St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LINER II, 36X52 CONT NUET

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905561
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 II, 36X52 CONT NUET

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905561
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,JJ,NEUT,CONT,VI,36X54

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905554
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,JJ,NEUT,CONT,VI,36X54

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905554
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 LONGEVITY

Facility

$5,632.33

Service Code	HCPCS C1776
Hospital Charge Code	64907179
Hospital Revenue Code	278
Min. Negotiated Rate	$2,816.16
Max. Negotiated Rate	$2,816.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,816.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2,816.16

LINER LONGEVITY

Facility

$5,632.33

Service Code	HCPCS C1776
Hospital Charge Code	64907179
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,913.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,097.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,379.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,816.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,238.59
Rate for Payer: EmblemHealth Commercial	$2,816.16
Rate for Payer: Fidelis Medicare Advantage	$5,913.95
Rate for Payer: Group Health Inc Commercial	$2,816.16
Rate for Payer: Group Health Inc Medicare	$1,971.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,816.16
Rate for Payer: Hamaspik Choice Inc Medicare	$2,816.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,661.01

LINER MDM COCR

Facility

$3,375.00

Service Code	HCPCS C1776
Hospital Charge Code	64907201
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,543.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,856.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,025.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,940.62
Rate for Payer: EmblemHealth Commercial	$1,687.50
Rate for Payer: Fidelis Medicare Advantage	$3,543.75
Rate for Payer: Group Health Inc Commercial	$1,687.50
Rate for Payer: Group Health Inc Medicare	$1,181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,193.75

LINER MDM COCR

Facility

$3,375.00

Service Code	HCPCS C1776
Hospital Charge Code	64907201
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50

LINER MDM COCR 36MM C

Facility

$7,211.25

Service Code	HCPCS C1776
Hospital Charge Code	64905733
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,571.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,966.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,326.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,605.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,146.47
Rate for Payer: EmblemHealth Commercial	$3,605.62
Rate for Payer: Fidelis Medicare Advantage	$7,571.81
Rate for Payer: Group Health Inc Commercial	$3,605.62
Rate for Payer: Group Health Inc Medicare	$2,523.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,605.62
Rate for Payer: Hamaspik Choice Inc Medicare	$3,605.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,687.31

LINER MDM COCR 36MM C

Facility

$7,211.25

Service Code	HCPCS C1776
Hospital Charge Code	64905733
Hospital Revenue Code	278
Min. Negotiated Rate	$3,605.62
Max. Negotiated Rate	$3,605.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,605.62
Rate for Payer: Hamaspik Choice Inc Medicare	$3,605.62

LINER MDM INS X3 22.2MM/36C

Facility

$5,681.25

Service Code	HCPCS C1776
Hospital Charge Code	64905736
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,965.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,124.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,408.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,840.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,266.72
Rate for Payer: EmblemHealth Commercial	$2,840.62
Rate for Payer: Fidelis Medicare Advantage	$5,965.31
Rate for Payer: Group Health Inc Commercial	$2,840.62
Rate for Payer: Group Health Inc Medicare	$1,988.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,840.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,840.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,692.81

LINER MDM INS X3 22.2MM/36C

Facility

$5,681.25

Service Code	HCPCS C1776
Hospital Charge Code	64905736
Hospital Revenue Code	278
Min. Negotiated Rate	$2,840.62
Max. Negotiated Rate	$2,840.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,840.62
Rate for Payer: Hamaspik Choice Inc Medicare	$2,840.62

LINER MDM ORTHO

Facility

$3,375.00

Service Code	HCPCS C1776
Hospital Charge Code	64907198
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,543.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,856.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,025.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,940.62
Rate for Payer: EmblemHealth Commercial	$1,687.50
Rate for Payer: Fidelis Medicare Advantage	$3,543.75
Rate for Payer: Group Health Inc Commercial	$1,687.50
Rate for Payer: Group Health Inc Medicare	$1,181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,193.75

LINER MDM ORTHO

Facility

$3,375.00

Service Code	HCPCS C1776
Hospital Charge Code	64907198
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50

LINER MULTIPOLAR 5001

Facility

$1,225.00

Service Code	HCPCS C1776
Hospital Charge Code	64907039
Hospital Revenue Code	278
Min. Negotiated Rate	$612.50
Max. Negotiated Rate	$612.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$612.50
Rate for Payer: Hamaspik Choice Inc Medicare	$612.50

LINER MULTIPOLAR 5001

Facility

$1,225.00

Service Code	HCPCS C1776
Hospital Charge Code	64907039
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,286.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$673.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$735.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$612.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$704.38
Rate for Payer: EmblemHealth Commercial	$612.50
Rate for Payer: Fidelis Medicare Advantage	$1,286.25
Rate for Payer: Group Health Inc Commercial	$612.50
Rate for Payer: Group Health Inc Medicare	$428.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$612.50
Rate for Payer: Hamaspik Choice Inc Medicare	$612.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$796.25

LINER TRIDNT INST

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907200
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: EmblemHealth Commercial	$1,500.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

LINER TRIDNT INST

Facility

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907200
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

LINER VIVACIT E 36MM F

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64906988
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 VIVACIT E 36MM F

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64906988
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 VIVACIT-E 36MM SZ G

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907012
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 VIVACIT-E 36MM SZ G

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907012
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 VIVACIT-E NTRL 36X58 1336

Facility

$3,400.00

Hospital Charge Code	64906663
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 X-LINKED POLY

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907133
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 X-LINKED POLY

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907133
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