St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROXIMAL LATERAL TIBIA PLATE F3

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	64903713
Hospital Revenue Code	278
Min. Negotiated Rate	$3,292.50
Max. Negotiated Rate	$3,292.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,292.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,292.50

PROXIMAL LATERAL TIBIA PLATE F3

Facility

$6,585.00

Service Code	HCPCS C1713
Hospital Charge Code	64903713
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,914.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,621.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,951.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,292.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,786.38
Rate for Payer: EmblemHealth Commercial	$3,292.50
Rate for Payer: Fidelis Medicare Advantage	$6,914.25
Rate for Payer: Group Health Inc Commercial	$3,292.50
Rate for Payer: Group Health Inc Medicare	$2,304.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,292.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,292.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,280.25

PROXIMAL LATERAL TIBIA PLATE F4

Facility

$6,997.50

Service Code	HCPCS C1713
Hospital Charge Code	64904900
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,347.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,848.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,198.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,498.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,023.56
Rate for Payer: EmblemHealth Commercial	$3,498.75
Rate for Payer: Fidelis Medicare Advantage	$7,347.38
Rate for Payer: Group Health Inc Commercial	$3,498.75
Rate for Payer: Group Health Inc Medicare	$2,449.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,498.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,498.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,548.38

PROXIMAL LATERAL TIBIA PLATE F4

Facility

$6,997.50

Service Code	HCPCS C1713
Hospital Charge Code	64904900
Hospital Revenue Code	278
Min. Negotiated Rate	$3,498.75
Max. Negotiated Rate	$3,498.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,498.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,498.75

PROXIMAL LATERAL TIBIA PLATE F5

Facility

$7,272.50

Service Code	HCPCS C1713
Hospital Charge Code	64904999
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,636.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,999.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,363.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,636.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,181.69
Rate for Payer: EmblemHealth Commercial	$3,636.25
Rate for Payer: Fidelis Medicare Advantage	$7,636.12
Rate for Payer: Group Health Inc Commercial	$3,636.25
Rate for Payer: Group Health Inc Medicare	$2,545.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,636.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3,636.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,727.12

PROXIMAL LATERAL TIBIA PLATE F5

Facility

$7,272.50

Service Code	HCPCS C1713
Hospital Charge Code	64904999
Hospital Revenue Code	278
Min. Negotiated Rate	$3,636.25
Max. Negotiated Rate	$3,636.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,636.25
Rate for Payer: Hamaspik Choice Inc Medicare	$3,636.25

PROXIMAL MDAL PL RIGHT 6H/L97MM

Facility

$5,253.00

Service Code	HCPCS C1713
Hospital Charge Code	64905762
Hospital Revenue Code	278
Min. Negotiated Rate	$2,626.50
Max. Negotiated Rate	$2,626.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,626.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,626.50

PROXIMAL MDAL PL RIGHT 6H/L97MM

Facility

$5,253.00

Service Code	HCPCS C1713
Hospital Charge Code	64905762
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,515.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,889.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,151.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,626.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,020.48
Rate for Payer: EmblemHealth Commercial	$2,626.50
Rate for Payer: Fidelis Medicare Advantage	$5,515.65
Rate for Payer: Group Health Inc Commercial	$2,626.50
Rate for Payer: Group Health Inc Medicare	$1,838.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,626.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,626.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,414.45

PROXIMATE LINEAR CUTTER

Facility

$242.74

Hospital Charge Code	64905440
Hospital Revenue Code	270
Min. Negotiated Rate	$84.96
Max. Negotiated Rate	$194.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$133.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$121.37
Rate for Payer: Aetna Government	$121.37
Rate for Payer: Brighton Health Commercial	$182.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$194.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$165.06
Rate for Payer: Group Health Inc Commercial	$121.37
Rate for Payer: Group Health Inc Medicare	$84.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$121.37
Rate for Payer: Hamaspik Choice Inc Medicare	$121.37

PROXIMATE LINEAR CUTTER W/SAF

Facility

$394.53

Hospital Charge Code	64905442
Hospital Revenue Code	270
Min. Negotiated Rate	$138.09
Max. Negotiated Rate	$315.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.26
Rate for Payer: Aetna Government	$197.26
Rate for Payer: Brighton Health Commercial	$295.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$315.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.28
Rate for Payer: Group Health Inc Commercial	$197.26
Rate for Payer: Group Health Inc Medicare	$138.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.26
Rate for Payer: Hamaspik Choice Inc Medicare	$197.26

PROXIMATE LINEAR STOP RELOAD

Facility

$115.19

Hospital Charge Code	64905179
Hospital Revenue Code	270
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$92.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$57.60
Rate for Payer: Aetna Government	$57.60
Rate for Payer: Brighton Health Commercial	$86.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.33
Rate for Payer: Group Health Inc Commercial	$57.60
Rate for Payer: Group Health Inc Medicare	$40.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.60
Rate for Payer: Hamaspik Choice Inc Medicare	$57.60

PROXIMATE RELOAD UNIT 90MM

Facility

$127.93

Hospital Charge Code	64905175
Hospital Revenue Code	270
Min. Negotiated Rate	$44.78
Max. Negotiated Rate	$102.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$63.96
Rate for Payer: Aetna Government	$63.96
Rate for Payer: Brighton Health Commercial	$95.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$102.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.99
Rate for Payer: Group Health Inc Commercial	$63.96
Rate for Payer: Group Health Inc Medicare	$44.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$63.96
Rate for Payer: Hamaspik Choice Inc Medicare	$63.96

