St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

COMPONENT MODULAR HEAD 28MM

Facility

$1,222.00

Service Code	HCPCS C1776
Hospital Charge Code	40209660
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,283.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$672.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$733.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$611.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$702.65
Rate for Payer: EmblemHealth Commercial	$611.00
Rate for Payer: Fidelis Medicare Advantage	$1,283.10
Rate for Payer: Group Health Inc Commercial	$611.00
Rate for Payer: Group Health Inc Medicare	$427.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$611.00
Rate for Payer: Hamaspik Choice Inc Medicare	$611.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$794.30

COMPONENT MODULAR HEAD 28MM

Facility

$1,222.00

Service Code	HCPCS C1776
Hospital Charge Code	40209660
Hospital Revenue Code	278
Min. Negotiated Rate	$611.00
Max. Negotiated Rate	$611.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$611.00
Rate for Payer: Hamaspik Choice Inc Medicare	$611.00

COMPONENT MODULAR HEAD 28MM2

Facility

$1,830.00

Service Code	HCPCS C1776
Hospital Charge Code	64901097
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,921.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,006.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,098.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,052.25
Rate for Payer: EmblemHealth Commercial	$915.00
Rate for Payer: Fidelis Medicare Advantage	$1,921.50
Rate for Payer: Group Health Inc Commercial	$915.00
Rate for Payer: Group Health Inc Medicare	$640.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$915.00
Rate for Payer: Hamaspik Choice Inc Medicare	$915.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,189.50

COMPONENT MODULAR HEAD 28MM2

Facility

$1,830.00

Service Code	HCPCS C1776
Hospital Charge Code	64901097
Hospital Revenue Code	278
Min. Negotiated Rate	$915.00
Max. Negotiated Rate	$915.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$915.00
Rate for Payer: Hamaspik Choice Inc Medicare	$915.00

COMPONENT STEMMED TIBIAL

Facility

$4,550.90

Service Code	HCPCS C1776
Hospital Charge Code	40205057
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,778.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,503.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,730.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,275.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,616.77
Rate for Payer: EmblemHealth Commercial	$2,275.45
Rate for Payer: Fidelis Medicare Advantage	$4,778.44
Rate for Payer: Group Health Inc Commercial	$2,275.45
Rate for Payer: Group Health Inc Medicare	$1,592.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,275.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,958.08

COMPONENT STEMMED TIBIAL

Facility

$4,550.90

Service Code	HCPCS C1776
Hospital Charge Code	40205057
Hospital Revenue Code	278
Min. Negotiated Rate	$2,275.45
Max. Negotiated Rate	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,275.45

COMPONENT STEMMED TIBIAL

Facility

$5,391.13

Service Code	HCPCS C1713
Hospital Charge Code	64901697
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,660.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,965.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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

COMPONENT STEMMED TIBIAL

Facility

$5,391.13

Service Code	HCPCS C1713
Hospital Charge Code	64901697
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

COMPONENT TIBIAL COMPL KNEE

Facility

$5,391.13

Service Code	HCPCS C1776
Hospital Charge Code	64901974
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

COMPONENT TIBIAL COMPL KNEE

Facility

$5,391.13

Service Code	HCPCS C1776
Hospital Charge Code	64901974
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

COMPONET FIXATIN PHALAG 9P15S180W

Facility

$700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906476
Hospital Revenue Code	278
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$735.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$420.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: EmblemHealth Commercial	$350.00
Rate for Payer: Fidelis Medicare Advantage	$735.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00

COMPONET FIXATIN PHALAG 9P15S180W

Facility

$700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906476
Hospital Revenue Code	278
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

COMPONET UNIV HEAD BPOLAR-UH15228

Facility

$825.00

Service Code	HCPCS C1776
Hospital Charge Code	64906467
Hospital Revenue Code	278
Min. Negotiated Rate	$412.50
Max. Negotiated Rate	$412.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.50
Rate for Payer: Hamaspik Choice Inc Medicare	$412.50

COMPONET UNIV HEAD BPOLAR-UH15228

Facility

$825.00

Service Code	HCPCS C1776
Hospital Charge Code	64906467
Hospital Revenue Code	278
Min. Negotiated Rate	$288.75
Max. Negotiated Rate	$866.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$453.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$495.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$412.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$474.38
Rate for Payer: EmblemHealth Commercial	$412.50
Rate for Payer: Fidelis Medicare Advantage	$866.25
Rate for Payer: Group Health Inc Commercial	$412.50
Rate for Payer: Group Health Inc Medicare	$288.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$412.50
Rate for Payer: Hamaspik Choice Inc Medicare	$412.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$536.25

COMP ORTHO ADOLESCENT DENT

Facility

$2,465.00

Service Code	HCPCS D8080
Hospital Charge Code	42303366
Hospital Revenue Code	361
Min. Negotiated Rate	$862.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,355.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$872.16
Rate for Payer: Aetna Government	$872.16
Rate for Payer: Brighton Health Commercial	$1,848.75
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	$1,232.50
Rate for Payer: Group Health Inc Medicare	$862.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,232.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,232.50

COMP ORTHO ADULT DENT

Facility

$2,465.00

Service Code	HCPCS D8090
Hospital Charge Code	42303367
Hospital Revenue Code	361
Min. Negotiated Rate	$862.75
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,355.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$869.25
Rate for Payer: Aetna Government	$869.25
Rate for Payer: Brighton Health Commercial	$1,848.75
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	$1,232.50
Rate for Payer: Group Health Inc Medicare	$862.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,232.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,232.50

