St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TENDON, ANTE TIB 8.0X290

Facility

$5,852.50

Service Code	HCPCS C1762
Hospital Charge Code	64905461
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.82
Max. Negotiated Rate	$6,145.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,218.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$3,511.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,926.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,365.19
Rate for Payer: EmblemHealth Commercial	$2,926.25
Rate for Payer: Fidelis Medicare Advantage	$6,145.12
Rate for Payer: Group Health Inc Commercial	$2,926.25
Rate for Payer: Group Health Inc Medicare	$2,048.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,926.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,926.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,804.12

TENDON, ANTE TIB 8.0X290

Facility

$5,852.50

Service Code	HCPCS C1762
Hospital Charge Code	40203989
Hospital Revenue Code	278
Min. Negotiated Rate	$2,926.25
Max. Negotiated Rate	$2,926.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,926.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,926.25

TENDON, ANTE TIB 8.0X290

Facility

$5,852.50

Service Code	HCPCS C1762
Hospital Charge Code	64905461
Hospital Revenue Code	278
Min. Negotiated Rate	$2,926.25
Max. Negotiated Rate	$2,926.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,926.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,926.25

TENDON, ANTE TIB 8.0X290

Facility

$5,852.50

Service Code	HCPCS C1762
Hospital Charge Code	40203989
Hospital Revenue Code	278
Min. Negotiated Rate	$1,879.82
Max. Negotiated Rate	$6,145.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,218.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,879.82
Rate for Payer: Aetna Government	$1,879.82
Rate for Payer: Brighton Health Commercial	$3,511.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,926.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,365.19
Rate for Payer: EmblemHealth Commercial	$2,926.25
Rate for Payer: Fidelis Medicare Advantage	$6,145.12
Rate for Payer: Group Health Inc Commercial	$2,926.25
Rate for Payer: Group Health Inc Medicare	$2,048.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,926.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,926.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,804.12

TENDON EXCISION PALM/FINGER

Facility

$4,105.13

Service Code	HCPCS 26145
Hospital Charge Code	40064135
Hospital Revenue Code	260
Min. Negotiated Rate	$1,486.89
Max. Negotiated Rate	$3,078.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,858.61
Rate for Payer: Aetna Government	$1,858.61
Rate for Payer: Brighton Health Commercial	$3,078.85
Rate for Payer: Cash Price	$1,858.61
Rate for Payer: Cash Price	$1,858.61
Rate for Payer: Cash Price	$1,858.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,858.61
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: Elderplan Medicare Advantage	$1,858.61
Rate for Payer: EmblemHealth Commercial	$1,858.61
Rate for Payer: Fidelis Essential Plan Aliesa	$1,579.82
Rate for Payer: Fidelis Essential Plan QHP	$1,654.16
Rate for Payer: Fidelis Medicare Advantage	$1,858.61
Rate for Payer: Fidelis Qualified Health Plan	$1,654.16
Rate for Payer: Group Health Inc Commercial	$1,858.61
Rate for Payer: Group Health Inc Medicare	$1,858.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,052.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1,858.61
Rate for Payer: Healthfirst Medicare Advantage	$1,579.82
Rate for Payer: Healthfirst QHP	$1,858.61
Rate for Payer: Senior Whole Health Medicare Advantage	$1,858.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,858.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,486.89
Rate for Payer: Wellcare Medicare	$1,765.68

TENDON EXCISION PALM/FINGER

Facility

$4,105.13

Service Code	HCPCS 26145
Hospital Charge Code	40064135
Hospital Revenue Code	260
Rate for Payer: Cash Price	$1,858.61

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$29,494.93

Service Code	MSDRG 557
Min. Negotiated Rate	$13,349.60
Max. Negotiated Rate	$29,494.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,955.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28,916.60
Rate for Payer: Aetna Government	$28,916.60
Rate for Payer: Brighton Health Commercial	$22,573.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$29,494.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26,884.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$22,186.14
Rate for Payer: Elderplan Medicare Advantage	$27,470.77
Rate for Payer: EmblemHealth Commercial	$13,349.60
Rate for Payer: Fidelis Medicare Advantage	$28,916.60
Rate for Payer: Group Health Inc Commercial	$28,916.60
Rate for Payer: Group Health Inc Medicare	$28,916.60
Rate for Payer: Hamaspik Choice Inc Medicare	$28,916.60
Rate for Payer: Healthfirst Medicare Advantage	$13,446.22
Rate for Payer: Senior Whole Health Medicare Advantage	$28,916.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28,916.60
Rate for Payer: Wellcare Medicare	$27,470.77

