St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

OSTEOPLASTY-FOR ORTHOGNATHIC DEFO

Facility

$11,340.00

Service Code	HCPCS D7940
Hospital Charge Code	42302060
Hospital Revenue Code	361
Rate for Payer: Cash Price	$1,018.19

OSTEOPLASTY-FOR ORTHOGNATHIC DEFO

Facility

$11,340.00

Service Code	HCPCS D7940
Hospital Charge Code	42302060
Hospital Revenue Code	361
Min. Negotiated Rate	$712.73
Max. Negotiated Rate	$8,505.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,237.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Affinity Essential Plan 1&2	$712.73
Rate for Payer: Affinity Essential Plan 3&4	$712.73
Rate for Payer: Affinity Medicaid/CHP/HARP	$712.73
Rate for Payer: Brighton Health Commercial	$8,505.00
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,670.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Humana Medicare	$1,038.55
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: United Healthcare Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

OSTEOSET RESOR MINI BEAD KIT

Facility

$2,967.50

Hospital Charge Code	64907520
Hospital Revenue Code	270
Min. Negotiated Rate	$1,038.62
Max. Negotiated Rate	$2,374.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,632.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,483.75
Rate for Payer: Aetna Government	$1,483.75
Rate for Payer: Brighton Health Commercial	$2,225.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,374.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,017.90
Rate for Payer: Group Health Inc Commercial	$1,483.75
Rate for Payer: Group Health Inc Medicare	$1,038.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,483.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,483.75

OSTEOSPONGE BLACK 14MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40205434
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,575.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$862.50
Rate for Payer: EmblemHealth Commercial	$750.00
Rate for Payer: Fidelis Medicare Advantage	$1,575.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$975.00

OSTEOSPONGE BLACK 14MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40205434
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

OSTEOSPONGE FILLER 10CC

Facility

$1,900.00

Service Code	HCPCS C1713
Hospital Charge Code	40205435
Hospital Revenue Code	278
Min. Negotiated Rate	$950.00
Max. Negotiated Rate	$950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$950.00

OSTEOSPONGE FILLER 10CC

Facility

$1,900.00

Service Code	HCPCS C1713
Hospital Charge Code	40205435
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,995.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,045.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,140.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,092.50
Rate for Payer: EmblemHealth Commercial	$950.00
Rate for Payer: Fidelis Medicare Advantage	$1,995.00
Rate for Payer: Group Health Inc Commercial	$950.00
Rate for Payer: Group Health Inc Medicare	$665.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,235.00

OSTEOSPONGE FILLER 15.0CC

Facility

$2,868.75

Hospital Charge Code	64906200
Hospital Revenue Code	270
Min. Negotiated Rate	$1,004.06
Max. Negotiated Rate	$2,295.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,577.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,434.38
Rate for Payer: Aetna Government	$1,434.38
Rate for Payer: Brighton Health Commercial	$2,151.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,295.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,950.75
Rate for Payer: Group Health Inc Commercial	$1,434.38
Rate for Payer: Group Health Inc Medicare	$1,004.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,434.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,434.38

OSTEOSPONGE FILLER 30CC

Facility

$2,868.75

Service Code	HCPCS C1781
Hospital Charge Code	64906488
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$3,012.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,577.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$1,721.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,434.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,649.53
Rate for Payer: EmblemHealth Commercial	$1,434.38
Rate for Payer: Fidelis Medicare Advantage	$3,012.19
Rate for Payer: Group Health Inc Commercial	$1,434.38
Rate for Payer: Group Health Inc Medicare	$1,004.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,434.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,434.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,864.69

OSTEOSPONGE FILLER 30CC

Facility

$2,868.75

Service Code	HCPCS C1781
Hospital Charge Code	64906488
Hospital Revenue Code	278
Min. Negotiated Rate	$1,434.38
Max. Negotiated Rate	$1,434.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,434.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1,434.38

OSTEOTECH GRAFTCAGE ACX

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209533
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,575.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$862.50
Rate for Payer: EmblemHealth Commercial	$750.00
Rate for Payer: Fidelis Medicare Advantage	$1,575.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$975.00

OSTEOTECH GRAFTCAGE ACX

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209533
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

OSTEOTECH GRAFTON GEL 10CC

Facility

$2,684.00

Service Code	HCPCS C1713
Hospital Charge Code	40205943
Hospital Revenue Code	278
Min. Negotiated Rate	$1,342.00
Max. Negotiated Rate	$1,342.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,342.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,342.00

OSTEOTECH GRAFTON GEL 10CC

Facility

$2,684.00

Service Code	HCPCS C1713
Hospital Charge Code	40205943
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,818.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,476.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,610.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,342.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,543.30
Rate for Payer: EmblemHealth Commercial	$1,342.00
Rate for Payer: Fidelis Medicare Advantage	$2,818.20
Rate for Payer: Group Health Inc Commercial	$1,342.00
Rate for Payer: Group Health Inc Medicare	$939.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,342.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,342.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,744.60

OSTEOTECH GRAFTON XPANSE

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40209534
Hospital Revenue Code	278
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