COMP ORTHO TRANSITIONAL DENTITION

Facility

$2,465.00

Service Code	HCPCS D8070
Hospital Charge Code	42303365
Hospital Revenue Code	361
Min. Negotiated Rate	$642.64
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,355.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$642.64
Rate for Payer: Aetna Government	$642.64
Rate for Payer: Brighton Health Commercial	$1,848.75
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	$1,232.50
Rate for Payer: Group Health Inc Medicare	$862.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,232.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,232.50

COMPOSITE MESH

Facility

$742.64

Service Code	HCPCS C1781
Hospital Charge Code	40209571
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$779.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$408.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$445.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$371.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$427.02
Rate for Payer: EmblemHealth Commercial	$371.32
Rate for Payer: Fidelis Medicare Advantage	$779.77
Rate for Payer: Group Health Inc Commercial	$371.32
Rate for Payer: Group Health Inc Medicare	$259.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$371.32
Rate for Payer: Hamaspik Choice Inc Medicare	$371.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$482.72

COMPOSITE MESH

Facility

$742.64

Service Code	HCPCS C1781
Hospital Charge Code	40209571
Hospital Revenue Code	278
Min. Negotiated Rate	$371.32
Max. Negotiated Rate	$371.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$371.32
Rate for Payer: Hamaspik Choice Inc Medicare	$371.32

COMP. PERIO EVALUATION

Facility

$90.00

Service Code	HCPCS D0180
Hospital Charge Code	42303410
Hospital Revenue Code	361
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$152.87
Rate for Payer: Aetna Government	$152.87
Rate for Payer: Affinity Essential Plan 1&2	$107.01
Rate for Payer: Affinity Essential Plan 3&4	$107.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$107.01
Rate for Payer: Brighton Health Commercial	$67.50
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$152.87
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	$152.87
Rate for Payer: EmblemHealth Commercial	$152.87
Rate for Payer: Fidelis Essential Plan Aliesa	$129.94
Rate for Payer: Fidelis Essential Plan QHP	$136.05
Rate for Payer: Fidelis Medicare Advantage	$152.87
Rate for Payer: Fidelis Qualified Health Plan	$136.05
Rate for Payer: Group Health Inc Commercial	$152.87
Rate for Payer: Group Health Inc Medicare	$152.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.00
Rate for Payer: Hamaspik Choice Inc Medicare	$152.87
Rate for Payer: Healthfirst Medicare Advantage	$129.94
Rate for Payer: Healthfirst QHP	$152.87
Rate for Payer: Humana Medicare	$155.93
Rate for Payer: Senior Whole Health Medicare Advantage	$152.87
Rate for Payer: United Healthcare Medicare Advantage	$152.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.30
Rate for Payer: Wellcare Medicare	$145.23

COMP. PERIO EVALUATION

Facility

$90.00

Service Code	HCPCS D0180
Hospital Charge Code	42303410
Hospital Revenue Code	361
Rate for Payer: Cash Price	$152.87

COMPREHENSIVE ESTABLISH

Facility

$351.13

Service Code	HCPCS 92014
Hospital Charge Code	42101100
Hospital Revenue Code	510
Rate for Payer: Cash Price	$152.87

COMPREHENSIVE ESTABLISH

Facility

$351.13

Service Code	HCPCS 92014
Hospital Charge Code	42101100
Hospital Revenue Code	510
Min. Negotiated Rate	$107.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$193.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$152.87
Rate for Payer: Aetna Government	$152.87
Rate for Payer: Affinity Essential Plan 1&2	$107.01
Rate for Payer: Affinity Essential Plan 3&4	$107.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$107.01
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$152.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Elderplan Medicare Advantage	$152.87
Rate for Payer: Fidelis Essential Plan Aliesa	$129.94
Rate for Payer: Fidelis Essential Plan QHP	$136.05
Rate for Payer: Fidelis Medicare Advantage	$152.87
Rate for Payer: Fidelis Qualified Health Plan	$136.05
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.56
Rate for Payer: Hamaspik Choice Inc Medicare	$152.87
Rate for Payer: Healthfirst Medicare Advantage	$129.94
Rate for Payer: Healthfirst QHP	$152.87
Rate for Payer: Humana Medicare	$155.93
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$152.87
Rate for Payer: Senior Whole Health Medicare Advantage	$152.87
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$152.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.30
Rate for Payer: Wellcare Medicare	$145.23

COMPREHENSIVE EST PT 1/MORE VISIT

Facility

$358.63

Service Code	HCPCS 92014
Hospital Charge Code	30300114
Hospital Revenue Code	510
Rate for Payer: Cash Price	$152.87

COMPREHENSIVE EST PT 1/MORE VISIT

Facility

$358.63

Service Code	HCPCS 92014
Hospital Charge Code	30300114
Hospital Revenue Code	510
Min. Negotiated Rate	$107.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$197.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$152.87
Rate for Payer: Aetna Government	$152.87
Rate for Payer: Affinity Essential Plan 1&2	$107.01
Rate for Payer: Affinity Essential Plan 3&4	$107.01
Rate for Payer: Affinity Medicaid/CHP/HARP	$107.01
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Cash Price	$152.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$152.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Elderplan Medicare Advantage	$152.87
Rate for Payer: Fidelis Essential Plan Aliesa	$129.94
Rate for Payer: Fidelis Essential Plan QHP	$136.05
Rate for Payer: Fidelis Medicare Advantage	$152.87
Rate for Payer: Fidelis Qualified Health Plan	$136.05
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$179.32
Rate for Payer: Hamaspik Choice Inc Medicare	$152.87
Rate for Payer: Healthfirst Medicare Advantage	$129.94
Rate for Payer: Healthfirst QHP	$152.87
Rate for Payer: Humana Medicare	$155.93
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$152.87
Rate for Payer: Senior Whole Health Medicare Advantage	$152.87
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$152.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$152.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.30
Rate for Payer: Wellcare Medicare	$145.23

Know your out-of-pocket cost for care.

All Charges