St. Barnabas Hospital

All Charges

Charge

Type

Price

FEMORAL COMPONENT L SZ4

Facility IP

$6,744.25

Service Code	HCPCS C1776
Hospital Charge Code	64904781
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

FEMORAL COMPONENT L SZ4

Facility OP

$6,744.25

Service Code	HCPCS C1776
Hospital Charge Code	64904781
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,081.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,709.34
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	$3,372.12
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

FEMORAL COMPONENT POROUS SZ C LFT

Facility OP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202099
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,762.00
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	$3,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,933.00
Rate for Payer: Fidelis Medicare Advantage	$7,182.00
Rate for Payer: Group Health Inc Commercial	$3,420.00
Rate for Payer: Group Health Inc Medicare	$2,394.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,446.00

FEMORAL COMPONENT POROUS SZ C LFT

Facility IP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202099
Hospital Revenue Code	278
Min. Negotiated Rate	$3,420.00
Max. Negotiated Rate	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00

FEMORAL COMPONENT POROUS SZ C RT

Facility IP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202101
Hospital Revenue Code	278
Min. Negotiated Rate	$3,420.00
Max. Negotiated Rate	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00

FEMORAL COMPONENT POROUS SZ C RT

Facility OP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202101
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,762.00
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	$3,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,933.00
Rate for Payer: Fidelis Medicare Advantage	$7,182.00
Rate for Payer: Group Health Inc Commercial	$3,420.00
Rate for Payer: Group Health Inc Medicare	$2,394.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,446.00

FEMORAL COMPONENT POROUS SZ D LFT

Facility OP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202102
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,762.00
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	$3,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,933.00
Rate for Payer: Fidelis Medicare Advantage	$7,182.00
Rate for Payer: Group Health Inc Commercial	$3,420.00
Rate for Payer: Group Health Inc Medicare	$2,394.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,446.00

FEMORAL COMPONENT POROUS SZ D LFT

Facility IP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202102
Hospital Revenue Code	278
Min. Negotiated Rate	$3,420.00
Max. Negotiated Rate	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00

FEMORAL COMPONENT POROUS SZ D RT

Facility OP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202103
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,762.00
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	$3,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,933.00
Rate for Payer: Fidelis Medicare Advantage	$7,182.00
Rate for Payer: Group Health Inc Commercial	$3,420.00
Rate for Payer: Group Health Inc Medicare	$2,394.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,446.00

FEMORAL COMPONENT POROUS SZ D RT

Facility IP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202103
Hospital Revenue Code	278
Min. Negotiated Rate	$3,420.00
Max. Negotiated Rate	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00

FEMORAL COMPONENT POROUS SZ E LFT

Facility IP

$8,684.00

Service Code	HCPCS C1776
Hospital Charge Code	40202097
Hospital Revenue Code	278
Min. Negotiated Rate	$4,342.00
Max. Negotiated Rate	$4,342.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,342.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,342.00

FEMORAL COMPONENT POROUS SZ E LFT

Facility OP

$8,684.00

Service Code	HCPCS C1776
Hospital Charge Code	40202097
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,118.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,776.20
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	$4,342.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,993.30
Rate for Payer: Fidelis Medicare Advantage	$9,118.20
Rate for Payer: Group Health Inc Commercial	$4,342.00
Rate for Payer: Group Health Inc Medicare	$3,039.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,342.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,342.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,644.60

FEMORAL COMPONENT POROUS SZ E RT

Facility IP

$6,548.00

Service Code	HCPCS C1776
Hospital Charge Code	40202104
Hospital Revenue Code	278
Min. Negotiated Rate	$3,274.00
Max. Negotiated Rate	$3,274.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,274.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,274.00

FEMORAL COMPONENT POROUS SZ E RT

Facility OP

$6,548.00

Service Code	HCPCS C1776
Hospital Charge Code	40202104
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,875.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,601.40
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	$3,274.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,765.10
Rate for Payer: Fidelis Medicare Advantage	$6,875.40
Rate for Payer: Group Health Inc Commercial	$3,274.00
Rate for Payer: Group Health Inc Medicare	$2,291.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,274.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,274.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,256.20

FEMORAL COMPONENT POROUS SZ F LFT

Facility IP

$8,684.00

Service Code	HCPCS C1776
Hospital Charge Code	40202098
Hospital Revenue Code	278
Min. Negotiated Rate	$4,342.00
Max. Negotiated Rate	$4,342.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,342.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,342.00

