St. Barnabas Hospital

All Charges

Charge

Type

Price

STEM STS DISTAL

Facility IP

$12,440.00

Service Code	HCPCS C1776
Hospital Charge Code	64907130
Hospital Revenue Code	278
Min. Negotiated Rate	$6,220.00
Max. Negotiated Rate	$6,220.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,220.00

STEM TAPER ZMR XL 17X135MM

Facility OP

$11,220.00

Service Code	HCPCS C1776
Hospital Charge Code	64905851
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$11,781.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,171.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,451.50
Rate for Payer: Fidelis Medicare Advantage	$11,781.00
Rate for Payer: Group Health Inc Commercial	$5,610.00
Rate for Payer: Group Health Inc Medicare	$3,927.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,293.00

STEM TAPER ZMR XL 17X135MM

Facility IP

$11,220.00

Service Code	HCPCS C1776
Hospital Charge Code	64905851
Hospital Revenue Code	278
Min. Negotiated Rate	$5,610.00
Max. Negotiated Rate	$5,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,610.00

STEM TIB CMNTD SZ E NON-POR

Facility IP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905779
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

STEM TIB CMNTD SZ E NON-POR

Facility OP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905779
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

STEM TIBIAL CMNTED SZ D NON

Facility OP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905754
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

STEM TIBIAL CMNTED SZ D NON

Facility IP

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

STEM TIBIAL COMPONENT SZ 4

Facility IP

$212.63

Hospital Charge Code	40200038
Hospital Revenue Code	278
Min. Negotiated Rate	$106.32
Max. Negotiated Rate	$106.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.32
Rate for Payer: Hamaspik Choice Inc Medicare	$106.32

STEM TIBIAL COMPONENT SZ 4

Facility OP

$212.63

Hospital Charge Code	40200038
Hospital Revenue Code	278
Min. Negotiated Rate	$74.42
Max. Negotiated Rate	$223.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$106.32
Rate for Payer: Aetna Government	$106.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$106.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.26
Rate for Payer: Fidelis Medicare Advantage	$223.26
Rate for Payer: Group Health Inc Commercial	$106.32
Rate for Payer: Group Health Inc Medicare	$74.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.32
Rate for Payer: Hamaspik Choice Inc Medicare	$106.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$138.21

STEM TIBIAL COMPONENT SZ 5

Facility OP

$4,720.00

Service Code	HCPCS C1776
Hospital Charge Code	40200039
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,956.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,596.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,714.00
Rate for Payer: Fidelis Medicare Advantage	$4,956.00
Rate for Payer: Group Health Inc Commercial	$2,360.00
Rate for Payer: Group Health Inc Medicare	$1,652.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,360.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,068.00

STEM TIBIAL COMPONENT SZ 5

Facility IP

$4,720.00

Service Code	HCPCS C1776
Hospital Charge Code	40200039
Hospital Revenue Code	278
Min. Negotiated Rate	$2,360.00
Max. Negotiated Rate	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,360.00

STEM TIBIAL PRECT SZ4 REV

Facility IP

$5,391.13

Service Code	HCPCS C1776
Hospital Charge Code	64906992
Hospital Revenue Code	278
Min. Negotiated Rate	$2,695.56
Max. Negotiated Rate	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2,695.56

STEM TIBIAL PRECT SZ4 REV

Facility OP

$5,391.13

Service Code	HCPCS C1776
Hospital Charge Code	64906992
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,660.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,965.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,695.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,099.90
Rate for Payer: Fidelis Medicare Advantage	$5,660.69
Rate for Payer: Group Health Inc Commercial	$2,695.56
Rate for Payer: Group Health Inc Medicare	$1,886.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2,695.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,504.23

STENGER TEST,SPEECH

Facility OP

$1,470.80

Service Code	HCPCS 92577
Hospital Charge Code	42004511
Hospital Revenue Code	471
Min. Negotiated Rate	$22.88
Max. Negotiated Rate	$1,176.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$808.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$619.82
Rate for Payer: Aetna Government	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Cash Price	$619.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$619.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,176.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,000.14
Rate for Payer: Elderplan Medicare Advantage	$619.82
Rate for Payer: EmblemHealth Commercial	$619.82
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22.88
Rate for Payer: Fidelis Essential Plan Aliesa	$526.85
Rate for Payer: Fidelis Essential Plan QHP	$551.64
Rate for Payer: Fidelis Medicare Advantage	$619.82
Rate for Payer: Fidelis Qualified Health Plan	$551.64
Rate for Payer: Group Health Inc Commercial	$619.82
Rate for Payer: Group Health Inc Medicare	$619.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$735.40
Rate for Payer: Hamaspik Choice Inc Medicare	$619.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.42
Rate for Payer: Healthfirst Medicare Advantage	$526.85
Rate for Payer: Healthfirst QHP	$619.82
Rate for Payer: Senior Whole Health Medicare Advantage	$619.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$619.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$495.86
Rate for Payer: Wellcare Medicare	$588.83