OSTEOTECH GRAFTON XPANSE

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	40209534
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,050.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$575.00
Rate for Payer: EmblemHealth Commercial	$500.00
Rate for Payer: Fidelis Medicare Advantage	$1,050.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$650.00

OSTEOTOMY

Facility

$7,933.18

Service Code	HCPCS 21121
Hospital Charge Code	40082710
Hospital Revenue Code	360
Min. Negotiated Rate	$1,468.00
Max. Negotiated Rate	$5,949.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,723.23
Rate for Payer: Aetna Government	$3,723.23
Rate for Payer: Affinity Essential Plan 1&2	$2,606.26
Rate for Payer: Affinity Essential Plan 3&4	$2,606.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,606.26
Rate for Payer: Brighton Health Commercial	$5,949.88
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Cash Price	$3,723.23
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,723.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,723.23
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,164.75
Rate for Payer: Fidelis Essential Plan QHP	$3,313.67
Rate for Payer: Fidelis Medicare Advantage	$3,723.23
Rate for Payer: Fidelis Qualified Health Plan	$3,313.67
Rate for Payer: Group Health Inc Commercial	$3,723.23
Rate for Payer: Group Health Inc Medicare	$3,723.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,966.59
Rate for Payer: Hamaspik Choice Inc Medicare	$3,723.23
Rate for Payer: Healthfirst Medicare Advantage	$3,164.75
Rate for Payer: Healthfirst QHP	$3,723.23
Rate for Payer: Humana Medicare	$3,797.69
Rate for Payer: Senior Whole Health Medicare Advantage	$3,723.23
Rate for Payer: United Healthcare Commercial	$1,468.00
Rate for Payer: United Healthcare Medicare Advantage	$3,723.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,723.23
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,978.58
Rate for Payer: Wellcare Medicare	$3,537.07

OSTEOTOMY

Facility

$7,933.18

Service Code	HCPCS 21121
Hospital Charge Code	40082710
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,723.23

OSTEOTOMY-BODY OF MANDIE

Facility

$2,755.00

Service Code	HCPCS D7945
Hospital Charge Code	42302085
Hospital Revenue Code	361
Min. Negotiated Rate	$964.25
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,515.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,460.81
Rate for Payer: Aetna Government	$2,460.81
Rate for Payer: Brighton Health Commercial	$2,066.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$1,377.50
Rate for Payer: Group Health Inc Medicare	$964.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,377.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,377.50

Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation

Facility

$8,438.58

Service Code	CPT 28300
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$8,438.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Affinity Essential Plan 1&2	$5,791.18
Rate for Payer: Affinity Essential Plan 3&4	$5,791.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$5,791.18
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Humana Medicare	$8,438.58
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: United Healthcare Commercial	$2,546.00
Rate for Payer: United Healthcare Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

Osteotomy; metacarpal, each

Facility

$3,818.01

Service Code	CPT 26565
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,818.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Affinity Essential Plan 1&2	$2,620.20
Rate for Payer: Affinity Essential Plan 3&4	$2,620.20
Rate for Payer: Affinity Medicaid/CHP/HARP	$2,620.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Humana Medicare	$3,818.01
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: United Healthcare Commercial	$1,835.00
Rate for Payer: United Healthcare Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

OSTEOTOMY-RAMUS, CLOSED

Facility

$3,625.00

Service Code	HCPCS D7941
Hospital Charge Code	42302065
Hospital Revenue Code	361
Min. Negotiated Rate	$1,268.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,993.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,258.73
Rate for Payer: Aetna Government	$2,258.73
Rate for Payer: Brighton Health Commercial	$2,718.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$1,812.50
Rate for Payer: Group Health Inc Medicare	$1,268.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,812.50

OSTEOTOMY-RAMUS, OPEN WITH BONE G

Facility

$5,437.50

Service Code	HCPCS D7943
Hospital Charge Code	42302075
Hospital Revenue Code	361
Min. Negotiated Rate	$1,903.12
Max. Negotiated Rate	$4,078.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,990.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,075.19
Rate for Payer: Aetna Government	$2,075.19
Rate for Payer: Brighton Health Commercial	$4,078.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$2,718.75
Rate for Payer: Group Health Inc Medicare	$1,903.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,718.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,718.75

OSTEOTOMY-SEGMENTED OR SUBAPICAL/

Facility

$2,900.00

Service Code	HCPCS D7944
Hospital Charge Code	42302080
Hospital Revenue Code	361
Min. Negotiated Rate	$1,015.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,595.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,849.50
Rate for Payer: Aetna Government	$1,849.50
Rate for Payer: Brighton Health Commercial	$2,175.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$1,450.00
Rate for Payer: Group Health Inc Medicare	$1,015.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,450.00

OSTOMED DRILL BIT 1.6MM

Facility

$350.00

Hospital Charge Code	40203652
Hospital Revenue Code	272
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.00
Rate for Payer: Aetna Government	$175.00
Rate for Payer: Brighton Health Commercial	$262.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.00
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

Know your out-of-pocket cost for care.

All Charges