St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD

Professional

Both

$9,652.27

Service Code	HCPCS 21175
Min. Negotiated Rate	$7,239.20
Max. Negotiated Rate	$7,239.20
Rate for Payer: Cash Price	$2,589.73
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,239.20
Rate for Payer: SOMOS Essential	$7,239.20

PR RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT

Professional

Both

$3,247.06

Service Code	HCPCS 26545
Min. Negotiated Rate	$2,435.30
Max. Negotiated Rate	$2,435.30
Rate for Payer: Cash Price	$878.13
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,435.30
Rate for Payer: SOMOS Essential	$2,435.30

PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS

Professional

Both

$3,193.23

Service Code	HCPCS 26542
Min. Negotiated Rate	$2,394.92
Max. Negotiated Rate	$2,394.92
Rate for Payer: Cash Price	$862.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,394.92
Rate for Payer: SOMOS Essential	$2,394.92

PR RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF

Professional

Both

$3,689.88

Service Code	HCPCS 26541
Min. Negotiated Rate	$2,767.41
Max. Negotiated Rate	$2,767.41
Rate for Payer: Cash Price	$997.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,767.41
Rate for Payer: SOMOS Essential	$2,767.41

PR RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC

Professional

Both

$3,246.92

Service Code	HCPCS 21181
Min. Negotiated Rate	$2,435.19
Max. Negotiated Rate	$2,435.19
Rate for Payer: Cash Price	$874.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,435.19
Rate for Payer: SOMOS Essential	$2,435.19

PR RCNSTJ DISLC PATELLA W/PATELLECTOMY

Professional

Both

$3,326.68

Service Code	HCPCS 27424
Min. Negotiated Rate	$2,495.01
Max. Negotiated Rate	$2,495.01
Rate for Payer: Cash Price	$898.95
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,495.01
Rate for Payer: SOMOS Essential	$2,495.01

PR RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL

Professional

Both

$3,287.80

Service Code	HCPCS 27422
Min. Negotiated Rate	$2,465.85
Max. Negotiated Rate	$2,465.85
Rate for Payer: Cash Price	$889.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,465.85
Rate for Payer: SOMOS Essential	$2,465.85

PR RCNSTJ DISLOCATING PATELLA

Professional

Both

$3,309.46

Service Code	HCPCS 27420
Min. Negotiated Rate	$2,482.10
Max. Negotiated Rate	$2,482.10
Rate for Payer: Cash Price	$900.67
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,482.10
Rate for Payer: SOMOS Essential	$2,482.10

PR RCNSTJ EYELID FULL THICKNESS LOWER EYELID 1 STG

Professional

Both

$3,796.10

Service Code	HCPCS 67973
Min. Negotiated Rate	$2,847.08
Max. Negotiated Rate	$2,847.08
Rate for Payer: Cash Price	$1,044.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,847.08
Rate for Payer: SOMOS Essential	$2,847.08

PR RCNSTJ EYELID FULL THICKNESS SECOND STAGE

Professional

Both

$2,804.87

Service Code	HCPCS 67975
Min. Negotiated Rate	$2,103.65
Max. Negotiated Rate	$2,103.65
Rate for Payer: Cash Price	$770.15
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,103.65
Rate for Payer: SOMOS Essential	$2,103.65

PR RCNSTJ EYELID FULL THICKNESS <TWO-THIRDS 1 STG

Professional

Both

$2,958.73

Service Code	HCPCS 67971
Min. Negotiated Rate	$2,219.05
Max. Negotiated Rate	$2,219.05
Rate for Payer: Cash Price	$812.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,219.05
Rate for Payer: SOMOS Essential	$2,219.05

PR RCNSTJ EYELID FULL THICKNESS UPPER EYELID 1 STG

Professional

Both

$3,781.40

Service Code	HCPCS 67974
Min. Negotiated Rate	$2,836.05
Max. Negotiated Rate	$2,836.05
Rate for Payer: Cash Price	$1,041.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,836.05
Rate for Payer: SOMOS Essential	$2,836.05

