St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FEM STM W/FEM TAPER

Facility

$8,608.12

Service Code	HCPCS C1776
Hospital Charge Code	64907282
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,038.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,734.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,164.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,304.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,949.67
Rate for Payer: EmblemHealth Commercial	$4,304.06
Rate for Payer: Fidelis Medicare Advantage	$9,038.53
Rate for Payer: Group Health Inc Commercial	$4,304.06
Rate for Payer: Group Health Inc Medicare	$3,012.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,304.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4,304.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,595.28

FEM STM W/FEM TAPER

Facility

$8,608.12

Service Code	HCPCS C1776
Hospital Charge Code	64907282
Hospital Revenue Code	278
Min. Negotiated Rate	$4,304.06
Max. Negotiated Rate	$4,304.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,304.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4,304.06

FEM TRI TS

Facility

$23,640.00

Service Code	HCPCS C1776
Hospital Charge Code	64907208
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$24,822.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13,002.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$14,184.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,820.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,593.00
Rate for Payer: EmblemHealth Commercial	$11,820.00
Rate for Payer: Fidelis Medicare Advantage	$24,822.00
Rate for Payer: Group Health Inc Commercial	$11,820.00
Rate for Payer: Group Health Inc Medicare	$8,274.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,820.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,820.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,366.00

FEM TRI TS

Facility

$23,640.00

Service Code	HCPCS C1776
Hospital Charge Code	64907208
Hospital Revenue Code	278
Min. Negotiated Rate	$11,820.00
Max. Negotiated Rate	$11,820.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,820.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,820.00

FEMUR, CEMENT PER STD SZ7 L

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905511
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$8,662.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,537.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$4,950.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,743.75
Rate for Payer: EmblemHealth Commercial	$4,125.00
Rate for Payer: Fidelis Medicare Advantage	$8,662.50
Rate for Payer: Group Health Inc Commercial	$4,125.00
Rate for Payer: Group Health Inc Medicare	$2,887.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,362.50

FEMUR, CEMENT PER STD SZ7 L

Facility

$8,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905511
Hospital Revenue Code	278
Min. Negotiated Rate	$4,125.00
Max. Negotiated Rate	$4,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,125.00

FEMUR, CEMENT PS SZ4 L

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905517
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, CEMENT PS SZ4 L

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905517
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: Brighton Health Commercial	$4,650.00
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: EmblemHealth Commercial	$3,875.00
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 CEMENT RIGHT SZ5

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905313
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,662.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,537.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,950.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,743.75
Rate for Payer: EmblemHealth Commercial	$4,125.00
Rate for Payer: Fidelis Medicare Advantage	$8,662.50
Rate for Payer: Group Health Inc Commercial	$4,125.00
Rate for Payer: Group Health Inc Medicare	$2,887.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,362.50

FEMUR CEMENT RIGHT SZ5

Facility

$8,250.00

Service Code	HCPCS C1776
Hospital Charge Code	64905313
Hospital Revenue Code	278
Min. Negotiated Rate	$4,125.00
Max. Negotiated Rate	$4,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,125.00

FEMUR CMNTD PS CMT CCR NRW SZ4 L

Facility

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40204602
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 CMNTD PS CMT CCR NRW SZ4 L

Facility

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40204602
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: Brighton Health Commercial	$3,960.00
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: EmblemHealth Commercial	$3,300.00
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 CMNT PS RIGHT SZ10

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905454
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: Brighton Health Commercial	$4,650.00
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: EmblemHealth Commercial	$3,875.00
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 CMNT PS RIGHT SZ10

Facility

$7,750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905454
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, CMTD, PS CMT CCR NRW SZ4 L

Facility

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40007521
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, CMTD, PS CMT CCR NRW SZ4 L

Facility

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40007521
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: Brighton Health Commercial	$3,960.00
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: EmblemHealth Commercial	$3,300.00
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,CMTD PS CMT CCR STD SZ7 L

Facility

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40007516
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,CMTD PS CMT CCR STD SZ7 L

Facility

$6,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40007516
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: Brighton Health Commercial	$3,960.00
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: EmblemHealth Commercial	$3,300.00
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 DIST MRH POLY

Facility

$5,463.75

Service Code	HCPCS C1776
Hospital Charge Code	64907313
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,736.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,005.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,278.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,731.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,141.66
Rate for Payer: EmblemHealth Commercial	$2,731.88
Rate for Payer: Fidelis Medicare Advantage	$5,736.94
Rate for Payer: Group Health Inc Commercial	$2,731.88
Rate for Payer: Group Health Inc Medicare	$1,912.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,731.88
Rate for Payer: Hamaspik Choice Inc Medicare	$2,731.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,551.44

FEMUR DIST MRH POLY

Facility

$5,463.75

Service Code	HCPCS C1776
Hospital Charge Code	64907313
Hospital Revenue Code	278
Min. Negotiated Rate	$2,731.88
Max. Negotiated Rate	$2,731.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,731.88
Rate for Payer: Hamaspik Choice Inc Medicare	$2,731.88

FEMUR LEFT PS LEGION SIZE 4

Facility

$9,705.00

Service Code	HCPCS C1713
Hospital Charge Code	64904491
Hospital Revenue Code	278
Min. Negotiated Rate	$4,852.50
Max. Negotiated Rate	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50

FEMUR LEFT PS LEGION SIZE 4

Facility

$9,705.00

Service Code	HCPCS C1713
Hospital Charge Code	64904491
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,190.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,337.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,823.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,852.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,580.38
Rate for Payer: EmblemHealth Commercial	$4,852.50
Rate for Payer: Fidelis Medicare Advantage	$10,190.25
Rate for Payer: Group Health Inc Commercial	$4,852.50
Rate for Payer: Group Health Inc Medicare	$3,396.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,308.25

FEMUR LEGION OXI SZ 6 RIGHT

Facility

$9,705.00

Service Code	HCPCS C1776
Hospital Charge Code	64904854
Hospital Revenue Code	278
Min. Negotiated Rate	$4,852.50
Max. Negotiated Rate	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50

FEMUR LEGION OXI SZ 6 RIGHT

Facility

$9,705.00

Service Code	HCPCS C1776
Hospital Charge Code	64904854
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,190.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,337.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,823.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,852.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,580.38
Rate for Payer: EmblemHealth Commercial	$4,852.50
Rate for Payer: Fidelis Medicare Advantage	$10,190.25
Rate for Payer: Group Health Inc Commercial	$4,852.50
Rate for Payer: Group Health Inc Medicare	$3,396.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,852.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,852.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,308.25

FEMUR POST AUG 11 5MM

Facility

$2,805.00

Service Code	HCPCS C1889
Hospital Charge Code	64907522
Hospital Revenue Code	278
Min. Negotiated Rate	$981.75
Max. Negotiated Rate	$2,945.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,542.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,402.50
Rate for Payer: Aetna Government	$1,402.50
Rate for Payer: Brighton Health Commercial	$1,683.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,402.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,612.88
Rate for Payer: EmblemHealth Commercial	$1,402.50
Rate for Payer: Fidelis Medicare Advantage	$2,945.25
Rate for Payer: Group Health Inc Commercial	$1,402.50
Rate for Payer: Group Health Inc Medicare	$981.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,402.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,402.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,823.25

Know your out-of-pocket cost for care.

All Charges