St. Barnabas Hospital

All Charges

Charge

Type

Price

FEM DIST GMRS

Facility OP

$24,347.50

Service Code	HCPCS C1776
Hospital Charge Code	64907272
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$25,564.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13,391.12
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	$12,173.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,999.81
Rate for Payer: Fidelis Medicare Advantage	$25,564.88
Rate for Payer: Group Health Inc Commercial	$12,173.75
Rate for Payer: Group Health Inc Medicare	$8,521.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,173.75
Rate for Payer: Hamaspik Choice Inc Medicare	$12,173.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,825.88

FEM DIST GROW PROS

Facility OP

$40,245.00

Service Code	HCPCS C1776
Hospital Charge Code	64907271
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$42,257.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22,134.75
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	$20,122.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$23,140.88
Rate for Payer: Fidelis Medicare Advantage	$42,257.25
Rate for Payer: Group Health Inc Commercial	$20,122.50
Rate for Payer: Group Health Inc Medicare	$14,085.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,122.50
Rate for Payer: Hamaspik Choice Inc Medicare	$20,122.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,159.25

FEM DIST GROW PROS

Facility IP

$40,245.00

Service Code	HCPCS C1776
Hospital Charge Code	64907271
Hospital Revenue Code	278
Min. Negotiated Rate	$20,122.50
Max. Negotiated Rate	$20,122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,122.50
Rate for Payer: Hamaspik Choice Inc Medicare	$20,122.50

FEM DST TRI AUG

Facility OP

$4,065.00

Service Code	HCPCS C1776
Hospital Charge Code	64907216
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,268.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,235.75
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	$2,032.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,337.38
Rate for Payer: Fidelis Medicare Advantage	$4,268.25
Rate for Payer: Group Health Inc Commercial	$2,032.50
Rate for Payer: Group Health Inc Medicare	$1,422.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,032.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,032.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,642.25

FEM DST TRI AUG

Facility IP

$4,065.00

Service Code	HCPCS C1776
Hospital Charge Code	64907216
Hospital Revenue Code	278
Min. Negotiated Rate	$2,032.50
Max. Negotiated Rate	$2,032.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,032.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,032.50

FEM NEUT PROX

Facility IP

$16,897.50

Service Code	HCPCS C1776
Hospital Charge Code	64907303
Hospital Revenue Code	278
Min. Negotiated Rate	$8,448.75
Max. Negotiated Rate	$8,448.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,448.75
Rate for Payer: Hamaspik Choice Inc Medicare	$8,448.75

FEM NEUT PROX

Facility OP

$16,897.50

Service Code	HCPCS C1776
Hospital Charge Code	64907303
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,742.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,293.62
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	$8,448.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,716.06
Rate for Payer: Fidelis Medicare Advantage	$17,742.38
Rate for Payer: Group Health Inc Commercial	$8,448.75
Rate for Payer: Group Health Inc Medicare	$5,914.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,448.75
Rate for Payer: Hamaspik Choice Inc Medicare	$8,448.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,983.38

FEMORAL BUSHING HRHK

Facility IP

$1,012.50

Service Code	HCPCS C1776
Hospital Charge Code	64907258
Hospital Revenue Code	278
Min. Negotiated Rate	$506.25
Max. Negotiated Rate	$506.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25

FEMORAL BUSHING HRHK

Facility OP

$1,012.50

Service Code	HCPCS C1776
Hospital Charge Code	64907258
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,063.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$556.88
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	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: Fidelis Medicare Advantage	$1,063.12
Rate for Payer: Group Health Inc Commercial	$506.25
Rate for Payer: Group Health Inc Medicare	$354.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$506.25
Rate for Payer: Hamaspik Choice Inc Medicare	$506.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$658.12

FEMORAL CEMENT RESTRCTR SZ9-15MM

Facility IP

$944.00

Service Code	HCPCS C1776
Hospital Charge Code	40202306
Hospital Revenue Code	278
Min. Negotiated Rate	$472.00
Max. Negotiated Rate	$472.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$472.00
Rate for Payer: Hamaspik Choice Inc Medicare	$472.00

FEMORAL CEMENT RESTRCTR SZ9-15MM

Facility OP

$944.00

Service Code	HCPCS C1776
Hospital Charge Code	40202306
Hospital Revenue Code	278
Min. Negotiated Rate	$330.40
Max. Negotiated Rate	$991.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$519.20
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	$472.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$542.80
Rate for Payer: Fidelis Medicare Advantage	$991.20
Rate for Payer: Group Health Inc Commercial	$472.00
Rate for Payer: Group Health Inc Medicare	$330.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$472.00
Rate for Payer: Hamaspik Choice Inc Medicare	$472.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$613.60

FEMORAL COMPONENT

Facility OP

$8,374.20

Service Code	HCPCS C1776
Hospital Charge Code	40202096
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

