St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL

Professional

Both

$4,252.26

Service Code	HCPCS 27457
Min. Negotiated Rate	$3,189.20
Max. Negotiated Rate	$3,189.20
Rate for Payer: Cash Price	$1,123.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,189.20
Rate for Payer: SOMOS Essential	$3,189.20

PR OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL

Professional

Both

$4,256.53

Service Code	HCPCS 27455
Min. Negotiated Rate	$3,192.40
Max. Negotiated Rate	$3,192.40
Rate for Payer: Cash Price	$1,147.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,192.40
Rate for Payer: SOMOS Essential	$3,192.40

PR OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE

Professional

Both

$1,441.86

Service Code	HCPCS 28312
Min. Negotiated Rate	$1,081.40
Max. Negotiated Rate	$1,081.40
Rate for Payer: Cash Price	$405.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,081.40
Rate for Payer: SOMOS Essential	$1,081.40

PR OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE

Professional

Both

$1,524.50

Service Code	HCPCS 28310
Min. Negotiated Rate	$1,143.38
Max. Negotiated Rate	$1,143.38
Rate for Payer: Cash Price	$423.45
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,143.38
Rate for Payer: SOMOS Essential	$1,143.38

PR OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM

Professional

Both

$1,662.75

Service Code	HCPCS 22216
Min. Negotiated Rate	$1,247.06
Max. Negotiated Rate	$1,247.06
Rate for Payer: Cash Price	$439.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,247.06
Rate for Payer: SOMOS Essential	$1,247.06

PR OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM

Professional

Both

$1,632.51

Service Code	HCPCS 22226
Min. Negotiated Rate	$1,224.38
Max. Negotiated Rate	$1,224.38
Rate for Payer: Cash Price	$432.66
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,224.38
Rate for Payer: SOMOS Essential	$1,224.38

PR OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT

Professional

Both

$2,861.99

Service Code	HCPCS 28305
Min. Negotiated Rate	$2,146.49
Max. Negotiated Rate	$2,146.49
Rate for Payer: Cash Price	$788.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,146.49
Rate for Payer: SOMOS Essential	$2,146.49

PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT

Professional

Both

$3,886.82

Service Code	HCPCS 28309
Min. Negotiated Rate	$2,915.12
Max. Negotiated Rate	$2,915.12
Rate for Payer: Cash Price	$1,063.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,915.12
Rate for Payer: SOMOS Essential	$2,915.12

PR OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR

Professional

Both

$1,732.54

Service Code	HCPCS 28306
Min. Negotiated Rate	$1,299.40
Max. Negotiated Rate	$1,299.40
Rate for Payer: Cash Price	$478.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,299.40
Rate for Payer: SOMOS Essential	$1,299.40

PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA

Professional

Both

$1,641.89

Service Code	HCPCS 28308
Min. Negotiated Rate	$1,231.42
Max. Negotiated Rate	$1,231.42
Rate for Payer: Cash Price	$454.25
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,231.42
Rate for Payer: SOMOS Essential	$1,231.42

PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE

Professional

Both

$2,292.50

Service Code	HCPCS 28307
Min. Negotiated Rate	$1,719.38
Max. Negotiated Rate	$1,719.38
Rate for Payer: Cash Price	$622.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,719.38
Rate for Payer: SOMOS Essential	$1,719.38

PROSTHESIS AMS 700 CX W/PUMP

Facility

$18,661.34

Service Code	HCPCS C1813
Hospital Charge Code	40203430
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$19,594.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,263.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$11,196.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,330.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,730.27
Rate for Payer: EmblemHealth Commercial	$9,330.67
Rate for Payer: Fidelis Medicare Advantage	$19,594.41
Rate for Payer: Group Health Inc Commercial	$9,330.67
Rate for Payer: Group Health Inc Medicare	$6,531.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,330.67
Rate for Payer: Hamaspik Choice Inc Medicare	$9,330.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,129.87

PROSTHESIS AMS 700 CX W/PUMP

Facility

$18,661.34

Service Code	HCPCS C1813
Hospital Charge Code	40203430
Hospital Revenue Code	278
Min. Negotiated Rate	$9,330.67
Max. Negotiated Rate	$9,330.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,330.67
Rate for Payer: Hamaspik Choice Inc Medicare	$9,330.67

PROSTHESIS, AMS800, CUFF IZ

Facility

$12,862.50

Service Code	HCPCS C1815
Hospital Charge Code	64905549
Hospital Revenue Code	278
Min. Negotiated Rate	$6,431.25
Max. Negotiated Rate	$6,431.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,431.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6,431.25

PROSTHESIS, AMS800, CUFF IZ

Facility

$12,862.50

Service Code	HCPCS C1815
Hospital Charge Code	64905549
Hospital Revenue Code	278
Min. Negotiated Rate	$2,453.47
Max. Negotiated Rate	$13,505.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,074.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,453.47
Rate for Payer: Aetna Government	$2,453.47
Rate for Payer: Brighton Health Commercial	$7,717.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,431.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,395.94
Rate for Payer: EmblemHealth Commercial	$6,431.25
Rate for Payer: Fidelis Medicare Advantage	$13,505.62
Rate for Payer: Group Health Inc Commercial	$6,431.25
Rate for Payer: Group Health Inc Medicare	$4,501.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,431.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6,431.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,360.62

