St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION

Professional

Both

$7,069.93

Service Code	HCPCS 21150
Min. Negotiated Rate	$5,302.45
Max. Negotiated Rate	$5,302.45
Rate for Payer: Cash Price	$1,908.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,302.45
Rate for Payer: SOMOS Essential	$5,302.45

PR RCNSTJ MIDFACE LEFORT III W/FHD W/LEFORT I

Professional

Both

$12,057.47

Service Code	HCPCS 21160
Min. Negotiated Rate	$9,043.10
Max. Negotiated Rate	$9,043.10
Rate for Payer: Cash Price	$3,251.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$9,043.10
Rate for Payer: SOMOS Essential	$9,043.10

PR RCNSTJ MIDFACE LEFORT III W/FHD W/O LEFORT I

Professional

Both

$11,115.65

Service Code	HCPCS 21159
Min. Negotiated Rate	$8,336.74
Max. Negotiated Rate	$8,336.74
Rate for Payer: Cash Price	$2,999.38
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,336.74
Rate for Payer: SOMOS Essential	$8,336.74

PR RCNSTJ MIDFACE LEFORT III W/LEFORT I

Professional

Both

$9,281.06

Service Code	HCPCS 21155
Min. Negotiated Rate	$6,960.80
Max. Negotiated Rate	$6,960.80
Rate for Payer: Cash Price	$2,506.47
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,960.80
Rate for Payer: SOMOS Essential	$6,960.80

PR RCNSTJ MIDFACE LEFORT III W/O LEFORT I

Professional

Both

$8,369.66

Service Code	HCPCS 21154
Min. Negotiated Rate	$6,277.24
Max. Negotiated Rate	$6,277.24
Rate for Payer: Cash Price	$2,260.20
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,277.24
Rate for Payer: SOMOS Essential	$6,277.24

PR RCNSTJ MIDFACE LEFORT II W/BONE GRAFTS

Professional

Both

$7,780.61

Service Code	HCPCS 21151
Min. Negotiated Rate	$5,835.46
Max. Negotiated Rate	$5,835.46
Rate for Payer: Cash Price	$2,099.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,835.46
Rate for Payer: SOMOS Essential	$5,835.46

PR RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE

Professional

Both

$3,572.52

Service Code	HCPCS 21246
Min. Negotiated Rate	$2,679.39
Max. Negotiated Rate	$2,679.39
Rate for Payer: Cash Price	$970.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,679.39
Rate for Payer: SOMOS Essential	$2,679.39

PR RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL

Professional

Both

$3,999.80

Service Code	HCPCS 21245
Min. Negotiated Rate	$2,999.85
Max. Negotiated Rate	$2,999.85
Rate for Payer: Cash Price	$1,084.64
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,999.85
Rate for Payer: SOMOS Essential	$2,999.85

PR RCNSTJ MNDBLR CONDYLE W/BONE CARTLG AUTOGRAFTS

Professional

Both

$6,640.76

Service Code	HCPCS 21247
Min. Negotiated Rate	$4,980.57
Max. Negotiated Rate	$4,980.57
Rate for Payer: Cash Price	$1,800.79
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,980.57
Rate for Payer: SOMOS Essential	$4,980.57

PR RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI

Professional

Both

$6,032.88

Service Code	HCPCS 21196
Min. Negotiated Rate	$4,524.66
Max. Negotiated Rate	$4,524.66
Rate for Payer: Cash Price	$1,633.98
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,524.66
Rate for Payer: SOMOS Essential	$4,524.66

PR RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD

Professional

Both

$5,653.31

Service Code	HCPCS 21195
Min. Negotiated Rate	$4,239.98
Max. Negotiated Rate	$4,239.98
Rate for Payer: Cash Price	$1,530.76
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,239.98
Rate for Payer: SOMOS Essential	$4,239.98

PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT

Professional

Both

$5,988.61

Service Code	HCPCS 21194
Min. Negotiated Rate	$4,491.46
Max. Negotiated Rate	$4,491.46
Rate for Payer: Cash Price	$1,622.27
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,491.46
Rate for Payer: SOMOS Essential	$4,491.46