FEMORAL COMPONENT

Facility IP

$8,374.20

Service Code	HCPCS C1776
Hospital Charge Code	40202096
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

FEMORAL COMPONENT 12 HO SYNER

Facility OP

$9,752.50

Service Code	HCPCS C1776
Hospital Charge Code	64903044
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,240.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,363.88
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	$4,876.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,607.69
Rate for Payer: Fidelis Medicare Advantage	$10,240.12
Rate for Payer: Group Health Inc Commercial	$4,876.25
Rate for Payer: Group Health Inc Medicare	$3,413.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,876.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,876.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,339.12

FEMORAL COMPONENT 12 HO SYNER

Facility IP

$9,752.50

Service Code	HCPCS C1776
Hospital Charge Code	64903044
Hospital Revenue Code	278
Min. Negotiated Rate	$4,876.25
Max. Negotiated Rate	$4,876.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,876.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,876.25

FEMORAL COMPONENT#4 RGHT CEMENTED

Facility IP

$5,352.00

Service Code	HCPCS C1776
Hospital Charge Code	40201335
Hospital Revenue Code	278
Min. Negotiated Rate	$2,676.00
Max. Negotiated Rate	$2,676.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,676.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,676.00

FEMORAL COMPONENT#4 RGHT CEMENTED

Facility OP

$5,352.00

Service Code	HCPCS C1776
Hospital Charge Code	40201335
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,619.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,943.60
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	$2,676.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,077.40
Rate for Payer: Fidelis Medicare Advantage	$5,619.60
Rate for Payer: Group Health Inc Commercial	$2,676.00
Rate for Payer: Group Health Inc Medicare	$1,873.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,676.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,676.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,478.80

FEMORAL COMPONENT#5 RGHT CEMENTED

Facility IP

$6,360.00

Service Code	HCPCS C1776
Hospital Charge Code	40201336
Hospital Revenue Code	278
Min. Negotiated Rate	$3,180.00
Max. Negotiated Rate	$3,180.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,180.00

FEMORAL COMPONENT#5 RGHT CEMENTED

Facility OP

$6,360.00

Service Code	HCPCS C1776
Hospital Charge Code	40201336
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,678.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,498.00
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	$3,180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,657.00
Rate for Payer: Fidelis Medicare Advantage	$6,678.00
Rate for Payer: Group Health Inc Commercial	$3,180.00
Rate for Payer: Group Health Inc Medicare	$2,226.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,134.00

FEMORAL COMPONENT #6 CEMENTED

Facility OP

$6,880.00

Service Code	HCPCS C1776
Hospital Charge Code	40201337
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,224.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,784.00
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	$3,440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,956.00
Rate for Payer: Fidelis Medicare Advantage	$7,224.00
Rate for Payer: Group Health Inc Commercial	$3,440.00
Rate for Payer: Group Health Inc Medicare	$2,408.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,440.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,440.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,472.00

FEMORAL COMPONENT #6 CEMENTED

Facility IP

$6,880.00

Service Code	HCPCS C1776
Hospital Charge Code	40201337
Hospital Revenue Code	278
Min. Negotiated Rate	$3,440.00
Max. Negotiated Rate	$3,440.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,440.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,440.00

FEMORAL COMPONENT#7 LFT CEMENTED

Facility IP

$5,406.00

Service Code	HCPCS C1776
Hospital Charge Code	40201338
Hospital Revenue Code	278
Min. Negotiated Rate	$2,703.00
Max. Negotiated Rate	$2,703.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,703.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,703.00

FEMORAL COMPONENT#7 LFT CEMENTED

Facility OP

$5,406.00

Service Code	HCPCS C1776
Hospital Charge Code	40201338
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,676.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,973.30
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	$2,703.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,108.45
Rate for Payer: Fidelis Medicare Advantage	$5,676.30
Rate for Payer: Group Health Inc Commercial	$2,703.00
Rate for Payer: Group Health Inc Medicare	$1,892.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,703.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,703.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,513.90

FEMORAL COMPONENT CR SZ D L

Facility OP

$8,093.38

Service Code	HCPCS C1776
Hospital Charge Code	64905110
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,498.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,451.36
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	$4,046.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,653.69
Rate for Payer: Fidelis Medicare Advantage	$8,498.05
Rate for Payer: Group Health Inc Commercial	$4,046.69
Rate for Payer: Group Health Inc Medicare	$2,832.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,046.69
Rate for Payer: Hamaspik Choice Inc Medicare	$4,046.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,260.70

FEMORAL COMPONENT CR SZ D L

Facility IP

$8,093.38

Service Code	HCPCS C1776
Hospital Charge Code	64905110
Hospital Revenue Code	278
Min. Negotiated Rate	$4,046.69
Max. Negotiated Rate	$4,046.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,046.69
Rate for Payer: Hamaspik Choice Inc Medicare	$4,046.69

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