St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL COMPONENT

Facility

$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

$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 12 HO SYNER

Facility

$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: Brighton Health Commercial	$5,851.50
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: EmblemHealth Commercial	$4,876.25
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#4 RGHT CEMENTED

Facility

$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: Brighton Health Commercial	$3,211.20
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: EmblemHealth Commercial	$2,676.00
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#4 RGHT CEMENTED

Facility

$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#5 RGHT CEMENTED

Facility

$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

$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: Brighton Health Commercial	$3,816.00
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: EmblemHealth Commercial	$3,180.00
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

$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: Brighton Health Commercial	$4,128.00
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: EmblemHealth Commercial	$3,440.00
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

$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

$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: Brighton Health Commercial	$3,243.60
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: EmblemHealth Commercial	$2,703.00
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#7 LFT CEMENTED

Facility

$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 CR SZ D L

Facility

$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: Brighton Health Commercial	$4,856.03
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: EmblemHealth Commercial	$4,046.69
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

$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

FEMORAL COMPONENT L SZ4

Facility

$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: Brighton Health Commercial	$4,046.55
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: EmblemHealth Commercial	$3,372.12
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 L SZ4

Facility

$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 POROUS SZ C LFT

Facility

$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 LFT

Facility

$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: Brighton Health Commercial	$4,104.00
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: EmblemHealth Commercial	$3,420.00
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 RT

Facility

$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: Brighton Health Commercial	$4,104.00
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: EmblemHealth Commercial	$3,420.00
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 RT

Facility

$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 D LFT

Facility

$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: Brighton Health Commercial	$4,104.00
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: EmblemHealth Commercial	$3,420.00
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

$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

$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: Brighton Health Commercial	$4,104.00
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: EmblemHealth Commercial	$3,420.00
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

$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

$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

$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: Brighton Health Commercial	$5,210.40
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: EmblemHealth Commercial	$4,342.00
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

Know your out-of-pocket cost for care.

All Charges