St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PATELLA MEDIALIZED 35MM CEM

Facility

$1,375.00

Service Code	HCPCS C1776
Hospital Charge Code	64905236
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,443.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$756.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$825.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$790.62
Rate for Payer: EmblemHealth Commercial	$687.50
Rate for Payer: Fidelis Medicare Advantage	$1,443.75
Rate for Payer: Group Health Inc Commercial	$687.50
Rate for Payer: Group Health Inc Medicare	$481.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$893.75

PATELLA MEDIALIZED 35MM CEM

Facility

$1,375.00

Service Code	HCPCS C1776
Hospital Charge Code	64905236
Hospital Revenue Code	278
Min. Negotiated Rate	$687.50
Max. Negotiated Rate	$687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$687.50

PATELLA MTL ASYM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907224
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

PATELLA MTL ASYM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907224
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: EmblemHealth Commercial	$1,000.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

PATELLA MTL SYM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907225
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

PATELLA MTL SYM

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907225
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: EmblemHealth Commercial	$1,000.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

PATELLA PSN 32MM 8.5MM

Facility

$1,200.00

Hospital Charge Code	64906735
Hospital Revenue Code	279
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$960.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$600.00
Rate for Payer: Aetna Government	$600.00
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$816.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

PATELLA PSN 39MM 8.0MM

Facility

$1,200.00

Hospital Charge Code	64906732
Hospital Revenue Code	279
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$960.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$600.00
Rate for Payer: Aetna Government	$600.00
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$816.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

PATELLA PSN INST 26MM 7.5MM

Facility

$800.00

Service Code	HCPCS C1776
Hospital Charge Code	64906481
Hospital Revenue Code	278
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

PATELLA PSN INST 26MM 7.5MM

Facility

$800.00

Service Code	HCPCS C1776
Hospital Charge Code	64906481
Hospital Revenue Code	278
Min. Negotiated Rate	$280.00
Max. Negotiated Rate	$840.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$480.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$460.00
Rate for Payer: EmblemHealth Commercial	$400.00
Rate for Payer: Fidelis Medicare Advantage	$840.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$520.00

PATELLA SYMMETRIC TRI

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64907222
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,837.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$962.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,050.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,006.25
Rate for Payer: EmblemHealth Commercial	$875.00
Rate for Payer: Fidelis Medicare Advantage	$1,837.50
Rate for Payer: Group Health Inc Commercial	$875.00
Rate for Payer: Group Health Inc Medicare	$612.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,137.50

PATELLA SYMMETRIC TRI

Facility

$1,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64907222
Hospital Revenue Code	278
Min. Negotiated Rate	$875.00
Max. Negotiated Rate	$875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$875.00

PATELLA XLIN 32MM

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40204600
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,320.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: EmblemHealth Commercial	$1,100.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

PATELLA XLIN 32MM

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40007519
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

PATELLA XLIN 32MM

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40007519
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,320.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,265.00
Rate for Payer: EmblemHealth Commercial	$1,100.00
Rate for Payer: Fidelis Medicare Advantage	$2,310.00
Rate for Payer: Group Health Inc Commercial	$1,100.00
Rate for Payer: Group Health Inc Medicare	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,430.00

PATELLA XLIN 32MM

Facility

$2,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40204600
Hospital Revenue Code	278
Min. Negotiated Rate	$1,100.00
Max. Negotiated Rate	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,100.00

PATELLA XLINK APLLY 32MM DI

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64905515
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,100.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,150.00
Rate for Payer: EmblemHealth Commercial	$1,000.00
Rate for Payer: Fidelis Medicare Advantage	$2,100.00
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,300.00

PATELLA XLINK APLLY 32MM DI

Facility

$2,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64905515
Hospital Revenue Code	278
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.00

PATH CLIN CONSLTJ HIGH 41-60

Facility

$459.08

Service Code	HCPCS 80505
Hospital Charge Code	40628837
Hospital Revenue Code	310
Min. Negotiated Rate	$138.26
Max. Negotiated Rate	$367.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$252.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.52
Rate for Payer: Aetna Government	$197.52
Rate for Payer: Affinity Essential Plan 1&2	$138.26
Rate for Payer: Affinity Essential Plan 3&4	$138.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$138.26
Rate for Payer: Brighton Health Commercial	$197.52
Rate for Payer: Cash Price	$197.52
Rate for Payer: Cash Price	$197.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$197.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$367.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$312.17
Rate for Payer: Elderplan Medicare Advantage	$197.52
Rate for Payer: EmblemHealth Commercial	$197.52
Rate for Payer: Fidelis Essential Plan Aliesa	$167.89
Rate for Payer: Fidelis Essential Plan QHP	$175.79
Rate for Payer: Fidelis Medicare Advantage	$197.52
Rate for Payer: Fidelis Qualified Health Plan	$175.79
Rate for Payer: Group Health Inc Commercial	$197.52
Rate for Payer: Group Health Inc Medicare	$197.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.54
Rate for Payer: Hamaspik Choice Inc Medicare	$197.52
Rate for Payer: Healthfirst Medicare Advantage	$197.52
Rate for Payer: Healthfirst QHP	$197.52
Rate for Payer: Humana Medicare	$201.47
Rate for Payer: Senior Whole Health Medicare Advantage	$197.52
Rate for Payer: United Healthcare Medicare Advantage	$197.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$158.02
Rate for Payer: Wellcare Medicare	$177.77

