St. Barnabas Hospital

All Charges

Charge

Type

Price

COMBO FIXATION BOLT

Facility IP

$239.00

Service Code	HCPCS C1713
Hospital Charge Code	64904105
Hospital Revenue Code	278
Min. Negotiated Rate	$119.50
Max. Negotiated Rate	$119.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.50
Rate for Payer: Hamaspik Choice Inc Medicare	$119.50

COMBO FIXATION BOLT

Facility OP

$239.00

Service Code	HCPCS C1713
Hospital Charge Code	64904105
Hospital Revenue Code	278
Min. Negotiated Rate	$83.65
Max. Negotiated Rate	$250.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$131.45
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	$119.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$137.42
Rate for Payer: Fidelis Medicare Advantage	$250.95
Rate for Payer: Group Health Inc Commercial	$119.50
Rate for Payer: Group Health Inc Medicare	$83.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$119.50
Rate for Payer: Hamaspik Choice Inc Medicare	$119.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$155.35

COMBO SPINAL EPI CONT TRAY 18GA

Facility OP

$79.94

Hospital Charge Code	64903804
Hospital Revenue Code	270
Min. Negotiated Rate	$27.98
Max. Negotiated Rate	$63.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.97
Rate for Payer: Aetna Government	$39.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.36
Rate for Payer: Group Health Inc Commercial	$39.97
Rate for Payer: Group Health Inc Medicare	$27.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.97
Rate for Payer: Hamaspik Choice Inc Medicare	$39.97

CO/MEMBANE DIFFUSING CAPACITY

Facility OP

$173.43

Service Code	HCPCS 94729 TC
Hospital Charge Code	30305591
Hospital Revenue Code	460
Min. Negotiated Rate	$53.19
Max. Negotiated Rate	$138.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$95.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$86.72
Rate for Payer: Aetna Government	$86.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$138.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$117.93
Rate for Payer: Fidelis CHP/HARP/Medicaid	$53.19
Rate for Payer: Group Health Inc Commercial	$86.72
Rate for Payer: Group Health Inc Medicare	$60.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$86.72
Rate for Payer: Hamaspik Choice Inc Medicare	$86.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$59.10

COMMISSURE SPLINT

Facility OP

$568.00

Service Code	HCPCS D5987
Hospital Charge Code	42301400
Hospital Revenue Code	361
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$312.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,018.19
Rate for Payer: Aetna Government	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Cash Price	$1,018.19
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,018.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$1,018.19
Rate for Payer: EmblemHealth Commercial	$1,018.19
Rate for Payer: Fidelis Essential Plan Aliesa	$865.46
Rate for Payer: Fidelis Essential Plan QHP	$906.19
Rate for Payer: Fidelis Medicare Advantage	$1,018.19
Rate for Payer: Fidelis Qualified Health Plan	$906.19
Rate for Payer: Group Health Inc Commercial	$1,018.19
Rate for Payer: Group Health Inc Medicare	$1,018.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$284.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,018.19
Rate for Payer: Healthfirst Medicare Advantage	$865.46
Rate for Payer: Healthfirst QHP	$1,018.19
Rate for Payer: Senior Whole Health Medicare Advantage	$1,018.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,018.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$814.55
Rate for Payer: Wellcare Medicare	$967.28