STENT .035 120 6FR

Facility IP

$4,987.50

Service Code	HCPCS C1874
Hospital Charge Code	64904766
Hospital Revenue Code	278
Min. Negotiated Rate	$2,493.75
Max. Negotiated Rate	$2,493.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,493.75

STENT .035 120 6FR

Facility OP

$4,987.50

Service Code	HCPCS C1874
Hospital Charge Code	64904766
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$5,236.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,743.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,493.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,867.81
Rate for Payer: Fidelis Medicare Advantage	$5,236.88
Rate for Payer: Group Health Inc Commercial	$2,493.75
Rate for Payer: Group Health Inc Medicare	$1,745.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,493.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2,493.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,241.88

STENT > 1000

Facility OP

$2,725.00

Hospital Charge Code	40203068
Hospital Revenue Code	272
Min. Negotiated Rate	$953.75
Max. Negotiated Rate	$2,180.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,498.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,362.50
Rate for Payer: Aetna Government	$1,362.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,853.00
Rate for Payer: Group Health Inc Commercial	$1,362.50
Rate for Payer: Group Health Inc Medicare	$953.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,362.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,362.50

STENT > 1000.00

Facility IP

$2,725.00

Service Code	HCPCS C1874
Hospital Charge Code	40203027
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.50
Max. Negotiated Rate	$1,362.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,362.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,362.50

STENT > 1000.00

Facility OP

$2,725.00

Service Code	HCPCS C1874
Hospital Charge Code	40203027
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$2,861.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,498.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,362.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,566.88
Rate for Payer: Fidelis Medicare Advantage	$2,861.25
Rate for Payer: Group Health Inc Commercial	$1,362.50
Rate for Payer: Group Health Inc Medicare	$953.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,362.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,362.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,771.25

STENT 100.00 - 499.00

Facility IP

$350.89

Service Code	HCPCS C1874
Hospital Charge Code	40203025
Hospital Revenue Code	278
Min. Negotiated Rate	$175.44
Max. Negotiated Rate	$175.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.44
Rate for Payer: Hamaspik Choice Inc Medicare	$175.44

STENT 100.00 - 499.00

Facility OP

$350.89

Service Code	HCPCS C1874
Hospital Charge Code	40203025
Hospital Revenue Code	278
Min. Negotiated Rate	$122.81
Max. Negotiated Rate	$368.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.76
Rate for Payer: Fidelis Medicare Advantage	$368.43
Rate for Payer: Group Health Inc Commercial	$175.44
Rate for Payer: Group Health Inc Medicare	$122.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.44
Rate for Payer: Hamaspik Choice Inc Medicare	$175.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$228.08

STENT 100-499

Facility OP

$350.89

Hospital Charge Code	40203066
Hospital Revenue Code	272
Min. Negotiated Rate	$122.81
Max. Negotiated Rate	$280.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.44
Rate for Payer: Aetna Government	$175.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$280.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$238.61
Rate for Payer: Group Health Inc Commercial	$175.44
Rate for Payer: Group Health Inc Medicare	$122.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.44
Rate for Payer: Hamaspik Choice Inc Medicare	$175.44

STENT 500.00 - 1000.00

Facility OP

$1,200.00

Service Code	HCPCS C1874
Hospital Charge Code	40203026
Hospital Revenue Code	278
Min. Negotiated Rate	$265.52
Max. Negotiated Rate	$1,260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.52
Rate for Payer: Aetna Government	$265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

STENT 500.00 - 1000.00

Facility IP

$1,200.00

Service Code	HCPCS C1874
Hospital Charge Code	40203026
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

STENT 500-1000

Facility OP

$1,200.00

Hospital Charge Code	40203067
Hospital Revenue Code	272
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: 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

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