St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FEMORAL CRUCIATE RETAIN SZ5 RIGHT

Facility

$5,625.00

Service Code	HCPCS C1776
Hospital Charge Code	64905238
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,906.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,093.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,812.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,234.38
Rate for Payer: EmblemHealth Commercial	$2,812.50
Rate for Payer: Fidelis Medicare Advantage	$5,906.25
Rate for Payer: Group Health Inc Commercial	$2,812.50
Rate for Payer: Group Health Inc Medicare	$1,968.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,812.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,812.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,656.25

FEMORAL CRUC RETAIN SZ5 RT

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	40005150
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,725.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,475.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,587.50
Rate for Payer: EmblemHealth Commercial	$2,250.00
Rate for Payer: Fidelis Medicare Advantage	$4,725.00
Rate for Payer: Group Health Inc Commercial	$2,250.00
Rate for Payer: Group Health Inc Medicare	$1,575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,925.00

FEMORAL CRUC RETAIN SZ5 RT

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	40005150
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,250.00

FEMORAL DIST BLK SZ E 5MM

Facility

$7,900.00

Service Code	HCPCS L1690
Hospital Charge Code	64905885
Hospital Revenue Code	278
Min. Negotiated Rate	$3,950.00
Max. Negotiated Rate	$3,950.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,950.00

FEMORAL DIST BLK SZ E 5MM

Facility

$7,900.00

Service Code	HCPCS L1690
Hospital Charge Code	64905885
Hospital Revenue Code	278
Min. Negotiated Rate	$989.62
Max. Negotiated Rate	$8,295.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,345.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$989.62
Rate for Payer: Aetna Government	$989.62
Rate for Payer: Brighton Health Commercial	$4,740.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,950.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,542.50
Rate for Payer: EmblemHealth Commercial	$3,950.00
Rate for Payer: Fidelis Medicare Advantage	$8,295.00
Rate for Payer: Group Health Inc Commercial	$3,950.00
Rate for Payer: Group Health Inc Medicare	$2,765.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,950.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,950.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,135.00

FEMORAL HD 12/14 40MM 10.5

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905597
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,504.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,311.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,431.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,192.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,371.38
Rate for Payer: EmblemHealth Commercial	$1,192.50
Rate for Payer: Fidelis Medicare Advantage	$2,504.25
Rate for Payer: Group Health Inc Commercial	$1,192.50
Rate for Payer: Group Health Inc Medicare	$834.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,192.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,550.25

FEMORAL HD 12/14 40MM 10.5

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905597
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.50
Max. Negotiated Rate	$1,192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,192.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,192.50

FEMORAL HEAD CCHROME 22MM

Facility

$1,680.25

Service Code	HCPCS C1776
Hospital Charge Code	64905051
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,764.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$924.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,008.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$840.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$966.14
Rate for Payer: EmblemHealth Commercial	$840.12
Rate for Payer: Fidelis Medicare Advantage	$1,764.26
Rate for Payer: Group Health Inc Commercial	$840.12
Rate for Payer: Group Health Inc Medicare	$588.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$840.12
Rate for Payer: Hamaspik Choice Inc Medicare	$840.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,092.16

FEMORAL HEAD CCHROME 22MM

Facility

$1,680.25

Service Code	HCPCS C1776
Hospital Charge Code	64905051
Hospital Revenue Code	278
Min. Negotiated Rate	$840.12
Max. Negotiated Rate	$840.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$840.12
Rate for Payer: Hamaspik Choice Inc Medicare	$840.12

FEMORAL HEAD/COMPONENT > 2000

Facility

$8,646.03

Service Code	HCPCS C1776
Hospital Charge Code	40203093
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,078.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,755.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,187.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,323.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,971.47
Rate for Payer: EmblemHealth Commercial	$4,323.02
Rate for Payer: Fidelis Medicare Advantage	$9,078.33
Rate for Payer: Group Health Inc Commercial	$4,323.02
Rate for Payer: Group Health Inc Medicare	$3,026.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,323.02
Rate for Payer: Hamaspik Choice Inc Medicare	$4,323.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,619.92

FEMORAL HEAD/COMPONENT > 2000

Facility

$8,646.03

Service Code	HCPCS C1776
Hospital Charge Code	40203093
Hospital Revenue Code	278
Min. Negotiated Rate	$4,323.02
Max. Negotiated Rate	$4,323.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,323.02
Rate for Payer: Hamaspik Choice Inc Medicare	$4,323.02

FEMORAL HEAD LONG 8X26

Facility

$2,228.00

Service Code	HCPCS C1776
Hospital Charge Code	40205370
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,339.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,225.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,336.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,114.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,281.10
Rate for Payer: EmblemHealth Commercial	$1,114.00
Rate for Payer: Fidelis Medicare Advantage	$2,339.40
Rate for Payer: Group Health Inc Commercial	$1,114.00
Rate for Payer: Group Health Inc Medicare	$779.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,114.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,448.20