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$19,899.13

Service Code	MSDRG 558
Min. Negotiated Rate	$7,532.28
Max. Negotiated Rate	$19,899.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,952.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19,508.95
Rate for Payer: Aetna Government	$19,508.95
Rate for Payer: Brighton Health Commercial	$12,736.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19,899.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15,169.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,518.18
Rate for Payer: Elderplan Medicare Advantage	$18,533.50
Rate for Payer: EmblemHealth Commercial	$7,532.28
Rate for Payer: Fidelis Medicare Advantage	$19,508.95
Rate for Payer: Group Health Inc Commercial	$19,508.95
Rate for Payer: Group Health Inc Medicare	$19,508.95
Rate for Payer: Hamaspik Choice Inc Medicare	$19,508.95
Rate for Payer: Healthfirst Medicare Advantage	$9,071.66
Rate for Payer: Senior Whole Health Medicare Advantage	$19,508.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19,508.95
Rate for Payer: Wellcare Medicare	$18,533.50

TENDON LENGTHENING - TOE

Facility

$8,291.05

Service Code	HCPCS 28240
Hospital Charge Code	40021665
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

TENDON LENGTHENING - TOE

Facility

$8,291.05

Service Code	HCPCS 28240
Hospital Charge Code	40021665
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

TENDON REPAIR - ARM, WRIST

Facility

$8,291.05

Service Code	HCPCS 25275
Hospital Charge Code	40082860
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

TENDON REPAIR - ARM, WRIST

Facility

$8,291.05

Service Code	HCPCS 25275
Hospital Charge Code	40082860
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

TENDON ROD 5MMX24.5CM

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Charge Code	40202078
Hospital Revenue Code	278
Min. Negotiated Rate	$1,238.00
Max. Negotiated Rate	$1,238.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,238.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,238.00

TENDON ROD 5MMX24.5CM

Facility

$2,476.00

Service Code	HCPCS C1713
Hospital Charge Code	40202078
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,599.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,361.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,485.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,238.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,423.70
Rate for Payer: EmblemHealth Commercial	$1,238.00
Rate for Payer: Fidelis Medicare Advantage	$2,599.80
Rate for Payer: Group Health Inc Commercial	$1,238.00
Rate for Payer: Group Health Inc Medicare	$866.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,238.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,238.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,609.40

Tendon sheath incision (eg, for trigger finger)

Facility

$2,915.00

Service Code	CPT 26055
Hospital Revenue Code	360
Min. Negotiated Rate	$1,486.89
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,858.61
Rate for Payer: Aetna Government	$1,858.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,858.61
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: Elderplan Medicare Advantage	$1,858.61
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,579.82
Rate for Payer: Fidelis Essential Plan QHP	$1,654.16
Rate for Payer: Fidelis Medicare Advantage	$1,858.61
Rate for Payer: Fidelis Qualified Health Plan	$1,654.16
Rate for Payer: Group Health Inc Commercial	$1,858.61
Rate for Payer: Group Health Inc Medicare	$1,858.61
Rate for Payer: Hamaspik Choice Inc Medicare	$1,858.61
Rate for Payer: Healthfirst Medicare Advantage	$1,579.82
Rate for Payer: Healthfirst QHP	$1,858.61
Rate for Payer: Senior Whole Health Medicare Advantage	$1,858.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,858.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,486.89
Rate for Payer: Wellcare Medicare	$1,765.68

TENDON TRANSFERS ARM

Facility

$8,291.05

Service Code	HCPCS 25310
Hospital Charge Code	40013178
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

TENDON TRANSFERS ARM

Facility

$8,291.05

Service Code	HCPCS 25310
Hospital Charge Code	40013178
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

TENDON TRANSFERS ELBOW

Facility

$18,117.83

Service Code	HCPCS 24301
Hospital Charge Code	40013179
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
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: Elderplan Medicare Advantage	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

TENDON TRANSFERS ELBOW

Facility

$18,117.83

Service Code	HCPCS 24301
Hospital Charge Code	40013179
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

TENDON TRANSFERS HAND

Facility

$8,291.05

Service Code	HCPCS 26480
Hospital Charge Code	40013181
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

TENDON TRANSFERS HAND

Facility

$8,291.05

Service Code	HCPCS 26480
Hospital Charge Code	40013181
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

TENDON TRANSFERS LEG

Facility

$8,291.05

Service Code	HCPCS 26483
Hospital Charge Code	40013182
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

TENDON TRANSFERS LEG

Facility

$8,291.05

Service Code	HCPCS 26483
Hospital Charge Code	40013182
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

TENDON TRANSFERS UPPER ARM

Facility

$18,117.83

Service Code	HCPCS 24301
Hospital Charge Code	40013180
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
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: Elderplan Medicare Advantage	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

TENDON TRANSFERS UPPER ARM

Facility

$18,117.83

Service Code	HCPCS 24301
Hospital Charge Code	40013180
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

Know your out-of-pocket cost for care.

All Charges