PROSTHESIS - HIP

Facility

$3,093.55

Service Code	HCPCS 27090
Hospital Charge Code	40021605
Hospital Revenue Code	360
Min. Negotiated Rate	$855.30
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,701.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$855.30
Rate for Payer: Aetna Government	$855.30
Rate for Payer: Brighton Health Commercial	$2,320.16
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,546.78
Rate for Payer: Group Health Inc Medicare	$1,082.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,546.78
Rate for Payer: Hamaspik Choice Inc Medicare	$1,546.78
Rate for Payer: United Healthcare Commercial	$1,468.00

PROSTHESIS PENILE CX PREC 18CM

Facility

$22,622.73

Service Code	HCPCS C1813
Hospital Charge Code	64905903
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$23,753.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,442.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$13,573.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,311.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,008.07
Rate for Payer: EmblemHealth Commercial	$11,311.36
Rate for Payer: Fidelis Medicare Advantage	$23,753.87
Rate for Payer: Group Health Inc Commercial	$11,311.36
Rate for Payer: Group Health Inc Medicare	$7,917.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,311.36
Rate for Payer: Hamaspik Choice Inc Medicare	$11,311.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,704.77

PROSTHESIS PENILE CX PREC 18CM

Facility

$22,622.73

Service Code	HCPCS C1813
Hospital Charge Code	64905903
Hospital Revenue Code	278
Min. Negotiated Rate	$11,311.36
Max. Negotiated Rate	$11,311.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,311.36
Rate for Payer: Hamaspik Choice Inc Medicare	$11,311.36

PROSTHESIS PUMP AMS 700 CRX

Facility

$18,661.34

Service Code	HCPCS C1813
Hospital Charge Code	64906554
Hospital Revenue Code	278
Min. Negotiated Rate	$3,775.00
Max. Negotiated Rate	$19,594.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,263.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$11,196.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,330.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,730.27
Rate for Payer: EmblemHealth Commercial	$9,330.67
Rate for Payer: Fidelis Medicare Advantage	$19,594.41
Rate for Payer: Group Health Inc Commercial	$9,330.67
Rate for Payer: Group Health Inc Medicare	$6,531.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,330.67
Rate for Payer: Hamaspik Choice Inc Medicare	$9,330.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,129.87

PROSTHESIS PUMP AMS 700 CRX

Facility

$18,661.34

Service Code	HCPCS C1813
Hospital Charge Code	64906554
Hospital Revenue Code	278
Min. Negotiated Rate	$9,330.67
Max. Negotiated Rate	$9,330.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,330.67
Rate for Payer: Hamaspik Choice Inc Medicare	$9,330.67

PROSTHESIS PUMP AMS 700CX

Facility

$9,239.25

Service Code	HCPCS C1813
Hospital Charge Code	64906465
Hospital Revenue Code	278
Min. Negotiated Rate	$4,619.62
Max. Negotiated Rate	$4,619.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,619.62
Rate for Payer: Hamaspik Choice Inc Medicare	$4,619.62

PROSTHESIS PUMP AMS 700CX

Facility

$9,239.25

Service Code	HCPCS C1813
Hospital Charge Code	64906465
Hospital Revenue Code	278
Min. Negotiated Rate	$3,233.74
Max. Negotiated Rate	$9,701.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,081.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,775.00
Rate for Payer: Aetna Government	$3,775.00
Rate for Payer: Brighton Health Commercial	$5,543.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,619.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,312.57
Rate for Payer: EmblemHealth Commercial	$4,619.62
Rate for Payer: Fidelis Medicare Advantage	$9,701.21
Rate for Payer: Group Health Inc Commercial	$4,619.62
Rate for Payer: Group Health Inc Medicare	$3,233.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,619.62
Rate for Payer: Hamaspik Choice Inc Medicare	$4,619.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,005.51

PROSTHESIS PUMP MS AMS 700 24X12

Facility

$9,049.00

Hospital Charge Code	64906256
Hospital Revenue Code	270
Min. Negotiated Rate	$3,167.15
Max. Negotiated Rate	$7,239.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,976.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,524.50
Rate for Payer: Aetna Government	$4,524.50
Rate for Payer: Brighton Health Commercial	$6,786.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,239.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,153.32
Rate for Payer: Group Health Inc Commercial	$4,524.50
Rate for Payer: Group Health Inc Medicare	$3,167.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,524.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,524.50

PROSTHESIS WGNR CONE 125DEG

Facility

$3,649.00

Service Code	HCPCS C1776
Hospital Charge Code	64906272
Hospital Revenue Code	278
Min. Negotiated Rate	$1,824.50
Max. Negotiated Rate	$1,824.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,824.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,824.50

PROSTHESIS WGNR CONE 125DEG

Facility

$3,649.00

Service Code	HCPCS C1776
Hospital Charge Code	64906272
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,831.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,006.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,189.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,824.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,098.18
Rate for Payer: EmblemHealth Commercial	$1,824.50
Rate for Payer: Fidelis Medicare Advantage	$3,831.45
Rate for Payer: Group Health Inc Commercial	$1,824.50
Rate for Payer: Group Health Inc Medicare	$1,277.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,824.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,824.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,371.85

Know your out-of-pocket cost for care.

All Charges