St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROSTATECTOMY WITH CC

Facility

$42,822.55

Service Code	MSDRG 666
Min. Negotiated Rate	$14,481.81
Max. Negotiated Rate	$42,822.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25,323.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31,143.67
Rate for Payer: Aetna Government	$31,143.67
Rate for Payer: Brighton Health Commercial	$24,902.30
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$31,766.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29,657.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$24,474.87
Rate for Payer: Elderplan Medicare Advantage	$29,586.49
Rate for Payer: EmblemHealth Commercial	$14,726.70
Rate for Payer: Fidelis Medicare Advantage	$31,143.67
Rate for Payer: Group Health Inc Commercial	$31,143.67
Rate for Payer: Group Health Inc Medicare	$31,143.67
Rate for Payer: Hamaspik Choice Inc Medicare	$31,143.67
Rate for Payer: Healthfirst Medicare Advantage	$14,481.81
Rate for Payer: Humana Medicare	$42,822.55
Rate for Payer: Senior Whole Health Medicare Advantage	$31,143.67
Rate for Payer: United Healthcare Commercial	$34,153.93
Rate for Payer: United Healthcare Medicare Advantage	$31,143.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31,143.67
Rate for Payer: Wellcare Medicare	$29,586.49

PROSTATECTOMY WITH MCC

Facility

$68,977.67

Service Code	MSDRG 665
Min. Negotiated Rate	$23,326.99
Max. Negotiated Rate	$68,977.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45,548.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50,165.58
Rate for Payer: Aetna Government	$50,165.58
Rate for Payer: Brighton Health Commercial	$44,791.95
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$51,168.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53,345.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$44,023.13
Rate for Payer: Elderplan Medicare Advantage	$47,657.30
Rate for Payer: EmblemHealth Commercial	$26,489.00
Rate for Payer: Fidelis Medicare Advantage	$50,165.58
Rate for Payer: Group Health Inc Commercial	$50,165.58
Rate for Payer: Group Health Inc Medicare	$50,165.58
Rate for Payer: Hamaspik Choice Inc Medicare	$50,165.58
Rate for Payer: Healthfirst Medicare Advantage	$23,326.99
Rate for Payer: Humana Medicare	$68,977.67
Rate for Payer: Senior Whole Health Medicare Advantage	$50,165.58
Rate for Payer: United Healthcare Commercial	$61,432.93
Rate for Payer: United Healthcare Medicare Advantage	$50,165.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50,165.58
Rate for Payer: Wellcare Medicare	$47,657.30

PROSTATECTOMY WITHOUT CC/MCC

Facility

$30,089.19

Service Code	MSDRG 667
Min. Negotiated Rate	$9,000.32
Max. Negotiated Rate	$30,089.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15,476.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21,883.05
Rate for Payer: Aetna Government	$21,883.05
Rate for Payer: Brighton Health Commercial	$15,219.20
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$22,320.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18,125.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$14,957.98
Rate for Payer: Elderplan Medicare Advantage	$20,788.90
Rate for Payer: EmblemHealth Commercial	$9,000.32
Rate for Payer: Fidelis Medicare Advantage	$21,883.05
Rate for Payer: Group Health Inc Commercial	$21,883.05
Rate for Payer: Group Health Inc Medicare	$21,883.05
Rate for Payer: Hamaspik Choice Inc Medicare	$21,883.05
Rate for Payer: Healthfirst Medicare Advantage	$10,175.62
Rate for Payer: Humana Medicare	$30,089.19
Rate for Payer: Senior Whole Health Medicare Advantage	$21,883.05
Rate for Payer: United Healthcare Commercial	$20,873.40
Rate for Payer: United Healthcare Medicare Advantage	$21,883.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21,883.05
Rate for Payer: Wellcare Medicare	$20,788.90

