St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL COMPONENT POROUS SZ E RT

Facility

$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: Brighton Health Commercial	$3,928.80
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: EmblemHealth Commercial	$3,274.00
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 E RT

Facility

$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 F LFT

Facility

$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

$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: 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

FEMORAL COMPONENT PRECOAT

Facility

$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

$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: Brighton Health Commercial	$4,910.03
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: EmblemHealth Commercial	$4,091.69
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

$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 4 LEFT

Facility

$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: Brighton Health Commercial	$6,261.60
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: EmblemHealth Commercial	$5,218.00
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 D LFT

Facility

$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

$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: Brighton Health Commercial	$3,928.02
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: EmblemHealth Commercial	$3,273.35
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

$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 D RIGHT

Facility

$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: 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 SZ E LFT

Facility

$6,907.10

Service Code	HCPCS C1776
Hospital Charge Code	40200250
Hospital Revenue Code	278
Min. Negotiated Rate	$3,453.55
Max. Negotiated Rate	$3,453.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,453.55
Rate for Payer: Hamaspik Choice Inc Medicare	$3,453.55

FEMORAL COMPONENT SZ E LFT

Facility

$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: Brighton Health Commercial	$4,144.26
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: EmblemHealth Commercial	$3,453.55
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

FEMORAL COMPONENT SZ E RIGHT

Facility

$6,547.00

Service Code	HCPCS C1776
Hospital Charge Code	40202107
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,874.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,600.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,928.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,273.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,764.52
Rate for Payer: EmblemHealth Commercial	$3,273.50
Rate for Payer: Fidelis Medicare Advantage	$6,874.35
Rate for Payer: Group Health Inc Commercial	$3,273.50
Rate for Payer: Group Health Inc Medicare	$2,291.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,273.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,273.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,255.55

FEMORAL COMPONENT SZ E RIGHT

Facility

$6,547.00

Service Code	HCPCS C1776
Hospital Charge Code	40202107
Hospital Revenue Code	278
Min. Negotiated Rate	$3,273.50
Max. Negotiated Rate	$3,273.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,273.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3,273.50

FEMORAL COM P SZ F RGHT

Facility

$8,374.20

Service Code	HCPCS C1776
Hospital Charge Code	40205128
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 COM P SZ F RGHT

Facility

$8,374.20

Service Code	HCPCS C1776
Hospital Charge Code	40205128
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

FEMORAL COMPT POROUS SZD LT

Facility

$6,730.00

Service Code	HCPCS C1713
Hospital Charge Code	40009109
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,066.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,701.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,038.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,365.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,869.75
Rate for Payer: EmblemHealth Commercial	$3,365.00
Rate for Payer: Fidelis Medicare Advantage	$7,066.50
Rate for Payer: Group Health Inc Commercial	$3,365.00
Rate for Payer: Group Health Inc Medicare	$2,355.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,365.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,374.50

FEMORAL COMPT POROUS SZD LT

Facility

$6,730.00

Service Code	HCPCS C1713
Hospital Charge Code	40009109
Hospital Revenue Code	278
Min. Negotiated Rate	$3,365.00
Max. Negotiated Rate	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,365.00

FEMORAL COMPT POROUS SZE RT

Facility

$6,730.00

Service Code	HCPCS C1713
Hospital Charge Code	40009108
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,066.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,701.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,038.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,365.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,869.75
Rate for Payer: EmblemHealth Commercial	$3,365.00
Rate for Payer: Fidelis Medicare Advantage	$7,066.50
Rate for Payer: Group Health Inc Commercial	$3,365.00
Rate for Payer: Group Health Inc Medicare	$2,355.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,365.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,374.50

FEMORAL COMPT POROUS SZE RT

Facility

$6,730.00

Service Code	HCPCS C1713
Hospital Charge Code	40009108
Hospital Revenue Code	278
Min. Negotiated Rate	$3,365.00
Max. Negotiated Rate	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,365.00

FEMORAL COMPT POROUS SZF LT

Facility

$6,730.00

Service Code	HCPCS C1713
Hospital Charge Code	40009110
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,066.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,701.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,038.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,365.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,869.75
Rate for Payer: EmblemHealth Commercial	$3,365.00
Rate for Payer: Fidelis Medicare Advantage	$7,066.50
Rate for Payer: Group Health Inc Commercial	$3,365.00
Rate for Payer: Group Health Inc Medicare	$2,355.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,365.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,374.50

FEMORAL COMPT POROUS SZF LT

Facility

$6,730.00

Service Code	HCPCS C1713
Hospital Charge Code	40009110
Hospital Revenue Code	278
Min. Negotiated Rate	$3,365.00
Max. Negotiated Rate	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,365.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,365.00

FEMORAL CRUCIATE RETAIN SZ5 RIGHT

Facility

$5,625.00

Service Code	HCPCS C1776
Hospital Charge Code	64905238
Hospital Revenue Code	278
Min. Negotiated Rate	$2,812.50
Max. Negotiated Rate	$2,812.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,812.50

Know your out-of-pocket cost for care.

All Charges