St. Barnabas Hospital

All Charges

Charge

Type

Price

FEMUR PSN PS CMT CCR STD SZ6 L

Facility OP

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40204653
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 PSN PS CMT CCR STD SZ6 L

Facility IP

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40204653
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 PSN PS CMT STD SZ6 L

Facility OP

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905664
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 PS CMT STD SZ6 L

Facility IP

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905664
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 REV

Facility OP

$18,300.00

Service Code	HCPCS C1776
Hospital Charge Code	64907169
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$19,215.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,065.00
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	$9,150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,522.50
Rate for Payer: Fidelis Medicare Advantage	$19,215.00
Rate for Payer: Group Health Inc Commercial	$9,150.00
Rate for Payer: Group Health Inc Medicare	$6,405.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,895.00

FEMUR PSN REV

Facility IP

$18,300.00

Service Code	HCPCS C1776
Hospital Charge Code	64907169
Hospital Revenue Code	278
Min. Negotiated Rate	$9,150.00
Max. Negotiated Rate	$9,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$9,150.00

FEMUR PSN RGHT SZ 9

Facility IP

$8,200.00

Service Code	HCPCS C1776
Hospital Charge Code	64906801
Hospital Revenue Code	278
Min. Negotiated Rate	$4,100.00
Max. Negotiated Rate	$4,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,100.00

FEMUR PSN RGHT SZ 9

Facility OP

$8,200.00

Service Code	HCPCS C1776
Hospital Charge Code	64906801
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,610.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,510.00
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	$4,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,715.00
Rate for Payer: Fidelis Medicare Advantage	$8,610.00
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,330.00

FEMUR PSN RGT C-D 6-9 600514

Facility OP

$5,000.00

Hospital Charge Code	64906733
Hospital Revenue Code	279
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2,500.00
Rate for Payer: Aetna Government	$2,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,400.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

FEMUR PSN RGT SZ 8

Facility OP

$6,200.00

Hospital Charge Code	64906712
Hospital Revenue Code	279
Min. Negotiated Rate	$2,170.00
Max. Negotiated Rate	$4,960.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,410.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,100.00
Rate for Payer: Aetna Government	$3,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,216.00
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

FEMUR PSN RIGHT NARROW SZ 4-5602

Facility OP

$6,200.00

Hospital Charge Code	64906664
Hospital Revenue Code	279
Min. Negotiated Rate	$2,170.00
Max. Negotiated Rate	$4,960.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,410.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,100.00
Rate for Payer: Aetna Government	$3,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,216.00
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

FEMUR PSN S27 LFT POR COR

Facility OP

$8,200.00

Hospital Charge Code	64906779
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 STD LEFT SZ 10

Facility OP

$8,200.00

Hospital Charge Code	64906749
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 TRBULR RT SZ 7 06202

Facility OP

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64906658
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
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	$2,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,300.00
Rate for Payer: Fidelis Medicare Advantage	$4,200.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,600.00

FEMUR PSN TRBULR RT SZ 7 06202

Facility IP

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64906658
Hospital Revenue Code	278
Min. Negotiated Rate	$2,000.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

FEMUR SYNERGY POR SZ 13

Facility IP

$9,329.50

Service Code	HCPCS C1713
Hospital Charge Code	64905353
Hospital Revenue Code	278
Min. Negotiated Rate	$4,664.75
Max. Negotiated Rate	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,664.75

FEMUR SYNERGY POR SZ 13

Facility OP

$9,329.50

Service Code	HCPCS C1713
Hospital Charge Code	64905353
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,795.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,131.22
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	$4,664.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,364.46
Rate for Payer: Fidelis Medicare Advantage	$9,795.98
Rate for Payer: Group Health Inc Commercial	$4,664.75
Rate for Payer: Group Health Inc Medicare	$3,265.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,664.75
Rate for Payer: Hamaspik Choice Inc Medicare	$4,664.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,064.18

FEMUR SZ 6 LOFT LEGION RE

Facility OP

$20,752.50

Service Code	HCPCS C1713
Hospital Charge Code	64903971
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$21,790.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11,413.88
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	$10,376.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,932.69
Rate for Payer: Fidelis Medicare Advantage	$21,790.12
Rate for Payer: Group Health Inc Commercial	$10,376.25
Rate for Payer: Group Health Inc Medicare	$7,263.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,376.25
Rate for Payer: Hamaspik Choice Inc Medicare	$10,376.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13,489.12

FEMUR SZ 6 LOFT LEGION RE

Facility IP

$20,752.50

Service Code	HCPCS C1713
Hospital Charge Code	64903971
Hospital Revenue Code	278
Min. Negotiated Rate	$10,376.25
Max. Negotiated Rate	$10,376.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$10,376.25
Rate for Payer: Hamaspik Choice Inc Medicare	$10,376.25

FENTANYL 1000CMG NS 100 ML INF

Facility OP

$0.08

Hospital Charge Code	41657785
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

FENTANYL 1000MCG D5W 100ML INF

Facility OP

$0.08

Hospital Charge Code	41647781
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

FENTANYL 1000/MCG/D5W 200ML INF

Facility OP

$16.00

Hospital Charge Code	41657174
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

FENTANYL 1000MCG/D5W 200ML INF

Facility OP

$16.00

Hospital Charge Code	41647174
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

FENTANYL 1000MCG NS 100 ML INF

Facility OP

$0.08

Hospital Charge Code	41647785
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

FENTANYL 1000MCG/NS 200ML INF

Facility OP

$16.00

Hospital Charge Code	41647179
Hospital Revenue Code	250
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$12.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.00
Rate for Payer: Aetna Government	$8.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.88
Rate for Payer: Group Health Inc Commercial	$8.00
Rate for Payer: Group Health Inc Medicare	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.00
Rate for Payer: Hamaspik Choice Inc Medicare	$8.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.40

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