PROSTATIC SPECIFIC AG

Facility

$45.98

Service Code	HCPCS 84153
Hospital Charge Code	40602565
Hospital Revenue Code	301
Min. Negotiated Rate	$12.87
Max. Negotiated Rate	$34.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.39
Rate for Payer: Aetna Government	$18.39
Rate for Payer: Affinity Essential Plan 1&2	$12.87
Rate for Payer: Affinity Essential Plan 3&4	$12.87
Rate for Payer: Affinity Medicaid/CHP/HARP	$12.87
Rate for Payer: Brighton Health Commercial	$34.48
Rate for Payer: Cash Price	$18.39
Rate for Payer: Cash Price	$18.39
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.75
Rate for Payer: Elderplan Medicare Advantage	$18.39
Rate for Payer: EmblemHealth Commercial	$18.39
Rate for Payer: Fidelis Essential Plan Aliesa	$15.63
Rate for Payer: Fidelis Essential Plan QHP	$16.37
Rate for Payer: Fidelis Medicare Advantage	$18.39
Rate for Payer: Fidelis Qualified Health Plan	$16.37
Rate for Payer: Group Health Inc Commercial	$18.39
Rate for Payer: Group Health Inc Medicare	$18.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.99
Rate for Payer: Hamaspik Choice Inc Medicare	$18.39
Rate for Payer: Healthfirst Medicare Advantage	$18.39
Rate for Payer: Healthfirst QHP	$18.39
Rate for Payer: Humana Medicare	$18.76
Rate for Payer: Senior Whole Health Medicare Advantage	$18.39
Rate for Payer: United Healthcare Commercial	$23.30
Rate for Payer: United Healthcare Medicare Advantage	$18.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.71
Rate for Payer: Wellcare Medicare	$16.55

PROSTATIC SPECIFIC AG

Facility

$45.98

Service Code	HCPCS 84153
Hospital Charge Code	40602565
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.39

PR OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC

Professional

Both

$3,583.55

Service Code	HCPCS 28114
Min. Negotiated Rate	$2,687.66
Max. Negotiated Rate	$2,687.66
Rate for Payer: Cash Price	$979.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,687.66
Rate for Payer: SOMOS Essential	$2,687.66

PR OSTC PRTL EXOSTC/CONDYLC METAR HEAD

Professional

Both

$1,836.03

Service Code	HCPCS 28288
Min. Negotiated Rate	$1,377.02
Max. Negotiated Rate	$1,377.02
Rate for Payer: Cash Price	$507.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,377.02
Rate for Payer: SOMOS Essential	$1,377.02

PR OSTECTOMY CALCANEUS

Professional

Both

$1,796.10

Service Code	HCPCS 28118
Min. Negotiated Rate	$1,347.08
Max. Negotiated Rate	$1,347.08
Rate for Payer: Cash Price	$495.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,347.08
Rate for Payer: SOMOS Essential	$1,347.08

PR OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS

Professional

Both

$1,528.10

Service Code	HCPCS 28119
Min. Negotiated Rate	$1,146.08
Max. Negotiated Rate	$1,146.08
Rate for Payer: Cash Price	$422.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,146.08
Rate for Payer: SOMOS Essential	$1,146.08

PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD

Professional

Both

$1,343.48

Service Code	HCPCS 28111
Min. Negotiated Rate	$1,007.61
Max. Negotiated Rate	$1,007.61
Rate for Payer: Cash Price	$368.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,007.61
Rate for Payer: SOMOS Essential	$1,007.61

PR OSTECTOMY COMPLETE 5TH METATARSAL HEAD

Professional

Both

$1,790.64

Service Code	HCPCS 28113
Min. Negotiated Rate	$1,342.98
Max. Negotiated Rate	$1,342.98
Rate for Payer: Cash Price	$494.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,342.98
Rate for Payer: SOMOS Essential	$1,342.98

PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4

Professional

Both

$1,326.08

Service Code	HCPCS 28112
Min. Negotiated Rate	$994.56
Max. Negotiated Rate	$994.56
Rate for Payer: Cash Price	$364.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$994.56
Rate for Payer: SOMOS Essential	$994.56

PR OSTECTOMY PRTL 5TH METAR HEAD SPX

Professional

Both

$1,228.40

Service Code	HCPCS 28110
Min. Negotiated Rate	$921.30
Max. Negotiated Rate	$921.30
Rate for Payer: Cash Price	$341.69
Rate for Payer: SOMOS CHP/HARP/Medicaid	$921.30
Rate for Payer: SOMOS Essential	$921.30