COMMON DUCT EXPLORATION

Facility OP

$14,640.10

Service Code	HCPCS 47564
Hospital Charge Code	40010670
Hospital Revenue Code	360
Min. Negotiated Rate	$1,298.02
Max. Negotiated Rate	$11,903.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11,903.87
Rate for Payer: Aetna Government	$11,903.87
Rate for Payer: Cash Price	$11,903.87
Rate for Payer: Cash Price	$11,903.87
Rate for Payer: Cash Price	$11,903.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11,903.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$11,903.87
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,298.02
Rate for Payer: Fidelis Essential Plan Aliesa	$10,118.29
Rate for Payer: Fidelis Essential Plan QHP	$10,594.44
Rate for Payer: Fidelis Medicare Advantage	$11,903.87
Rate for Payer: Fidelis Qualified Health Plan	$10,594.44
Rate for Payer: Group Health Inc Commercial	$11,903.87
Rate for Payer: Group Health Inc Medicare	$11,903.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,320.05
Rate for Payer: Hamaspik Choice Inc Medicare	$11,903.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,442.24
Rate for Payer: Healthfirst Medicare Advantage	$10,118.29
Rate for Payer: Healthfirst QHP	$11,903.87
Rate for Payer: Senior Whole Health Medicare Advantage	$11,903.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,903.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9,523.10
Rate for Payer: Wellcare Medicare	$11,308.68

CO-MORBID CONDITION ASSESS

Facility OP

$25.00

Service Code	HCPCS 1026F
Hospital Charge Code	30305699
Hospital Revenue Code	969
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$12.50
Rate for Payer: Group Health Inc Medicare	$8.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50

COMP ACET BIPOLAR 43X28MM

Facility OP

$2,522.50

Service Code	HCPCS C1776
Hospital Charge Code	64901618
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,648.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,387.38
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	$1,261.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,450.44
Rate for Payer: Fidelis Medicare Advantage	$2,648.62
Rate for Payer: Group Health Inc Commercial	$1,261.25
Rate for Payer: Group Health Inc Medicare	$882.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,261.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,261.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,639.62

COMP ACET BIPOLAR 43X28MM

Facility IP

$2,522.50

Service Code	HCPCS C1776
Hospital Charge Code	64901618
Hospital Revenue Code	278
Min. Negotiated Rate	$1,261.25
Max. Negotiated Rate	$1,261.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,261.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1,261.25

COMP FEM CRU RET RT 68MM

Facility OP

$10,467.75

Service Code	HCPCS C1713
Hospital Charge Code	64901471
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,991.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,757.26
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	$5,233.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,018.96
Rate for Payer: Fidelis Medicare Advantage	$10,991.14
Rate for Payer: Group Health Inc Commercial	$5,233.88
Rate for Payer: Group Health Inc Medicare	$3,663.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,233.88
Rate for Payer: Hamaspik Choice Inc Medicare	$5,233.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,804.04

COMP FEM CRU RET RT 68MM

Facility IP

$10,467.75

Service Code	HCPCS C1713
Hospital Charge Code	64901471
Hospital Revenue Code	278
Min. Negotiated Rate	$5,233.88
Max. Negotiated Rate	$5,233.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,233.88
Rate for Payer: Hamaspik Choice Inc Medicare	$5,233.88

COMP FEMORAL POST STAB SZ4 RGHT

Facility IP

$6,744.25

Service Code	HCPCS C1713
Hospital Charge Code	64902708
Hospital Revenue Code	278
Min. Negotiated Rate	$3,372.12
Max. Negotiated Rate	$3,372.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,372.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3,372.12

COMP FEMORAL POST STAB SZ4 RGHT

Facility OP

$6,744.25

Service Code	HCPCS C1713
Hospital Charge Code	64902708
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,081.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,709.34
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	$3,372.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,877.94
Rate for Payer: Fidelis Medicare Advantage	$7,081.46
Rate for Payer: Group Health Inc Commercial	$3,372.12
Rate for Payer: Group Health Inc Medicare	$2,360.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,372.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3,372.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,383.76

COMP FEM POR CRUC RET SZ F RT

Facility OP

$10,467.75

Service Code	HCPCS C1713
Hospital Charge Code	64901994
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,991.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,757.26
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	$5,233.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,018.96
Rate for Payer: Fidelis Medicare Advantage	$10,991.14
Rate for Payer: Group Health Inc Commercial	$5,233.88
Rate for Payer: Group Health Inc Medicare	$3,663.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,233.88
Rate for Payer: Hamaspik Choice Inc Medicare	$5,233.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,804.04

