St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FELT POLYESTER 1X1

Facility

$42.00

Hospital Charge Code	40200979
Hospital Revenue Code	270
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.00
Rate for Payer: Aetna Government	$21.00
Rate for Payer: Brighton Health Commercial	$31.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$33.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$28.56
Rate for Payer: Group Health Inc Commercial	$21.00
Rate for Payer: Group Health Inc Medicare	$14.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.00
Rate for Payer: Hamaspik Choice Inc Medicare	$21.00

FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES

Facility

$36,863.92

Service Code	MSDRG 748
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$36,863.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20,715.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26,810.12
Rate for Payer: Aetna Government	$26,810.12
Rate for Payer: Brighton Health Commercial	$20,371.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27,346.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24,261.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$20,021.40
Rate for Payer: Elderplan Medicare Advantage	$25,469.61
Rate for Payer: EmblemHealth Commercial	$12,047.00
Rate for Payer: Fidelis Medicare Advantage	$26,810.12
Rate for Payer: Group Health Inc Commercial	$1,000.00
Rate for Payer: Group Health Inc Medicare	$26,810.12
Rate for Payer: Hamaspik Choice Inc Medicare	$26,810.12
Rate for Payer: Healthfirst Medicare Advantage	$12,466.71
Rate for Payer: Humana Medicare	$36,863.92
Rate for Payer: Senior Whole Health Medicare Advantage	$26,810.12
Rate for Payer: United Healthcare Commercial	$27,939.25
Rate for Payer: United Healthcare Medicare Advantage	$26,810.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26,810.12
Rate for Payer: Wellcare Medicare	$25,469.61

FEM ANTVRT GMRS

Facility

$16,897.50

Service Code	HCPCS C1776
Hospital Charge Code	64907270
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 ANTVRT GMRS

Facility

$16,897.50

Service Code	HCPCS C1776
Hospital Charge Code	64907270
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: Brighton Health Commercial	$10,138.50
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: EmblemHealth Commercial	$8,448.75
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

FEM CMNTD EON

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907330
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,612.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,987.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,350.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,625.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,168.75
Rate for Payer: EmblemHealth Commercial	$3,625.00
Rate for Payer: Fidelis Medicare Advantage	$7,612.50
Rate for Payer: Group Health Inc Commercial	$3,625.00
Rate for Payer: Group Health Inc Medicare	$2,537.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,625.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,712.50

FEM CMNTD EON

Facility

$7,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907330
Hospital Revenue Code	278
Min. Negotiated Rate	$3,625.00
Max. Negotiated Rate	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,625.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,625.00

FEM COMP TRI BDD

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64907209
Hospital Revenue Code	278
Min. Negotiated Rate	$3,750.00
Max. Negotiated Rate	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00

FEM COMP TRI BDD

Facility

$7,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64907209
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,875.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,125.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,500.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,312.50
Rate for Payer: EmblemHealth Commercial	$3,750.00
Rate for Payer: Fidelis Medicare Advantage	$7,875.00
Rate for Payer: Group Health Inc Commercial	$3,750.00
Rate for Payer: Group Health Inc Medicare	$2,625.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,875.00

FEM COMP TRI CMTD

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907207
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

FEM COMP TRI CMTD

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64907207
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

FEM DIS MRH AUGMENT

Facility

$2,377.50

Service Code	HCPCS C1776
Hospital Charge Code	64907255
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,496.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,307.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,426.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,188.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,367.06
Rate for Payer: EmblemHealth Commercial	$1,188.75
Rate for Payer: Fidelis Medicare Advantage	$2,496.38
Rate for Payer: Group Health Inc Commercial	$1,188.75
Rate for Payer: Group Health Inc Medicare	$832.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,188.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,188.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,545.38

FEM DIS MRH AUGMENT

Facility

$2,377.50

Service Code	HCPCS C1776
Hospital Charge Code	64907255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,188.75
Max. Negotiated Rate	$1,188.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,188.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,188.75

FEM DIST GMRS

Facility

$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: Brighton Health Commercial	$14,608.50
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: EmblemHealth Commercial	$12,173.75
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 GMRS

Facility

$24,347.50

Service Code	HCPCS C1776
Hospital Charge Code	64907272
Hospital Revenue Code	278
Min. Negotiated Rate	$12,173.75
Max. Negotiated Rate	$12,173.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$12,173.75
Rate for Payer: Hamaspik Choice Inc Medicare	$12,173.75

FEM DIST GROW PROS

Facility

$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 DIST GROW PROS

Facility

$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: Brighton Health Commercial	$24,147.00
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: EmblemHealth Commercial	$20,122.50
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 DST TRI AUG

Facility

$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 DST TRI AUG

Facility

$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: Brighton Health Commercial	$2,439.00
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: EmblemHealth Commercial	$2,032.50
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 NEUT PROX

Facility

$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

$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: Brighton Health Commercial	$10,138.50
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: EmblemHealth Commercial	$8,448.75
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

$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: Brighton Health Commercial	$607.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$506.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$582.19
Rate for Payer: EmblemHealth Commercial	$506.25
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 BUSHING HRHK

Facility

$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 CEMENT RESTRCTR SZ9-15MM

Facility

$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

$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: Brighton Health Commercial	$566.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$472.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$542.80
Rate for Payer: EmblemHealth Commercial	$472.00
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

$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: Brighton Health Commercial	$5,024.52
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: EmblemHealth Commercial	$4,187.10
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

Know your out-of-pocket cost for care.

All Charges