St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STEM EXTENSION REPLACEMENT SCREW

Facility

$194.00

Service Code	HCPCS C1713
Hospital Charge Code	40202128
Hospital Revenue Code	278
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$97.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.00
Rate for Payer: Hamaspik Choice Inc Medicare	$97.00

STEM FEM 18MM 185MM L

Facility

$6,223.16

Service Code	HCPCS C1776
Hospital Charge Code	64906937
Hospital Revenue Code	278
Min. Negotiated Rate	$3,111.58
Max. Negotiated Rate	$3,111.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,111.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3,111.58

STEM FEM 18MM 185MM L

Facility

$6,223.16

Service Code	HCPCS C1776
Hospital Charge Code	64906937
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,534.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,422.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,733.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,111.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,578.32
Rate for Payer: EmblemHealth Commercial	$3,111.58
Rate for Payer: Fidelis Medicare Advantage	$6,534.32
Rate for Payer: Group Health Inc Commercial	$3,111.58
Rate for Payer: Group Health Inc Medicare	$2,178.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,111.58
Rate for Payer: Hamaspik Choice Inc Medicare	$3,111.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,045.05

STEM FEM 23MM XL, 103MM

Facility

$17,880.00

Service Code	HCPCS C1776
Hospital Charge Code	64905848
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$18,774.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,834.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$10,728.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,940.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,281.00
Rate for Payer: EmblemHealth Commercial	$8,940.00
Rate for Payer: Fidelis Medicare Advantage	$18,774.00
Rate for Payer: Group Health Inc Commercial	$8,940.00
Rate for Payer: Group Health Inc Medicare	$6,258.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,940.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,940.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,622.00

STEM FEM 23MM XL, 103MM

Facility

$17,880.00

Service Code	HCPCS C1776
Hospital Charge Code	64905848
Hospital Revenue Code	278
Min. Negotiated Rate	$8,940.00
Max. Negotiated Rate	$8,940.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,940.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8,940.00

STEM FEM C-LESS TAPER W SZ 2

Facility

$17,115.75

Service Code	HCPCS C1713
Hospital Charge Code	64903651
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$17,971.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,413.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$10,269.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,557.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,841.56
Rate for Payer: EmblemHealth Commercial	$8,557.88
Rate for Payer: Fidelis Medicare Advantage	$17,971.54
Rate for Payer: Group Health Inc Commercial	$8,557.88
Rate for Payer: Group Health Inc Medicare	$5,990.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,125.24

STEM FEM C-LESS TAPER W SZ 2

Facility

$17,115.75

Service Code	HCPCS C1713
Hospital Charge Code	64903651
Hospital Revenue Code	278
Min. Negotiated Rate	$8,557.88
Max. Negotiated Rate	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88

STEM FEM CMNTD 17MM X 190MM

Facility

$22,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64905842
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$23,625.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,375.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$13,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,937.50
Rate for Payer: EmblemHealth Commercial	$11,250.00
Rate for Payer: Fidelis Medicare Advantage	$23,625.00
Rate for Payer: Group Health Inc Commercial	$11,250.00
Rate for Payer: Group Health Inc Medicare	$7,875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14,625.00

STEM FEM CMNTD 17MM X 190MM

Facility

$22,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64905842
Hospital Revenue Code	278
Min. Negotiated Rate	$11,250.00
Max. Negotiated Rate	$11,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,250.00

STEM, FEM COLL CEM 12/14 NK

Facility

$5,600.00

Service Code	HCPCS C1713
Hospital Charge Code	64905599
Hospital Revenue Code	278
Min. Negotiated Rate	$2,800.00
Max. Negotiated Rate	$2,800.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,800.00

STEM, FEM COLL CEM 12/14 NK

Facility

$5,600.00

Service Code	HCPCS C1713
Hospital Charge Code	64905599
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,880.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,080.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,360.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,220.00
Rate for Payer: EmblemHealth Commercial	$2,800.00
Rate for Payer: Fidelis Medicare Advantage	$5,880.00
Rate for Payer: Group Health Inc Commercial	$2,800.00
Rate for Payer: Group Health Inc Medicare	$1,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,800.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,640.00

STEM FEM COLLRD CMNTD 12/14 NECK

Facility

$4,480.00

Service Code	HCPCS C1776
Hospital Charge Code	40204618
Hospital Revenue Code	278
Min. Negotiated Rate	$2,240.00
Max. Negotiated Rate	$2,240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,240.00

STEM FEM COLLRD CMNTD 12/14 NECK

Facility

$4,480.00

Service Code	HCPCS C1776
Hospital Charge Code	40204618
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,704.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,464.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,688.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,576.00
Rate for Payer: EmblemHealth Commercial	$2,240.00
Rate for Payer: Fidelis Medicare Advantage	$4,704.00
Rate for Payer: Group Health Inc Commercial	$2,240.00
Rate for Payer: Group Health Inc Medicare	$1,568.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,240.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,912.00

