St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LINER 28MM BIPOLAR

Facility

$980.00

Service Code	HCPCS C1776
Hospital Charge Code	64906919
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,029.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$539.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$588.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$490.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$563.50
Rate for Payer: EmblemHealth Commercial	$490.00
Rate for Payer: Fidelis Medicare Advantage	$1,029.00
Rate for Payer: Group Health Inc Commercial	$490.00
Rate for Payer: Group Health Inc Medicare	$343.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.00
Rate for Payer: Hamaspik Choice Inc Medicare	$490.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$637.00

LINER 28MM BIPOLAR

Facility

$980.00

Service Code	HCPCS C1776
Hospital Charge Code	64906919
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$490.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.00
Rate for Payer: Hamaspik Choice Inc Medicare	$490.00

LINER ACETABULAR 32MM ID 48MM

Facility

$2,966.88

Service Code	HCPCS C1776
Hospital Charge Code	64904383
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,115.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,631.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,780.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,483.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,705.96
Rate for Payer: EmblemHealth Commercial	$1,483.44
Rate for Payer: Fidelis Medicare Advantage	$3,115.22
Rate for Payer: Group Health Inc Commercial	$1,483.44
Rate for Payer: Group Health Inc Medicare	$1,038.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,483.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,928.47

LINER ACETABULAR 32MM ID 48MM

Facility

$2,966.88

Service Code	HCPCS C1776
Hospital Charge Code	64904383
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.44
Max. Negotiated Rate	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,483.44

LINER ACETABULAR 32MM ID 50MM

Facility

$2,966.88

Service Code	HCPCS C1776
Hospital Charge Code	64903155
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.44
Max. Negotiated Rate	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,483.44

LINER ACETABULAR 32MM ID 50MM

Facility

$2,966.88

Service Code	HCPCS C1776
Hospital Charge Code	64903155
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,115.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,631.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,780.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,483.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,705.96
Rate for Payer: EmblemHealth Commercial	$1,483.44
Rate for Payer: Fidelis Medicare Advantage	$3,115.22
Rate for Payer: Group Health Inc Commercial	$1,483.44
Rate for Payer: Group Health Inc Medicare	$1,038.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,483.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,928.47

LINER ACETABULAR 32MM ID 52MM

Facility

$2,965.63

Service Code	HCPCS C1776
Hospital Charge Code	64903146
Hospital Revenue Code	278
Min. Negotiated Rate	$1,482.82
Max. Negotiated Rate	$1,482.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,482.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,482.82

LINER ACETABULAR 32MM ID 52MM

Facility

$2,965.63

Service Code	HCPCS C1776
Hospital Charge Code	64903146
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,113.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,631.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,779.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,482.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,705.24
Rate for Payer: EmblemHealth Commercial	$1,482.82
Rate for Payer: Fidelis Medicare Advantage	$3,113.91
Rate for Payer: Group Health Inc Commercial	$1,482.82
Rate for Payer: Group Health Inc Medicare	$1,037.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,482.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1,482.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,927.66

LINER ACETABULAR 36MM ID 56MM

Facility

$2,966.88

Service Code	HCPCS C1776
Hospital Charge Code	64902789
Hospital Revenue Code	278
Min. Negotiated Rate	$1,483.44
Max. Negotiated Rate	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,483.44

LINER ACETABULAR 36MM ID 56MM

Facility

$2,966.88

Service Code	HCPCS C1776
Hospital Charge Code	64902789
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,115.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,631.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,780.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,483.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,705.96
Rate for Payer: EmblemHealth Commercial	$1,483.44
Rate for Payer: Fidelis Medicare Advantage	$3,115.22
Rate for Payer: Group Health Inc Commercial	$1,483.44
Rate for Payer: Group Health Inc Medicare	$1,038.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,483.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1,483.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,928.47

LINER ACET NEUT MM 36 X 60

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905844
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

LINER ACET NEUT MM 36 X 60

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905844
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

LINER ACETUBE G7 36MM G

Facility

$3,800.00

Hospital Charge Code	64906853
Hospital Revenue Code	279
Min. Negotiated Rate	$1,330.00
Max. Negotiated Rate	$3,040.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,900.00
Rate for Payer: Aetna Government	$1,900.00
Rate for Payer: Brighton Health Commercial	$2,850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,040.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,584.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

LINER ACETUBE G7 36MM SZ F

Facility

$3,400.00

Hospital Charge Code	64906850
Hospital Revenue Code	279
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,700.00
Rate for Payer: Aetna Government	$1,700.00
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,312.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

LINER ACETUBE NEUT 36MM

Facility

$3,400.00

Hospital Charge Code	64906836
Hospital Revenue Code	279
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,700.00
Rate for Payer: Aetna Government	$1,700.00
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,312.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

LINER ALLOFIT 36MM KK XLINK 236

Facility

$3,400.00

Hospital Charge Code	64906699
Hospital Revenue Code	279
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,700.00
Rate for Payer: Aetna Government	$1,700.00
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,312.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

LINER BIPOLAR CUP 28MM I.D.

Facility

$980.00

Service Code	HCPCS C1776
Hospital Charge Code	64906592
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,029.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$539.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$588.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$490.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$563.50
Rate for Payer: EmblemHealth Commercial	$490.00
Rate for Payer: Fidelis Medicare Advantage	$1,029.00
Rate for Payer: Group Health Inc Commercial	$490.00
Rate for Payer: Group Health Inc Medicare	$343.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.00
Rate for Payer: Hamaspik Choice Inc Medicare	$490.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$637.00

LINER BIPOLAR CUP 28MM I.D.

Facility

$980.00

Service Code	HCPCS C1776
Hospital Charge Code	64906592
Hospital Revenue Code	278
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$490.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$490.00
Rate for Payer: Hamaspik Choice Inc Medicare	$490.00

LINER CNT VVCT-E ELVT 36X58

Facility

$3,400.00

Hospital Charge Code	64906703
Hospital Revenue Code	279
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,700.00
Rate for Payer: Aetna Government	$1,700.00
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,312.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

LINER CONT VIVA-E 36X64-885101636

Facility

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906456
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,020.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: EmblemHealth Commercial	$850.00
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

LINER CONT VIVA-E 36X64-885101636

Facility

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906456
Hospital Revenue Code	278
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

LINER CONT VIV NEUT 40X58

Facility

$5,205.00

Service Code	HCPCS C1776
Hospital Charge Code	64905598
Hospital Revenue Code	278
Min. Negotiated Rate	$2,602.50
Max. Negotiated Rate	$2,602.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,602.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,602.50

LINER CONT VIV NEUT 40X58

Facility

$5,205.00

Service Code	HCPCS C1776
Hospital Charge Code	64905598
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,465.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,862.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,123.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,602.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,992.88
Rate for Payer: EmblemHealth Commercial	$2,602.50
Rate for Payer: Fidelis Medicare Advantage	$5,465.25
Rate for Payer: Group Health Inc Commercial	$2,602.50
Rate for Payer: Group Health Inc Medicare	$1,821.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,602.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,602.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,383.25

LINER E-ELEV JJ 36 X 54

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905857
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

LINER E-ELEV JJ 36 X 54

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905857
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

Know your out-of-pocket cost for care.

All Charges