COMP FEM POR CRUC RET SZ F RT

Facility IP

$10,467.75

Service Code	HCPCS C1713
Hospital Charge Code	64901994
Hospital Revenue Code	278
Min. Negotiated Rate	$5,233.88
Max. Negotiated Rate	$5,233.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,233.88
Rate for Payer: Hamaspik Choice Inc Medicare	$5,233.88

COMP KNEE ART SURF GRN 10MM

Facility OP

$4,192.63

Service Code	HCPCS C1776
Hospital Charge Code	64901852
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,402.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,305.95
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	$2,096.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,410.76
Rate for Payer: Fidelis Medicare Advantage	$4,402.26
Rate for Payer: Group Health Inc Commercial	$2,096.32
Rate for Payer: Group Health Inc Medicare	$1,467.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,725.21

COMP KNEE ART SURF GRN 10MM

Facility IP

$4,192.63

Service Code	HCPCS C1776
Hospital Charge Code	64901852
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.32
Max. Negotiated Rate	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32

COMP KNEE ART SURF GRN 12MM

Facility IP

$3,539.40

Service Code	HCPCS C1776
Hospital Charge Code	40205066
Hospital Revenue Code	278
Min. Negotiated Rate	$1,769.70
Max. Negotiated Rate	$1,769.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,769.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1,769.70

COMP KNEE ART SURF GRN 12MM

Facility OP

$4,192.63

Service Code	HCPCS C1776
Hospital Charge Code	64902206
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,402.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,305.95
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	$2,096.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,410.76
Rate for Payer: Fidelis Medicare Advantage	$4,402.26
Rate for Payer: Group Health Inc Commercial	$2,096.32
Rate for Payer: Group Health Inc Medicare	$1,467.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,725.21

COMP KNEE ART SURF GRN 12MM

Facility IP

$4,192.63

Service Code	HCPCS C1776
Hospital Charge Code	64902206
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.32
Max. Negotiated Rate	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32

COMP KNEE ART SURF GRN 12MM

Facility OP

$3,539.40

Service Code	HCPCS C1776
Hospital Charge Code	40205066
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,716.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,946.67
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	$1,769.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,035.16
Rate for Payer: Fidelis Medicare Advantage	$3,716.37
Rate for Payer: Group Health Inc Commercial	$1,769.70
Rate for Payer: Group Health Inc Medicare	$1,238.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,769.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1,769.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,300.61

COMP KNEE ART SURF GRN 14MM

Facility IP

$4,192.63

Service Code	HCPCS C1776
Hospital Charge Code	64901973
Hospital Revenue Code	278
Min. Negotiated Rate	$2,096.32
Max. Negotiated Rate	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32

COMP KNEE ART SURF GRN 14MM

Facility OP

$4,192.63

Service Code	HCPCS C1776
Hospital Charge Code	64901973
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,402.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,305.95
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	$2,096.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,410.76
Rate for Payer: Fidelis Medicare Advantage	$4,402.26
Rate for Payer: Group Health Inc Commercial	$2,096.32
Rate for Payer: Group Health Inc Medicare	$1,467.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,096.32
Rate for Payer: Hamaspik Choice Inc Medicare	$2,096.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,725.21

COMP KNEE FEMORAL POR SZ G LFT

Facility OP

$8,374.20

Service Code	HCPCS C1776
Hospital Charge Code	40205078
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,792.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,605.81
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	$4,187.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,815.16
Rate for Payer: Fidelis Medicare Advantage	$8,792.91
Rate for Payer: Group Health Inc Commercial	$4,187.10
Rate for Payer: Group Health Inc Medicare	$2,930.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,187.10
Rate for Payer: Hamaspik Choice Inc Medicare	$4,187.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,443.23

COMP KNEE FEMORAL POR SZ G LFT

Facility IP

$8,374.20

Service Code	HCPCS C1776
Hospital Charge Code	40205078
Hospital Revenue Code	278
Min. Negotiated Rate	$4,187.10
Max. Negotiated Rate	$4,187.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,187.10
Rate for Payer: Hamaspik Choice Inc Medicare	$4,187.10

Price Transparency.

All Charges