PATH CLIN CONSLTJ HIGH 41-60

Facility

$459.08

Service Code	HCPCS 80505
Hospital Charge Code	40628837
Hospital Revenue Code	310
Rate for Payer: Cash Price	$197.52

PATH CLIN CONSLTJ MOD 21-40

Facility

$459.08

Service Code	HCPCS 80504
Hospital Charge Code	40628838
Hospital Revenue Code	310
Min. Negotiated Rate	$138.26
Max. Negotiated Rate	$367.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$252.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$197.52
Rate for Payer: Aetna Government	$197.52
Rate for Payer: Affinity Essential Plan 1&2	$138.26
Rate for Payer: Affinity Essential Plan 3&4	$138.26
Rate for Payer: Affinity Medicaid/CHP/HARP	$138.26
Rate for Payer: Brighton Health Commercial	$197.52
Rate for Payer: Cash Price	$197.52
Rate for Payer: Cash Price	$197.52
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$197.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$367.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$312.17
Rate for Payer: Elderplan Medicare Advantage	$197.52
Rate for Payer: EmblemHealth Commercial	$197.52
Rate for Payer: Fidelis Essential Plan Aliesa	$167.89
Rate for Payer: Fidelis Essential Plan QHP	$175.79
Rate for Payer: Fidelis Medicare Advantage	$197.52
Rate for Payer: Fidelis Qualified Health Plan	$175.79
Rate for Payer: Group Health Inc Commercial	$197.52
Rate for Payer: Group Health Inc Medicare	$197.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.54
Rate for Payer: Hamaspik Choice Inc Medicare	$197.52
Rate for Payer: Healthfirst Medicare Advantage	$197.52
Rate for Payer: Healthfirst QHP	$197.52
Rate for Payer: Humana Medicare	$201.47
Rate for Payer: Senior Whole Health Medicare Advantage	$197.52
Rate for Payer: United Healthcare Medicare Advantage	$197.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$197.52
Rate for Payer: Wellcare CHP/FHP/Medicaid	$158.02
Rate for Payer: Wellcare Medicare	$177.77

PATH CLIN CONSLTJ MOD 21-40

Facility

$459.08

Service Code	HCPCS 80504
Hospital Charge Code	40628838
Hospital Revenue Code	310
Rate for Payer: Cash Price	$197.52

PATH CLIN CONSLTJ PROLNG SVC

Facility

$0.01

Service Code	HCPCS 80506
Hospital Charge Code	40628836
Hospital Revenue Code	310
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

PATH CLIN CONSLTJ STRTFWD

Facility

$152.95

Service Code	HCPCS 80503
Hospital Charge Code	40729919
Hospital Revenue Code	310
Min. Negotiated Rate	$43.86
Max. Negotiated Rate	$122.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$84.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.66
Rate for Payer: Aetna Government	$62.66
Rate for Payer: Affinity Essential Plan 1&2	$43.86
Rate for Payer: Affinity Essential Plan 3&4	$43.86
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.86
Rate for Payer: Brighton Health Commercial	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Cash Price	$62.66
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$104.01
Rate for Payer: Elderplan Medicare Advantage	$62.66
Rate for Payer: EmblemHealth Commercial	$62.66
Rate for Payer: Fidelis Essential Plan Aliesa	$53.26
Rate for Payer: Fidelis Essential Plan QHP	$55.77
Rate for Payer: Fidelis Medicare Advantage	$62.66
Rate for Payer: Fidelis Qualified Health Plan	$55.77
Rate for Payer: Group Health Inc Commercial	$62.66
Rate for Payer: Group Health Inc Medicare	$62.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$76.48
Rate for Payer: Hamaspik Choice Inc Medicare	$62.66
Rate for Payer: Healthfirst Medicare Advantage	$62.66
Rate for Payer: Healthfirst QHP	$62.66
Rate for Payer: Humana Medicare	$63.91
Rate for Payer: Senior Whole Health Medicare Advantage	$62.66
Rate for Payer: United Healthcare Medicare Advantage	$62.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$50.13
Rate for Payer: Wellcare Medicare	$56.39

PATH CLIN CONSLTJ STRTFWD

Facility

$152.95

Service Code	HCPCS 80503
Hospital Charge Code	40729919
Hospital Revenue Code	310
Rate for Payer: Cash Price	$62.66

Know your out-of-pocket cost for care.

All Charges