FEMORAL COMPONENT POROUS SZ F LFT

Facility OP

$8,684.00

Service Code	HCPCS C1776
Hospital Charge Code	40202098
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,118.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,776.20
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	$4,342.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,993.30
Rate for Payer: Fidelis Medicare Advantage	$9,118.20
Rate for Payer: Group Health Inc Commercial	$4,342.00
Rate for Payer: Group Health Inc Medicare	$3,039.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,342.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,342.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,644.60

FEMORAL COMPONENT PRECOAT

Facility IP

$8,183.38

Service Code	HCPCS C1776
Hospital Charge Code	64904002
Hospital Revenue Code	278
Min. Negotiated Rate	$4,091.69
Max. Negotiated Rate	$4,091.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,091.69
Rate for Payer: Hamaspik Choice Inc Medicare	$4,091.69

FEMORAL COMPONENT PRECOAT

Facility OP

$8,183.38

Service Code	HCPCS C1776
Hospital Charge Code	64904002
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,592.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,500.86
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	$4,091.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,705.44
Rate for Payer: Fidelis Medicare Advantage	$8,592.55
Rate for Payer: Group Health Inc Commercial	$4,091.69
Rate for Payer: Group Health Inc Medicare	$2,864.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,091.69
Rate for Payer: Hamaspik Choice Inc Medicare	$4,091.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,319.20

FEMORAL COMPONENT SZ 4 LEFT

Facility OP

$10,436.00

Service Code	HCPCS C1776
Hospital Charge Code	40202109
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,957.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,739.80
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	$5,218.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,000.70
Rate for Payer: Fidelis Medicare Advantage	$10,957.80
Rate for Payer: Group Health Inc Commercial	$5,218.00
Rate for Payer: Group Health Inc Medicare	$3,652.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,218.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,218.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,783.40

FEMORAL COMPONENT SZ 4 LEFT

Facility IP

$10,436.00

Service Code	HCPCS C1776
Hospital Charge Code	40202109
Hospital Revenue Code	278
Min. Negotiated Rate	$5,218.00
Max. Negotiated Rate	$5,218.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,218.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,218.00

FEMORAL COMPONENT SZ D LFT

Facility IP

$6,546.70

Service Code	HCPCS C1776
Hospital Charge Code	40200249
Hospital Revenue Code	278
Min. Negotiated Rate	$3,273.35
Max. Negotiated Rate	$3,273.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,273.35
Rate for Payer: Hamaspik Choice Inc Medicare	$3,273.35

FEMORAL COMPONENT SZ D LFT

Facility OP

$6,546.70

Service Code	HCPCS C1776
Hospital Charge Code	40200249
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,874.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,600.68
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	$3,273.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,764.35
Rate for Payer: Fidelis Medicare Advantage	$6,874.04
Rate for Payer: Group Health Inc Commercial	$3,273.35
Rate for Payer: Group Health Inc Medicare	$2,291.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,273.35
Rate for Payer: Hamaspik Choice Inc Medicare	$3,273.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,255.36

FEMORAL COMPONENT SZ D RIGHT

Facility OP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202106
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,182.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,762.00
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	$3,420.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,933.00
Rate for Payer: Fidelis Medicare Advantage	$7,182.00
Rate for Payer: Group Health Inc Commercial	$3,420.00
Rate for Payer: Group Health Inc Medicare	$2,394.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,446.00

FEMORAL COMPONENT SZ D RIGHT

Facility IP

$6,840.00

Service Code	HCPCS C1776
Hospital Charge Code	40202106
Hospital Revenue Code	278
Min. Negotiated Rate	$3,420.00
Max. Negotiated Rate	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,420.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,420.00

FEMORAL COMPONENT SZ E LFT

Facility OP

$6,907.10

Service Code	HCPCS C1776
Hospital Charge Code	40200250
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,252.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,798.90
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	$3,453.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,971.58
Rate for Payer: Fidelis Medicare Advantage	$7,252.46
Rate for Payer: Group Health Inc Commercial	$3,453.55
Rate for Payer: Group Health Inc Medicare	$2,417.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,453.55
Rate for Payer: Hamaspik Choice Inc Medicare	$3,453.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,489.62

Price Transparency.

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