PR RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF

Professional

Both

$5,179.72

Service Code	HCPCS 21193
Min. Negotiated Rate	$3,884.79
Max. Negotiated Rate	$3,884.79
Rate for Payer: Cash Price	$1,403.44
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,884.79
Rate for Payer: SOMOS Essential	$3,884.79

PR RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE

Professional

Both

$4,312.35

Service Code	HCPCS 21244
Min. Negotiated Rate	$3,234.26
Max. Negotiated Rate	$3,234.26
Rate for Payer: Cash Price	$1,169.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,234.26
Rate for Payer: SOMOS Essential	$3,234.26

PR RCNSTJ ORBIT/FHD/NASETHMD EXC BONE GRF>40 <80

Professional

Both

$10,044.23

Service Code	HCPCS 21183
Min. Negotiated Rate	$7,533.17
Max. Negotiated Rate	$7,533.17
Rate for Payer: Cash Price	$2,696.30
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,533.17
Rate for Payer: SOMOS Essential	$7,533.17

PR RCNSTJ ORBIT/FHD/NASETHMD EXCBONE TUM GRF<40SQCM

Professional

Both

$9,231.57

Service Code	HCPCS 21182
Min. Negotiated Rate	$6,923.68
Max. Negotiated Rate	$6,923.68
Rate for Payer: Cash Price	$2,479.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,923.68
Rate for Payer: SOMOS Essential	$6,923.68

PR RCNSTJ ORBIT/FHD/NASETHMD EXC BONE TUM GRF>80SQ

Professional

Both

$10,798.20

Service Code	HCPCS 21184
Min. Negotiated Rate	$8,098.65
Max. Negotiated Rate	$8,098.65
Rate for Payer: Cash Price	$2,900.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8,098.65
Rate for Payer: SOMOS Essential	$8,098.65

PR RCNSTJ PLSTC BILIARY DUCTS W/END-TO-END ANAST

Professional

Both

$6,967.56

Service Code	HCPCS 47800
Min. Negotiated Rate	$5,225.67
Max. Negotiated Rate	$5,225.67
Rate for Payer: Cash Price	$1,855.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,225.67
Rate for Payer: SOMOS Essential	$5,225.67

PR RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE

Professional

Both

$4,620.49

Service Code	HCPCS 26587
Min. Negotiated Rate	$3,465.37
Max. Negotiated Rate	$3,465.37
Rate for Payer: Cash Price	$1,248.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,465.37
Rate for Payer: SOMOS Essential	$3,465.37

PR RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR

Professional

Both

$2,075.68

Service Code	HCPCS 28238
Min. Negotiated Rate	$1,556.76
Max. Negotiated Rate	$1,556.76
Rate for Payer: Cash Price	$567.14
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,556.76
Rate for Payer: SOMOS Essential	$1,556.76

PR RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ

Professional

Both

$3,908.94

Service Code	HCPCS 25337
Min. Negotiated Rate	$2,931.70
Max. Negotiated Rate	$2,931.70
Rate for Payer: Cash Price	$1,061.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,931.70
Rate for Payer: SOMOS Essential	$2,931.70

PR RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD

Professional

Both

$10,147.10

Service Code	HCPCS 21172
Min. Negotiated Rate	$7,610.32
Max. Negotiated Rate	$7,610.32
Rate for Payer: Cash Price	$2,677.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7,610.32
Rate for Payer: SOMOS Essential	$7,610.32

PR RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX

Professional

Both

$3,364.62

Service Code	HCPCS 26502
Min. Negotiated Rate	$2,523.46
Max. Negotiated Rate	$2,523.46
Rate for Payer: Cash Price	$906.81
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,523.46
Rate for Payer: SOMOS Essential	$2,523.46

PR RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX

Professional

Both

$2,937.06

Service Code	HCPCS 26500
Min. Negotiated Rate	$2,202.80
Max. Negotiated Rate	$2,202.80
Rate for Payer: Cash Price	$825.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,202.80
Rate for Payer: SOMOS Essential	$2,202.80

PR RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION

Professional

Both

$1,998.54

Service Code	HCPCS 28341
Min. Negotiated Rate	$1,498.90
Max. Negotiated Rate	$1,498.90
Rate for Payer: Cash Price	$552.77
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,498.90
Rate for Payer: SOMOS Essential	$1,498.90

Know your out-of-pocket cost for care.

All Charges