St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STEM TIBIAL COMPONENT SZ 4

Facility

$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: Brighton Health Commercial	$127.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$106.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.26
Rate for Payer: EmblemHealth Commercial	$106.32
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 4

Facility

$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 5

Facility

$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 COMPONENT SZ 5

Facility

$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: Brighton Health Commercial	$2,832.00
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: EmblemHealth Commercial	$2,360.00
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 PRECT SZ4 REV

Facility

$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: Brighton Health Commercial	$3,234.68
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: EmblemHealth Commercial	$2,695.56
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

STEM TIBIAL PRECT SZ4 REV

Facility

$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

STENGER TEST,SPEECH

Facility

$1,470.80

Service Code	HCPCS 92577
Hospital Charge Code	42004511
Hospital Revenue Code	471
Min. Negotiated Rate	$495.86
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: Brighton Health Commercial	$1,103.10
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 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 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

STENGER TEST,SPEECH

Facility

$1,470.80

Service Code	HCPCS 92577
Hospital Charge Code	42004511
Hospital Revenue Code	471
Rate for Payer: Cash Price	$619.82

STENT .035 120 6FR

Facility

$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

$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: Brighton Health Commercial	$2,992.50
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: EmblemHealth Commercial	$2,493.75
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

$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: Brighton Health Commercial	$2,043.75
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

$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: Brighton Health Commercial	$1,635.00
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: EmblemHealth Commercial	$1,362.50
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 > 1000.00

Facility

$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 100.00 - 499.00

Facility

$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

$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: Brighton Health Commercial	$210.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.76
Rate for Payer: EmblemHealth Commercial	$175.44
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

$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: Brighton Health Commercial	$263.17
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

$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 500.00 - 1000.00

Facility

$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: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
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 500-1000

Facility

$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: 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

STENT 6MMX200MMX135MM

Facility

$4,600.00

Service Code	HCPCS C1877
Hospital Charge Code	40004814
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$4,830.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,530.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$2,760.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,645.00
Rate for Payer: EmblemHealth Commercial	$2,300.00
Rate for Payer: Fidelis Medicare Advantage	$4,830.00
Rate for Payer: Group Health Inc Commercial	$2,300.00
Rate for Payer: Group Health Inc Medicare	$1,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,990.00

STENT 6MMX200MMX135MM

Facility

$4,600.00

Service Code	HCPCS C1877
Hospital Charge Code	40004814
Hospital Revenue Code	278
Min. Negotiated Rate	$2,300.00
Max. Negotiated Rate	$2,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,300.00

STENT 6MMX80MMX135CM

Facility

$3,200.00

Service Code	HCPCS C1877
Hospital Charge Code	40004813
Hospital Revenue Code	278
Min. Negotiated Rate	$127.45
Max. Negotiated Rate	$3,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,760.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.45
Rate for Payer: Aetna Government	$127.45
Rate for Payer: Brighton Health Commercial	$1,920.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,840.00
Rate for Payer: EmblemHealth Commercial	$1,600.00
Rate for Payer: Fidelis Medicare Advantage	$3,360.00
Rate for Payer: Group Health Inc Commercial	$1,600.00
Rate for Payer: Group Health Inc Medicare	$1,120.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,080.00

STENT 6MMX80MMX135CM

Facility

$3,200.00

Service Code	HCPCS C1877
Hospital Charge Code	40004813
Hospital Revenue Code	278
Min. Negotiated Rate	$1,600.00
Max. Negotiated Rate	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,600.00

STENT 8 X 60 ZILVER

Facility

$3,375.00

Service Code	HCPCS C1876
Hospital Charge Code	64904546
Hospital Revenue Code	278
Min. Negotiated Rate	$1,687.50
Max. Negotiated Rate	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50

STENT 8 X 60 ZILVER

Facility

$3,375.00

Service Code	HCPCS C1876
Hospital Charge Code	64904546
Hospital Revenue Code	278
Min. Negotiated Rate	$398.18
Max. Negotiated Rate	$3,543.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,856.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$398.18
Rate for Payer: Aetna Government	$398.18
Rate for Payer: Brighton Health Commercial	$2,025.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,687.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,940.62
Rate for Payer: EmblemHealth Commercial	$1,687.50
Rate for Payer: Fidelis Medicare Advantage	$3,543.75
Rate for Payer: Group Health Inc Commercial	$1,687.50
Rate for Payer: Group Health Inc Medicare	$1,181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,193.75

Know your out-of-pocket cost for care.

All Charges