St. Barnabas Hospital

All Charges

Charge

Type

Price

FEMUR, CMTD, PS CMT CCR NRW SZ4 L

Facility OP

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40007521
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,930.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,630.00
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	$3,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,795.00
Rate for Payer: Fidelis Medicare Advantage	$6,930.00
Rate for Payer: Group Health Inc Commercial	$3,300.00
Rate for Payer: Group Health Inc Medicare	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,290.00

FEMUR,CMTD PS CMT CCR STD SZ7 L

Facility OP

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40007516
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,930.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,630.00
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	$3,300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,795.00
Rate for Payer: Fidelis Medicare Advantage	$6,930.00
Rate for Payer: Group Health Inc Commercial	$3,300.00
Rate for Payer: Group Health Inc Medicare	$2,310.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,290.00

FEMUR,CMTD PS CMT CCR STD SZ7 L

Facility IP

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40007516
Hospital Revenue Code	278
Min. Negotiated Rate	$3,300.00
Max. Negotiated Rate	$3,300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,300.00

FEMUR DIST MRH POLY

Facility IP

$5,463.75

Service Code	HCPCS C1776
Hospital Charge Code	64907313
Hospital Revenue Code	278
Min. Negotiated Rate	$2,731.88
Max. Negotiated Rate	$2,731.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,731.88
Rate for Payer: Hamaspik Choice Inc Medicare	$2,731.88

FEMUR DIST MRH POLY

Facility OP

$5,463.75

Service Code	HCPCS C1776
Hospital Charge Code	64907313
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,736.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,005.06
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	$2,731.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,141.66
Rate for Payer: Fidelis Medicare Advantage	$5,736.94
Rate for Payer: Group Health Inc Commercial	$2,731.88
Rate for Payer: Group Health Inc Medicare	$1,912.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,731.88
Rate for Payer: Hamaspik Choice Inc Medicare	$2,731.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,551.44

FEMUR LEFT PS LEGION SIZE 4

Facility OP

$9,705.00

Service Code	HCPCS C1713
Hospital Charge Code	64904491
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,190.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,337.75
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	$4,852.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,580.38
Rate for Payer: Fidelis Medicare Advantage	$10,190.25
Rate for Payer: Group Health Inc Commercial	$4,852.50
Rate for Payer: Group Health Inc Medicare	$3,396.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,308.25

FEMUR LEFT PS LEGION SIZE 4

Facility IP

$9,705.00

Service Code	HCPCS C1713
Hospital Charge Code	64904491
Hospital Revenue Code	278
Min. Negotiated Rate	$4,852.50
Max. Negotiated Rate	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50

FEMUR LEGION OXI SZ 6 RIGHT

Facility IP

$9,705.00

Service Code	HCPCS C1776
Hospital Charge Code	64904854
Hospital Revenue Code	278
Min. Negotiated Rate	$4,852.50
Max. Negotiated Rate	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50

FEMUR LEGION OXI SZ 6 RIGHT

Facility OP

$9,705.00

Service Code	HCPCS C1776
Hospital Charge Code	64904854
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,190.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,337.75
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	$4,852.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,580.38
Rate for Payer: Fidelis Medicare Advantage	$10,190.25
Rate for Payer: Group Health Inc Commercial	$4,852.50
Rate for Payer: Group Health Inc Medicare	$3,396.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,308.25

FEMUR POST AUG 11 5MM

Facility IP

$2,805.00

Service Code	HCPCS C1889
Hospital Charge Code	64907522
Hospital Revenue Code	278
Min. Negotiated Rate	$1,402.50
Max. Negotiated Rate	$1,402.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,402.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,402.50

FEMUR POST AUG 11 5MM

Facility OP

$2,805.00

Service Code	HCPCS C1889
Hospital Charge Code	64907522
Hospital Revenue Code	278
Min. Negotiated Rate	$981.75
Max. Negotiated Rate	$2,945.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,542.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,402.50
Rate for Payer: Aetna Government	$1,402.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,402.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,612.88
Rate for Payer: Fidelis Medicare Advantage	$2,945.25
Rate for Payer: Group Health Inc Commercial	$1,402.50
Rate for Payer: Group Health Inc Medicare	$981.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,402.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,402.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,823.25