STEM FEMOR 12/14 13 250

Facility

$13,038.52

Service Code	HCPCS C1713
Hospital Charge Code	64907456
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$13,690.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7,171.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$7,823.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,519.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,497.15
Rate for Payer: EmblemHealth Commercial	$6,519.26
Rate for Payer: Fidelis Medicare Advantage	$13,690.45
Rate for Payer: Group Health Inc Commercial	$6,519.26
Rate for Payer: Group Health Inc Medicare	$4,563.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,519.26
Rate for Payer: Hamaspik Choice Inc Medicare	$6,519.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,475.04

STEM FEMOR 12/14 13 250

Facility

$13,038.52

Service Code	HCPCS C1713
Hospital Charge Code	64907456
Hospital Revenue Code	278
Min. Negotiated Rate	$6,519.26
Max. Negotiated Rate	$6,519.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,519.26
Rate for Payer: Hamaspik Choice Inc Medicare	$6,519.26

STEM FEMORAL CEMENTED SIZE 4 4

Facility

$10,721.25

Service Code	HCPCS C1776
Hospital Charge Code	64904355
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$11,257.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,896.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$6,432.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,360.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,164.72
Rate for Payer: EmblemHealth Commercial	$5,360.62
Rate for Payer: Fidelis Medicare Advantage	$11,257.31
Rate for Payer: Group Health Inc Commercial	$5,360.62
Rate for Payer: Group Health Inc Medicare	$3,752.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,360.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5,360.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,968.81

STEM FEMORAL CEMENTED SIZE 4 4

Facility

$10,721.25

Service Code	HCPCS C1776
Hospital Charge Code	64904355
Hospital Revenue Code	278
Min. Negotiated Rate	$5,360.62
Max. Negotiated Rate	$5,360.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,360.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5,360.62

STEM FEMORAL CEMENTLESS SIZE 1

Facility

$9,329.50

Service Code	HCPCS C1713
Hospital Charge Code	64902790
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,795.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,131.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,597.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,664.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,364.46
Rate for Payer: EmblemHealth Commercial	$4,664.75
Rate for Payer: Fidelis Medicare Advantage	$9,795.98
Rate for Payer: Group Health Inc Commercial	$4,664.75
Rate for Payer: Group Health Inc Medicare	$3,265.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,664.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,064.18

STEM FEMORAL CEMENTLESS SIZE 1

Facility

$9,329.50

Service Code	HCPCS C1713
Hospital Charge Code	64902790
Hospital Revenue Code	278
Min. Negotiated Rate	$4,664.75
Max. Negotiated Rate	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,664.75

STEM FEMORAL CEMENTLESS SZ12

Facility

$9,327.50

Service Code	HCPCS C1713
Hospital Charge Code	64903150
Hospital Revenue Code	278
Min. Negotiated Rate	$4,663.75
Max. Negotiated Rate	$4,663.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,663.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,663.75

STEM FEMORAL CEMENTLESS SZ12

Facility

$9,327.50

Service Code	HCPCS C1713
Hospital Charge Code	64903150
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,793.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,130.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,596.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,663.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,363.31
Rate for Payer: EmblemHealth Commercial	$4,663.75
Rate for Payer: Fidelis Medicare Advantage	$9,793.88
Rate for Payer: Group Health Inc Commercial	$4,663.75
Rate for Payer: Group Health Inc Medicare	$3,264.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,663.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,663.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,062.88

STEM FEMORAL CEMENT SZ2 35MM

Facility

$10,721.25

Service Code	HCPCS C1713
Hospital Charge Code	64904610
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$11,257.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,896.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$6,432.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,360.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,164.72
Rate for Payer: EmblemHealth Commercial	$5,360.62
Rate for Payer: Fidelis Medicare Advantage	$11,257.31
Rate for Payer: Group Health Inc Commercial	$5,360.62
Rate for Payer: Group Health Inc Medicare	$3,752.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,360.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5,360.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,968.81

STEM FEMORAL CEMENT SZ2 35MM

Facility

$10,721.25

Service Code	HCPCS C1713
Hospital Charge Code	64904610
Hospital Revenue Code	278
Min. Negotiated Rate	$5,360.62
Max. Negotiated Rate	$5,360.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,360.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5,360.62

STEM FEMORAL CEMLESS SZ4 38MM

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64904349
Hospital Revenue Code	278
Min. Negotiated Rate	$8,557.88
Max. Negotiated Rate	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88

STEM FEMORAL CEMLESS SZ4 38MM

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64904349
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,971.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,413.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$10,269.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,557.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,841.56
Rate for Payer: EmblemHealth Commercial	$8,557.88
Rate for Payer: Fidelis Medicare Advantage	$17,971.54
Rate for Payer: Group Health Inc Commercial	$8,557.88
Rate for Payer: Group Health Inc Medicare	$5,990.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,125.24

Know your out-of-pocket cost for care.

All Charges