PR RCNSTJ FOREHEAD &/ SUPRAORBITAL RIMS W/AUTOGRAFT

Professional

Both

$7,415.10

Service Code	HCPCS 21180
Min. Negotiated Rate	$5,561.32
Max. Negotiated Rate	$5,561.32
Rate for Payer: Cash Price	$1,991.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,561.32
Rate for Payer: SOMOS Essential	$5,561.32

PR RCNSTJ FOREHEAD &/ SUPRAORB RIMS W/ALGRF/PROSTC

Professional

Both

$6,638.59

Service Code	HCPCS 21179
Min. Negotiated Rate	$4,978.94
Max. Negotiated Rate	$4,978.94
Rate for Payer: Cash Price	$1,784.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,978.94
Rate for Payer: SOMOS Essential	$4,978.94

PR RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT

Professional

Both

$4,801.09

Service Code	HCPCS 24344
Min. Negotiated Rate	$3,600.82
Max. Negotiated Rate	$3,600.82
Rate for Payer: Cash Price	$1,322.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,600.82
Rate for Payer: SOMOS Essential	$3,600.82

PR RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE

Professional

Both

$4,620.28

Service Code	HCPCS 21249
Min. Negotiated Rate	$3,465.21
Max. Negotiated Rate	$3,465.21
Rate for Payer: Cash Price	$1,262.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,465.21
Rate for Payer: SOMOS Essential	$3,465.21

PR RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL

Professional

Both

$3,306.73

Service Code	HCPCS 21248
Min. Negotiated Rate	$2,480.05
Max. Negotiated Rate	$2,480.05
Rate for Payer: Cash Price	$905.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,480.05
Rate for Payer: SOMOS Essential	$2,480.05

PR RCNSTJ MDFC OTH/THN LEFORT OSTEOT & BONE GRAFTS

Professional

Both

$6,657.81

Service Code	HCPCS 21188
Min. Negotiated Rate	$4,993.36
Max. Negotiated Rate	$4,993.36
Rate for Payer: Cash Price	$1,801.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,993.36
Rate for Payer: SOMOS Essential	$4,993.36

PR RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF

Professional

Both

$4,887.05

Service Code	HCPCS 24346
Min. Negotiated Rate	$3,665.29
Max. Negotiated Rate	$3,665.29
Rate for Payer: Cash Price	$1,322.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,665.29
Rate for Payer: SOMOS Essential	$3,665.29

PR RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS

Professional

Both

$6,515.60

Service Code	HCPCS 21145
Min. Negotiated Rate	$4,886.70
Max. Negotiated Rate	$4,886.70
Rate for Payer: Cash Price	$1,765.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,886.70
Rate for Payer: SOMOS Essential	$4,886.70

PR RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT

Professional

Both

$5,612.11

Service Code	HCPCS 21141
Min. Negotiated Rate	$4,209.08
Max. Negotiated Rate	$4,209.08
Rate for Payer: Cash Price	$1,522.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,209.08
Rate for Payer: SOMOS Essential	$4,209.08

PR RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS

Professional

Both

$6,799.28

Service Code	HCPCS 21146
Min. Negotiated Rate	$5,099.46
Max. Negotiated Rate	$5,099.46
Rate for Payer: Cash Price	$1,844.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,099.46
Rate for Payer: SOMOS Essential	$5,099.46

PR RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT

Professional

Both

$5,756.28

Service Code	HCPCS 21142
Min. Negotiated Rate	$4,317.21
Max. Negotiated Rate	$4,317.21
Rate for Payer: Cash Price	$1,561.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,317.21
Rate for Payer: SOMOS Essential	$4,317.21

PR RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS

Professional

Both

$7,162.37

Service Code	HCPCS 21147
Min. Negotiated Rate	$5,371.78
Max. Negotiated Rate	$5,371.78
Rate for Payer: Cash Price	$1,939.26
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,371.78
Rate for Payer: SOMOS Essential	$5,371.78

PR RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT

Professional

Both

$5,927.92

Service Code	HCPCS 21143
Min. Negotiated Rate	$4,445.94
Max. Negotiated Rate	$4,445.94
Rate for Payer: Cash Price	$1,609.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,445.94
Rate for Payer: SOMOS Essential	$4,445.94

Know your out-of-pocket cost for care.

All Charges