FEMUR PSN 13MM LFT 10-12

Facility OP

$3,400.00

Hospital Charge Code	64906756
Hospital Revenue Code	279
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,700.00
Rate for Payer: Aetna Government	$1,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,312.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

FEMUR PSN CR CMT CCR SZ7 L

Facility OP

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905916
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,137.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,262.50
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	$3,875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,456.25
Rate for Payer: Fidelis Medicare Advantage	$8,137.50
Rate for Payer: Group Health Inc Commercial	$3,875.00
Rate for Payer: Group Health Inc Medicare	$2,712.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,037.50

FEMUR PSN CR CMT CCR SZ7 L

Facility IP

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905916
Hospital Revenue Code	278
Min. Negotiated Rate	$3,875.00
Max. Negotiated Rate	$3,875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,875.00

FEMUR PSN LEFT POST SZ9

Facility OP

$10,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907011
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,762.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,637.50
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	$5,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,893.75
Rate for Payer: Fidelis Medicare Advantage	$10,762.50
Rate for Payer: Group Health Inc Commercial	$5,125.00
Rate for Payer: Group Health Inc Medicare	$3,587.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,662.50

FEMUR PSN LEFT POST SZ9

Facility IP

$10,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907011
Hospital Revenue Code	278
Min. Negotiated Rate	$5,125.00
Max. Negotiated Rate	$5,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,125.00

FEMUR PSN LT SZ 7 TRA METAL

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906543
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

FEMUR PSN LT SZ 7 TRA METAL

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906543
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

FEMUR PSN NARW LFT 7

Facility IP

$6,200.00

Service Code	HCPCS C1776
Hospital Charge Code	64906945
Hospital Revenue Code	278
Min. Negotiated Rate	$3,100.00
Max. Negotiated Rate	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,100.00

FEMUR PSN NARW LFT 7

Facility OP

$6,200.00

Service Code	HCPCS C1776
Hospital Charge Code	64906945
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,510.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,410.00
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	$3,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,565.00
Rate for Payer: Fidelis Medicare Advantage	$6,510.00
Rate for Payer: Group Health Inc Commercial	$3,100.00
Rate for Payer: Group Health Inc Medicare	$2,170.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,030.00

FEMUR PSN POST RGHT SZ 5

Facility OP

$8,200.00

Hospital Charge Code	64906572
Hospital Revenue Code	279
Min. Negotiated Rate	$2,870.00
Max. Negotiated Rate	$6,560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,510.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,100.00
Rate for Payer: Aetna Government	$4,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,576.00
Rate for Payer: Group Health Inc Commercial	$4,100.00
Rate for Payer: Group Health Inc Medicare	$2,870.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,100.00

FEMUR PSN POST RGT SZ 8 TRABECLAR

Facility OP

$4,100.00

Service Code	HCPCS C1776
Hospital Charge Code	64906269
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,305.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,255.00
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	$2,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,357.50
Rate for Payer: Fidelis Medicare Advantage	$4,305.00
Rate for Payer: Group Health Inc Commercial	$2,050.00
Rate for Payer: Group Health Inc Medicare	$1,435.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,665.00

FEMUR PSN POST RGT SZ 8 TRABECLAR

Facility IP

$4,100.00

Service Code	HCPCS C1776
Hospital Charge Code	64906269
Hospital Revenue Code	278
Min. Negotiated Rate	$2,050.00
Max. Negotiated Rate	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,050.00

FEMUR PSN PS CMT CCR NRW SZ3 L

Facility IP

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905667
Hospital Revenue Code	278
Min. Negotiated Rate	$3,875.00
Max. Negotiated Rate	$3,875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,875.00

FEMUR PSN PS CMT CCR NRW SZ3 L

Facility OP

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905667
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,137.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,262.50
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	$3,875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,456.25
Rate for Payer: Fidelis Medicare Advantage	$8,137.50
Rate for Payer: Group Health Inc Commercial	$3,875.00
Rate for Payer: Group Health Inc Medicare	$2,712.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,037.50

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