Rate for Payer: SOMOS Essential	$2,967.88

PR REPAIR OF TRAUMATIC CORPOREAL TEAR(S)

Professional

Both

$2,846.03

Service Code	HCPCS 54437
Min. Negotiated Rate	$2,134.52
Max. Negotiated Rate	$2,134.52
Rate for Payer: Cash Price	$781.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,134.52
Rate for Payer: SOMOS Essential	$2,134.52

PR REPAIR OVAL WINDOW FISTULA

Professional

Both

$3,509.35

Service Code	HCPCS 69666
Min. Negotiated Rate	$2,632.01
Max. Negotiated Rate	$2,632.01
Rate for Payer: Cash Price	$949.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,632.01
Rate for Payer: SOMOS Essential	$2,632.01

PR REPAIR PATENT DUCTUS ARTERIOSUS LIGATION

Professional

Both

$4,310.15

Service Code	HCPCS 33820
Min. Negotiated Rate	$3,232.61
Max. Negotiated Rate	$3,232.61
Rate for Payer: Cash Price	$1,148.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,232.61
Rate for Payer: SOMOS Essential	$3,232.61

PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC

Professional

Both

$3,185.88

Service Code	HCPCS 21742
Min. Negotiated Rate	$2,389.41
Max. Negotiated Rate	$2,389.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,389.41
Rate for Payer: SOMOS Essential	$2,389.41

PR REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC

Professional

Both

$4,011.42

Service Code	HCPCS 21743
Min. Negotiated Rate	$3,008.56
Max. Negotiated Rate	$3,008.56
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,008.56
Rate for Payer: SOMOS Essential	$3,008.56

PR REPAIR PECTUS EXCAVATUM/CARINATUM OPEN

Professional

Both

$4,591.51

Service Code	HCPCS 21740
Min. Negotiated Rate	$3,443.63
Max. Negotiated Rate	$3,443.63
Rate for Payer: Cash Price	$1,225.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,443.63
Rate for Payer: SOMOS Essential	$3,443.63

PR REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON

Professional

Both

$2,852.05

Service Code	HCPCS 27650
Min. Negotiated Rate	$2,139.04
Max. Negotiated Rate	$2,139.04
Rate for Payer: Cash Price	$776.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,139.04
Rate for Payer: SOMOS Essential	$2,139.04

PR REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT

Professional

Both

$3,531.19

Service Code	HCPCS 27407
Min. Negotiated Rate	$2,648.39
Max. Negotiated Rate	$2,648.39
Rate for Payer: Cash Price	$956.03
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,648.39
Rate for Payer: SOMOS Essential	$2,648.39

PR REPAIR PULMONARY VENOUS STENOSIS

Professional

Both

$9,030.49

Service Code	HCPCS 33726
Min. Negotiated Rate	$6,772.87
Max. Negotiated Rate	$6,772.87
Rate for Payer: Cash Price	$2,398.80
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,772.87
Rate for Payer: SOMOS Essential	$6,772.87

PR REPAIR RECTOCELE SEPARATE PROCEDURE

Professional

Both

$2,990.72

Service Code	HCPCS 45560
Min. Negotiated Rate	$2,243.04
Max. Negotiated Rate	$2,243.04
Rate for Payer: Cash Price	$808.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,243.04
Rate for Payer: SOMOS Essential	$2,243.04

PR REPAIR RETINAL DETACHMENT SCLERAL BUCKLING

Professional

Both

$4,596.20

Service Code	HCPCS 67107
Min. Negotiated Rate	$3,447.15
Max. Negotiated Rate	$3,447.15
Rate for Payer: Cash Price	$1,264.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,447.15
Rate for Payer: SOMOS Essential	$3,447.15

PR REPAIR ROUND WINDOW FISTULA

Professional

Both

$3,510.57

Service Code	HCPCS 69667
Min. Negotiated Rate	$2,632.93
Max. Negotiated Rate	$2,632.93
Rate for Payer: Cash Price	$953.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,632.93
Rate for Payer: SOMOS Essential	$2,632.93

PR REPAIR SCLERAL STAPHYLOMA W/GRAFT

Professional

Both

$3,845.56

Service Code	HCPCS 66225
Min. Negotiated Rate	$2,884.17
Max. Negotiated Rate	$2,884.17
Rate for Payer: Cash Price	$1,059.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,884.17
Rate for Payer: SOMOS Essential	$2,884.17

PR REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT

Professional

Both

$3,087.18

Service Code	HCPCS 27654
Min. Negotiated Rate	$2,315.38
Max. Negotiated Rate	$2,315.38
Rate for Payer: Cash Price	$842.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,315.38
Rate for Payer: SOMOS Essential	$2,315.38

PR REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL

Professional

Both

$2,777.15

Service Code	HCPCS 27698
Min. Negotiated Rate	$2,082.86
Max. Negotiated Rate	$2,082.86
Rate for Payer: Cash Price	$750.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,082.86
Rate for Payer: SOMOS Essential	$2,082.86

PR REPAIR SPICA BODY CAST/JACKET

Professional

Both

$192.47

Service Code	HCPCS 29720
Min. Negotiated Rate	$144.35
Max. Negotiated Rate	$144.35
Rate for Payer: Cash Price	$51.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$144.35
Rate for Payer: SOMOS Essential	$144.35

PR REPAIR SYNDACTYLY EACH SPACE COMPLEX

Professional

Both

$6,103.41

Service Code	HCPCS 26562
Min. Negotiated Rate	$4,577.56
Max. Negotiated Rate	$4,577.56
Rate for Payer: Cash Price	$1,644.71
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,577.56
Rate for Payer: SOMOS Essential	$4,577.56

PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS

Professional

Both

$2,833.50

Service Code	HCPCS 26560
Min. Negotiated Rate	$2,125.12
Max. Negotiated Rate	$2,125.12
Rate for Payer: Cash Price	$764.10
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,125.12
Rate for Payer: SOMOS Essential	$2,125.12

PR REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT

Professional

Both

$4,373.46

Service Code	HCPCS 26561
Min. Negotiated Rate	$3,280.10
Max. Negotiated Rate	$3,280.10
Rate for Payer: Cash Price	$1,175.34
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,280.10
Rate for Payer: SOMOS Essential	$3,280.10

Know your out-of-pocket cost for care.

All Charges