PR OSTECTOMY SCAPULA PARTIAL

Professional

Both

$2,562.00

Service Code	HCPCS 23190
Min. Negotiated Rate	$1,921.50
Max. Negotiated Rate	$1,921.50
Rate for Payer: Cash Price	$694.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,921.50
Rate for Payer: SOMOS Essential	$1,921.50

PR OSTECTOMY STERNUM PARTIAL

Professional

Both

$2,252.81

Service Code	HCPCS 21620
Min. Negotiated Rate	$1,689.61
Max. Negotiated Rate	$1,689.61
Rate for Payer: Cash Price	$603.55
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,689.61
Rate for Payer: SOMOS Essential	$1,689.61

PR OSTECTOMY TARSAL COALITION

Professional

Both

$2,511.95

Service Code	HCPCS 28116
Min. Negotiated Rate	$1,883.96
Max. Negotiated Rate	$1,883.96
Rate for Payer: Cash Price	$677.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,883.96
Rate for Payer: SOMOS Essential	$1,883.96

PR OSTEOARTICULAR ALLOGRAFT W/ARTICULAR SURF & BONE

Professional

Both

$3,317.97

Service Code	HCPCS 20932
Min. Negotiated Rate	$2,488.48
Max. Negotiated Rate	$2,488.48
Rate for Payer: Cash Price	$886.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,488.48
Rate for Payer: SOMOS Essential	$2,488.48

PR OSTEOCHONDRAL ALLOGRAFT KNEE OPEN

Professional

Both

$6,060.01

Service Code	HCPCS 27415
Min. Negotiated Rate	$4,545.01
Max. Negotiated Rate	$4,545.01
Rate for Payer: Cash Price	$1,634.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,545.01
Rate for Payer: SOMOS Essential	$4,545.01

PR OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY

Professional

Both

$4,341.44

Service Code	HCPCS 27416
Min. Negotiated Rate	$3,256.08
Max. Negotiated Rate	$3,256.08
Rate for Payer: Cash Price	$1,170.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,256.08
Rate for Payer: SOMOS Essential	$3,256.08

PR OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS

Professional

Both

$95.87

Service Code	HCPCS 98925
Min. Negotiated Rate	$71.90
Max. Negotiated Rate	$71.90
Rate for Payer: Cash Price	$25.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$71.90
Rate for Payer: SOMOS Essential	$71.90

PR OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS

Professional

Both

$140.11

Service Code	HCPCS 98926
Min. Negotiated Rate	$105.08
Max. Negotiated Rate	$105.08
Rate for Payer: Cash Price	$38.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$105.08
Rate for Payer: SOMOS Essential	$105.08

PR OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS

Professional

Both

$181.51

Service Code	HCPCS 98927
Min. Negotiated Rate	$136.13
Max. Negotiated Rate	$136.13
Rate for Payer: Cash Price	$50.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$136.13
Rate for Payer: SOMOS Essential	$136.13

PR OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS

Professional

Both

$233.94

Service Code	HCPCS 98928
Min. Negotiated Rate	$175.46
Max. Negotiated Rate	$175.46
Rate for Payer: Cash Price	$64.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.46
Rate for Payer: SOMOS Essential	$175.46

PR OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS

Professional

Both

$279.51

Service Code	HCPCS 98929
Min. Negotiated Rate	$209.63
Max. Negotiated Rate	$209.63
Rate for Payer: Cash Price	$76.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$209.63
Rate for Payer: SOMOS Essential	$209.63

PR OSTEOPLASTY CARPAL BONE SHORTENING

Professional

Both

$3,476.59

Service Code	HCPCS 25394
Min. Negotiated Rate	$2,607.44
Max. Negotiated Rate	$2,607.44
Rate for Payer: Cash Price	$941.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,607.44
Rate for Payer: SOMOS Essential	$2,607.44

Know your out-of-pocket cost for care.

All Charges