FEMORAL HEAD LONG 8X26

Facility

$2,228.00

Service Code	HCPCS C1776
Hospital Charge Code	40205370
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.00
Max. Negotiated Rate	$1,114.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,114.00

FEMORAL HEAD STANDARD NEC

Facility

$2,228.00

Service Code	HCPCS C1776
Hospital Charge Code	40200349
Hospital Revenue Code	278
Min. Negotiated Rate	$1,114.00
Max. Negotiated Rate	$1,114.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,114.00

FEMORAL HEAD STANDARD NEC

Facility

$2,228.00

Service Code	HCPCS C1776
Hospital Charge Code	40200349
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,339.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,225.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,336.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,114.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,281.10
Rate for Payer: EmblemHealth Commercial	$1,114.00
Rate for Payer: Fidelis Medicare Advantage	$2,339.40
Rate for Payer: Group Health Inc Commercial	$1,114.00
Rate for Payer: Group Health Inc Medicare	$779.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,114.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,114.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,448.20

FEMORAL NAIL

Facility

$3,271.80

Service Code	HCPCS C1713
Hospital Charge Code	40203570
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,435.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,799.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,963.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,635.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,881.28
Rate for Payer: EmblemHealth Commercial	$1,635.90
Rate for Payer: Fidelis Medicare Advantage	$3,435.39
Rate for Payer: Group Health Inc Commercial	$1,635.90
Rate for Payer: Group Health Inc Medicare	$1,145.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,635.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,635.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,126.67

FEMORAL NAIL

Facility

$3,271.80

Service Code	HCPCS C1713
Hospital Charge Code	40203570
Hospital Revenue Code	278
Min. Negotiated Rate	$1,635.90
Max. Negotiated Rate	$1,635.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,635.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1,635.90

FEMORAL NAIL, A/R, R1500

Facility

$2,648.00

Service Code	HCPCS C1713
Hospital Charge Code	40202357
Hospital Revenue Code	278
Min. Negotiated Rate	$1,324.00
Max. Negotiated Rate	$1,324.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,324.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,324.00

FEMORAL NAIL, A/R, R1500

Facility

$2,648.00

Service Code	HCPCS C1713
Hospital Charge Code	40202357
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,780.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,456.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,588.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,324.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,522.60
Rate for Payer: EmblemHealth Commercial	$1,324.00
Rate for Payer: Fidelis Medicare Advantage	$2,780.40
Rate for Payer: Group Health Inc Commercial	$1,324.00
Rate for Payer: Group Health Inc Medicare	$926.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,324.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,324.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,721.20

FEMORAL NAIL T2 11X380

Facility

$2,940.00

Service Code	HCPCS C1713
Hospital Charge Code	40209922
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,087.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,617.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,764.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,470.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,690.50
Rate for Payer: EmblemHealth Commercial	$1,470.00
Rate for Payer: Fidelis Medicare Advantage	$3,087.00
Rate for Payer: Group Health Inc Commercial	$1,470.00
Rate for Payer: Group Health Inc Medicare	$1,029.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,470.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,911.00

FEMORAL NAIL T2 11X380

Facility

$2,940.00

Service Code	HCPCS C1713
Hospital Charge Code	40209922
Hospital Revenue Code	278
Min. Negotiated Rate	$1,470.00
Max. Negotiated Rate	$1,470.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,470.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,470.00

FEMORAL NAIL T2 12 X 460

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Charge Code	40201343
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.00
Max. Negotiated Rate	$1,035.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,035.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,035.00

FEMORAL NAIL T2 12 X 460

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Charge Code	40201343
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,173.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,138.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,242.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,035.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,190.25
Rate for Payer: EmblemHealth Commercial	$1,035.00
Rate for Payer: Fidelis Medicare Advantage	$2,173.50
Rate for Payer: Group Health Inc Commercial	$1,035.00
Rate for Payer: Group Health Inc Medicare	$724.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,035.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,035.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,345.50

FEMORAL NAIL T2 14 X 420MM

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Charge Code	40201344
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,173.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,138.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,242.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,035.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,190.25
Rate for Payer: EmblemHealth Commercial	$1,035.00
Rate for Payer: Fidelis Medicare Advantage	$2,173.50
Rate for Payer: Group Health Inc Commercial	$1,035.00
Rate for Payer: Group Health Inc Medicare	$724.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,035.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,035.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,345.50

FEMORAL NAIL T2 14 X 420MM

Facility

$2,070.00

Service Code	HCPCS C1713
Hospital Charge Code	40201344
Hospital Revenue Code	278
Min. Negotiated Rate	$1,035.00
Max. Negotiated Rate	$1,035.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,035.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,035.00

Know your out-of-pocket cost for care.

All Charges