St. Barnabas Hospital

All Charges

Charge

Type

Price

SYSTEM IMP FIX

Facility OP

$1,812.50

Service Code	HCPCS C1776
Hospital Charge Code	64907364
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,903.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$996.88
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	$906.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,042.19
Rate for Payer: Fidelis Medicare Advantage	$1,903.12
Rate for Payer: Group Health Inc Commercial	$906.25
Rate for Payer: Group Health Inc Medicare	$634.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$906.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,178.12

SYSTEM, INSULATED PD ACC BV TP

Facility OP

$1,100.00

Hospital Charge Code	64905046
Hospital Revenue Code	279
Min. Negotiated Rate	$385.00
Max. Negotiated Rate	$880.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$605.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$550.00
Rate for Payer: Aetna Government	$550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$880.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$748.00
Rate for Payer: Group Health Inc Commercial	$550.00
Rate for Payer: Group Health Inc Medicare	$385.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00

SYSTEM IRRIGATION VITAL VUE EXTD

Facility OP

$486.80

Hospital Charge Code	64904397
Hospital Revenue Code	270
Min. Negotiated Rate	$170.38
Max. Negotiated Rate	$389.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$267.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$243.40
Rate for Payer: Aetna Government	$243.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$389.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$331.02
Rate for Payer: Group Health Inc Commercial	$243.40
Rate for Payer: Group Health Inc Medicare	$170.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.40
Rate for Payer: Hamaspik Choice Inc Medicare	$243.40

SYSTEM IRRIGATION VITAL VUE EXTD

Facility OP

$402.38

Hospital Charge Code	40206011
Hospital Revenue Code	270
Min. Negotiated Rate	$140.83
Max. Negotiated Rate	$321.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$221.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$201.19
Rate for Payer: Aetna Government	$201.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$321.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$273.62
Rate for Payer: Group Health Inc Commercial	$201.19
Rate for Payer: Group Health Inc Medicare	$140.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$201.19
Rate for Payer: Hamaspik Choice Inc Medicare	$201.19

SYSTEM,KNEE ASF PS 13MM VEL3-5CD

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007520
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

SYSTEM,KNEE ASF PS 13MM VEL3-5CD

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007520
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

SYSTEM,KNEE ASF PS 14MM VEL6-9EF

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007514
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

SYSTEM,KNEE ASF PS 14MM VEL6-9EF

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007514
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

SYSTEM KNEE OFF ADPT TRI

Facility IP

$4,250.63

Service Code	HCPCS C1776
Hospital Charge Code	64907228
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.32
Max. Negotiated Rate	$2,125.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.32

SYSTEM KNEE OFF ADPT TRI

Facility OP

$4,250.63

Service Code	HCPCS C1776
Hospital Charge Code	64907228
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,463.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.85
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	$2,125.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,444.11
Rate for Payer: Fidelis Medicare Advantage	$4,463.16
Rate for Payer: Group Health Inc Commercial	$2,125.32
Rate for Payer: Group Health Inc Medicare	$1,487.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.91

SYSTEM, KNEE P 14MM 6-9 EF

Facility OP

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905509
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: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
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

SYSTEM, KNEE P 14MM 6-9 EF

Facility IP

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905509
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

SYSTEM, KNEE PERS 13MM VE

Facility OP

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905516
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: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
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

SYSTEM, KNEE PERS 13MM VE

Facility IP

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905516
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

SYSTEM MED GAS MGT

Facility OP

$237.50

Hospital Charge Code	64907335
Hospital Revenue Code	270
Min. Negotiated Rate	$83.12
Max. Negotiated Rate	$190.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.75
Rate for Payer: Aetna Government	$118.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75

SYSTEM OXYGEN DELIVERY RED

Facility OP

$38.75

Hospital Charge Code	64903065
Hospital Revenue Code	270
Min. Negotiated Rate	$13.56
Max. Negotiated Rate	$31.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.38
Rate for Payer: Aetna Government	$19.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.35
Rate for Payer: Group Health Inc Commercial	$19.38
Rate for Payer: Group Health Inc Medicare	$13.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.38
Rate for Payer: Hamaspik Choice Inc Medicare	$19.38

SYSTEM PERI 1.25 145 MC

Facility IP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905319
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$4,243.75
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75

SYSTEM PERI 1.25 145 MC

Facility OP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905319
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,668.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,880.31
Rate for Payer: Elderplan Medicare Advantage	$20,278.00
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,516.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40

SYSTEM PERI 1.25 145 SC

Facility OP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905320
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,668.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,880.31
Rate for Payer: Elderplan Medicare Advantage	$20,278.00
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,516.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40

SYSTEM PERI 1.25 145 SC

Facility IP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905320
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$4,243.75
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75

SYSTEM PERI 1.50 145

Facility IP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905318
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$4,243.75
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75

SYSTEM PERI 1.50 145

Facility OP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905318
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,668.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,880.31
Rate for Payer: Elderplan Medicare Advantage	$20,278.00
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,516.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40

SYSTEM PERI 1.50 145 SC

Facility OP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905321
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$20,278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,668.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20,278.00
Rate for Payer: Aetna Government	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$20,278.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,880.31
Rate for Payer: Elderplan Medicare Advantage	$20,278.00
Rate for Payer: Fidelis Medicare Advantage	$20,278.00
Rate for Payer: Group Health Inc Commercial	$20,278.00
Rate for Payer: Group Health Inc Medicare	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75
Rate for Payer: Healthfirst Medicare Advantage	$17,236.30
Rate for Payer: Healthfirst QHP	$20,278.00
Rate for Payer: Senior Whole Health Medicare Advantage	$20,278.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,516.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$16,222.40

SYSTEM PERI 1.50 145 SC

Facility IP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905321
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$4,243.75
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75

SYSTEM PERI 2.00 145 SC

Facility IP

$8,487.50

Service Code	HCPCS C9602
Hospital Charge Code	64905322
Hospital Revenue Code	278
Min. Negotiated Rate	$4,243.75
Max. Negotiated Rate	$4,243.75
Rate for Payer: Cash Price	$20,278.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,243.75

Price Transparency.

All Charges