PROXIMATE RL VASCULAR LIN STAP

Facility

$246.32

Hospital Charge Code	64905177
Hospital Revenue Code	270
Min. Negotiated Rate	$86.21
Max. Negotiated Rate	$197.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$135.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$123.16
Rate for Payer: Aetna Government	$123.16
Rate for Payer: Brighton Health Commercial	$184.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$197.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.50
Rate for Payer: Group Health Inc Commercial	$123.16
Rate for Payer: Group Health Inc Medicare	$86.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.16
Rate for Payer: Hamaspik Choice Inc Medicare	$123.16

PROXIMATE STAPLERS

Facility

$253.63

Hospital Charge Code	64905154
Hospital Revenue Code	270
Min. Negotiated Rate	$88.77
Max. Negotiated Rate	$202.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$139.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.82
Rate for Payer: Aetna Government	$126.82
Rate for Payer: Brighton Health Commercial	$190.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$202.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.47
Rate for Payer: Group Health Inc Commercial	$126.82
Rate for Payer: Group Health Inc Medicare	$88.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.82
Rate for Payer: Hamaspik Choice Inc Medicare	$126.82

PROXIMATE VASCULAR LIN STOP

Facility

$109.94

Hospital Charge Code	64905144
Hospital Revenue Code	270
Min. Negotiated Rate	$38.48
Max. Negotiated Rate	$87.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$54.97
Rate for Payer: Aetna Government	$54.97
Rate for Payer: Brighton Health Commercial	$82.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$87.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.76
Rate for Payer: Group Health Inc Commercial	$54.97
Rate for Payer: Group Health Inc Medicare	$38.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.97
Rate for Payer: Hamaspik Choice Inc Medicare	$54.97

PROX. LIN. CUT KNIFE RELOAD

Facility

$394.53

Hospital Charge Code	64902903
Hospital Revenue Code	270
Min. Negotiated Rate	$138.09
Max. Negotiated Rate	$315.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$216.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.26
Rate for Payer: Aetna Government	$197.26
Rate for Payer: Brighton Health Commercial	$295.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$315.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$268.28
Rate for Payer: Group Health Inc Commercial	$197.26
Rate for Payer: Group Health Inc Medicare	$138.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$197.26
Rate for Payer: Hamaspik Choice Inc Medicare	$197.26

PR PALATOP CL PALATE ATTACHMENT PHARYNGEAL FLAP

Professional

Both

$4,295.76

Service Code	HCPCS 42225
Min. Negotiated Rate	$3,221.82
Max. Negotiated Rate	$3,221.82
Rate for Payer: Cash Price	$1,156.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,221.82
Rate for Payer: SOMOS Essential	$3,221.82

PR PALATOP CL PALATE SOFT&/HARD PALATE ONLY

Professional

Both

$4,057.76

Service Code	HCPCS 42200
Min. Negotiated Rate	$3,043.32
Max. Negotiated Rate	$3,043.32
Rate for Payer: Cash Price	$1,092.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,043.32
Rate for Payer: SOMOS Essential	$3,043.32

PR PALATOP CLSR ALVEOLAR RIDGE GRF ALVEOLAR RIDGE

Professional

Both

$4,709.78

Service Code	HCPCS 42210
Min. Negotiated Rate	$3,532.34
Max. Negotiated Rate	$3,532.34
Rate for Payer: Cash Price	$1,267.61
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,532.34
Rate for Payer: SOMOS Essential	$3,532.34

PR PALATOPHARYNGOPLASTY

Professional

Both

$2,972.45

Service Code	HCPCS 42145
Min. Negotiated Rate	$2,229.34
Max. Negotiated Rate	$2,229.34
Rate for Payer: Cash Price	$807.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,229.34
Rate for Payer: SOMOS Essential	$2,229.34

PR PALATOPLASTY CLEFT PALATE MAJOR REVJ

Professional

Both

$3,073.00

Service Code	HCPCS 42215
Min. Negotiated Rate	$2,304.75
Max. Negotiated Rate	$2,304.75
Rate for Payer: Cash Price	$829.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,304.75
Rate for Payer: SOMOS Essential	$2,304.75

PR PALATOPLASTY CLEFT PALATE SEC LNGTH PX

Professional

Both

$2,531.97

Service Code	HCPCS 42220
Min. Negotiated Rate	$1,898.98
Max. Negotiated Rate	$1,898.98
Rate for Payer: Cash Price	$684.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,898.98
Rate for Payer: SOMOS Essential	$1,898.98

PR PALATOPLASTY W/CLSR ALVEOLAR RIDGE SOFT TISSUE

Professional

Both

$4,219.67

Service Code	HCPCS 42205
Min. Negotiated Rate	$3,164.75
Max. Negotiated Rate	$3,164.75
Rate for Payer: Cash Price	$1,136.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,164.75
Rate for Payer: SOMOS Essential	$3,164.75

PR PANCREATECTOMY TOTAL

Professional

Both

$8,225.70

Service Code	HCPCS 48155
Min. Negotiated Rate	$6,169.28
Max. Negotiated Rate	$6,169.28
Rate for Payer: Cash Price	$2,183.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,169.28
Rate for Payer: SOMOS Essential	$6,169.28

PR PANCREATICOJEJUNOSTOMY SIDE-TO-SIDE ANAST

Professional

Both

$7,566.09

Service Code	HCPCS 48548
Min. Negotiated Rate	$5,674.57
Max. Negotiated Rate	$5,674.57
Rate for Payer: Cash Price	$2,013.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,674.57
Rate for Payer: SOMOS Essential	$5,674.57

Know your out-of-pocket cost for care.

All Charges