St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STEM,FEMORAL CLLRD CMTD 12/14 NCK

Facility

$4,480.00

Service Code	HCPCS C1776
Hospital Charge Code	40007537
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,FEMORAL CLLRD CMTD 12/14 NCK

Facility

$4,480.00

Service Code	HCPCS C1776
Hospital Charge Code	40007537
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 FEMORAL REV CEMEN 250MML

Facility

$18,520.00

Service Code	HCPCS C1776
Hospital Charge Code	64903329
Hospital Revenue Code	278
Min. Negotiated Rate	$9,260.00
Max. Negotiated Rate	$9,260.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,260.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,260.00

STEM FEMORAL REV CEMEN 250MML

Facility

$18,520.00

Service Code	HCPCS C1776
Hospital Charge Code	64903329
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$19,446.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,186.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$11,112.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,649.00
Rate for Payer: EmblemHealth Commercial	$9,260.00
Rate for Payer: Fidelis Medicare Advantage	$19,446.00
Rate for Payer: Group Health Inc Commercial	$9,260.00
Rate for Payer: Group Health Inc Medicare	$6,482.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,260.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,260.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,038.00

STEM FEMOR SZ 4 40.22MM OF-S

Facility

$11,670.00

Service Code	HCPCS C1776
Hospital Charge Code	64905760
Hospital Revenue Code	278
Min. Negotiated Rate	$5,835.00
Max. Negotiated Rate	$5,835.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,835.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,835.00

STEM FEMOR SZ 4 40.22MM OF-S

Facility

$11,670.00

Service Code	HCPCS C1776
Hospital Charge Code	64905760
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$12,253.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,418.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$7,002.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,835.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,710.25
Rate for Payer: EmblemHealth Commercial	$5,835.00
Rate for Payer: Fidelis Medicare Advantage	$12,253.50
Rate for Payer: Group Health Inc Commercial	$5,835.00
Rate for Payer: Group Health Inc Medicare	$4,084.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,835.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,835.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,585.50

STEM FEM SZ 6 127MML

Facility

$18,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64903602
Hospital Revenue Code	278
Min. Negotiated Rate	$9,056.25
Max. Negotiated Rate	$9,056.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,056.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9,056.25

STEM FEM SZ 6 127MML

Facility

$18,112.50

Service Code	HCPCS C1713
Hospital Charge Code	64903602
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$19,018.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,961.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$10,867.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,056.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,414.69
Rate for Payer: EmblemHealth Commercial	$9,056.25
Rate for Payer: Fidelis Medicare Advantage	$19,018.12
Rate for Payer: Group Health Inc Commercial	$9,056.25
Rate for Payer: Group Health Inc Medicare	$6,339.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,056.25
Rate for Payer: Hamaspik Choice Inc Medicare	$9,056.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,773.12

STEM HEI

Facility

$6,715.00

Service Code	HCPCS C1776
Hospital Charge Code	64907184
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,050.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,693.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,029.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,357.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,861.12
Rate for Payer: EmblemHealth Commercial	$3,357.50
Rate for Payer: Fidelis Medicare Advantage	$7,050.75
Rate for Payer: Group Health Inc Commercial	$3,357.50
Rate for Payer: Group Health Inc Medicare	$2,350.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,357.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,357.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,364.75

STEM HEI

Facility

$6,715.00

Service Code	HCPCS C1776
Hospital Charge Code	64907184
Hospital Revenue Code	278
Min. Negotiated Rate	$3,357.50
Max. Negotiated Rate	$3,357.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,357.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,357.50

STEM HIP 127 DEG NECK

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64902777
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 HIP 127 DEG NECK

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64902777
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

STEM HIP 127 DEG NECK ANGLE

Facility

$17,115.75

Service Code	HCPCS C1713
Hospital Charge Code	64902666
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 HIP 127 DEG NECK ANGLE

Facility

$17,115.75

Service Code	HCPCS C1713
Hospital Charge Code	64902666
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 HIP 127DEG NECK ANGLE

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64902771
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 HIP 127DEG NECK ANGLE

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64902771
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

STEM HIP 127 NECK ANGLE

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64902689
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 HIP 127 NECK ANGLE

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64902689
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

STEM HIP LONG CMNTD

Facility

$19,567.50

Service Code	HCPCS C1776
Hospital Charge Code	64907329
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$20,545.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,762.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$11,740.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,783.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,251.31
Rate for Payer: EmblemHealth Commercial	$9,783.75
Rate for Payer: Fidelis Medicare Advantage	$20,545.88
Rate for Payer: Group Health Inc Commercial	$9,783.75
Rate for Payer: Group Health Inc Medicare	$6,848.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,783.75
Rate for Payer: Hamaspik Choice Inc Medicare	$9,783.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,718.88

STEM HIP LONG CMNTD

Facility

$19,567.50

Service Code	HCPCS C1776
Hospital Charge Code	64907329
Hospital Revenue Code	278
Min. Negotiated Rate	$9,783.75
Max. Negotiated Rate	$9,783.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,783.75
Rate for Payer: Hamaspik Choice Inc Medicare	$9,783.75

STEM HIP POROUS PRS FIT 11X135MM

Facility

$8,736.00

Service Code	HCPCS C1776
Hospital Charge Code	40205032
Hospital Revenue Code	278
Min. Negotiated Rate	$4,368.00
Max. Negotiated Rate	$4,368.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,368.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,368.00

STEM HIP POROUS PRS FIT 11X135MM

Facility

$8,736.00

Service Code	HCPCS C1776
Hospital Charge Code	40205032
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,172.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,804.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,241.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,368.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,023.20
Rate for Payer: EmblemHealth Commercial	$4,368.00
Rate for Payer: Fidelis Medicare Advantage	$9,172.80
Rate for Payer: Group Health Inc Commercial	$4,368.00
Rate for Payer: Group Health Inc Medicare	$3,057.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,368.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,368.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,678.40

STEM HIP PORUS MOD REVIS 23MM

Facility

$8,386.00

Service Code	HCPCS C1776
Hospital Charge Code	40209105
Hospital Revenue Code	278
Min. Negotiated Rate	$4,193.00
Max. Negotiated Rate	$4,193.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,193.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,193.00

STEM HIP PORUS MOD REVIS 23MM

Facility

$8,386.00

Service Code	HCPCS C1776
Hospital Charge Code	40209105
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,805.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,612.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,031.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,193.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,821.95
Rate for Payer: EmblemHealth Commercial	$4,193.00
Rate for Payer: Fidelis Medicare Advantage	$8,805.30
Rate for Payer: Group Health Inc Commercial	$4,193.00
Rate for Payer: Group Health Inc Medicare	$2,935.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,193.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,193.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,450.90

STEM HIP REVISN WGNR12/14-0102622

Facility

$6,116.34

Service Code	HCPCS C1776
Hospital Charge Code	64906418
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,422.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,363.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,669.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,058.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,516.90
Rate for Payer: EmblemHealth Commercial	$3,058.17
Rate for Payer: Fidelis Medicare Advantage	$6,422.16
Rate for Payer: Group Health Inc Commercial	$3,058.17
Rate for Payer: Group Health Inc Medicare	$2,140.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,058.17
Rate for Payer: Hamaspik Choice Inc Medicare	$3,058.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,975.62

Know your out-of-pocket cost for care.

All Charges