St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEADACHES WITHOUT MCC

Facility

$26,138.35

Service Code	MSDRG 103
Min. Negotiated Rate	$7,223.58
Max. Negotiated Rate	$26,138.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,421.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19,009.71
Rate for Payer: Aetna Government	$19,009.71
Rate for Payer: Brighton Health Commercial	$12,214.80
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$19,389.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14,547.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$12,005.14
Rate for Payer: Elderplan Medicare Advantage	$18,059.22
Rate for Payer: EmblemHealth Commercial	$7,223.58
Rate for Payer: Fidelis Medicare Advantage	$19,009.71
Rate for Payer: Group Health Inc Commercial	$19,009.71
Rate for Payer: Group Health Inc Medicare	$19,009.71
Rate for Payer: Hamaspik Choice Inc Medicare	$19,009.71
Rate for Payer: Healthfirst Medicare Advantage	$8,839.52
Rate for Payer: Humana Medicare	$26,138.35
Rate for Payer: Senior Whole Health Medicare Advantage	$19,009.71
Rate for Payer: United Healthcare Commercial	$16,752.81
Rate for Payer: United Healthcare Medicare Advantage	$19,009.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19,009.71
Rate for Payer: Wellcare Medicare	$18,059.22

HEAD COMPONENT

Facility

$2,799.00

Service Code	HCPCS C1776
Hospital Charge Code	64902916
Hospital Revenue Code	278
Min. Negotiated Rate	$1,399.50
Max. Negotiated Rate	$1,399.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.50

HEAD COMPONENT

Facility

$2,799.00

Service Code	HCPCS C1776
Hospital Charge Code	64902916
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,938.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,539.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,679.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,399.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,609.42
Rate for Payer: EmblemHealth Commercial	$1,399.50
Rate for Payer: Fidelis Medicare Advantage	$2,938.95
Rate for Payer: Group Health Inc Commercial	$1,399.50
Rate for Payer: Group Health Inc Medicare	$979.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,399.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,399.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,819.35

HEAD C-TAPPER LFIT LOW FRICTION

Facility

$1,093.00

Service Code	HCPCS C1776
Hospital Charge Code	64906276
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,147.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$601.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$655.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$546.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$628.48
Rate for Payer: EmblemHealth Commercial	$546.50
Rate for Payer: Fidelis Medicare Advantage	$1,147.65
Rate for Payer: Group Health Inc Commercial	$546.50
Rate for Payer: Group Health Inc Medicare	$382.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$546.50
Rate for Payer: Hamaspik Choice Inc Medicare	$546.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$710.45

HEAD C-TAPPER LFIT LOW FRICTION

Facility

$1,093.00

Service Code	HCPCS C1776
Hospital Charge Code	64906276
Hospital Revenue Code	278
Min. Negotiated Rate	$546.50
Max. Negotiated Rate	$546.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$546.50
Rate for Payer: Hamaspik Choice Inc Medicare	$546.50

HEAD DELTA CRMC

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	64907202
Hospital Revenue Code	278
Min. Negotiated Rate	$1,437.50
Max. Negotiated Rate	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,437.50

HEAD DELTA CRMC

Facility

$2,875.00

Service Code	HCPCS C1776
Hospital Charge Code	64907202
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,018.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,581.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,725.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,653.12
Rate for Payer: EmblemHealth Commercial	$1,437.50
Rate for Payer: Fidelis Medicare Advantage	$3,018.75
Rate for Payer: Group Health Inc Commercial	$1,437.50
Rate for Payer: Group Health Inc Medicare	$1,006.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,868.75

HEAD EVOLVE

Facility

$8,175.00

Service Code	HCPCS C1889
Hospital Charge Code	64907472
Hospital Revenue Code	278
Min. Negotiated Rate	$4,087.50
Max. Negotiated Rate	$4,087.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,087.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,087.50

HEAD EVOLVE

Facility

$8,175.00

Service Code	HCPCS C1889
Hospital Charge Code	64907472
Hospital Revenue Code	278
Min. Negotiated Rate	$2,861.25
Max. Negotiated Rate	$8,583.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,496.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,087.50
Rate for Payer: Aetna Government	$4,087.50
Rate for Payer: Brighton Health Commercial	$4,905.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,087.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,700.62
Rate for Payer: EmblemHealth Commercial	$4,087.50
Rate for Payer: Fidelis Medicare Advantage	$8,583.75
Rate for Payer: Group Health Inc Commercial	$4,087.50
Rate for Payer: Group Health Inc Medicare	$2,861.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,087.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,087.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,313.75

HEAD FEM 26X3MM COBALT CHROME

Facility

$2,731.50

Service Code	HCPCS C1713
Hospital Charge Code	64901433
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,868.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,502.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,638.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,365.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,570.61
Rate for Payer: EmblemHealth Commercial	$1,365.75
Rate for Payer: Fidelis Medicare Advantage	$2,868.08
Rate for Payer: Group Health Inc Commercial	$1,365.75
Rate for Payer: Group Health Inc Medicare	$956.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,775.48

HEAD FEM 26X3MM COBALT CHROME

Facility

$2,731.50

Service Code	HCPCS C1713
Hospital Charge Code	64901433
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.75
Max. Negotiated Rate	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75

HEAD FEM26X3MM COBALT CHROME

Facility

$1,713.60

Service Code	HCPCS C1776
Hospital Charge Code	40205201
Hospital Revenue Code	278
Min. Negotiated Rate	$856.80
Max. Negotiated Rate	$856.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$856.80
Rate for Payer: Hamaspik Choice Inc Medicare	$856.80

HEAD FEM26X3MM COBALT CHROME

Facility

$1,713.60

Service Code	HCPCS C1776
Hospital Charge Code	40205201
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,799.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$942.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,028.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$856.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$985.32
Rate for Payer: EmblemHealth Commercial	$856.80
Rate for Payer: Fidelis Medicare Advantage	$1,799.28
Rate for Payer: Group Health Inc Commercial	$856.80
Rate for Payer: Group Health Inc Medicare	$599.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$856.80
Rate for Payer: Hamaspik Choice Inc Medicare	$856.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,113.84

HEAD FEM 28MM DIA 12/14

Facility

$1,908.00

Service Code	HCPCS C1776
Hospital Charge Code	64906921
Hospital Revenue Code	278
Min. Negotiated Rate	$954.00
Max. Negotiated Rate	$954.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.00
Rate for Payer: Hamaspik Choice Inc Medicare	$954.00

HEAD FEM 28MM DIA 12/14

Facility

$1,908.00

Service Code	HCPCS C1776
Hospital Charge Code	64906921
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,003.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,144.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$954.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,097.10
Rate for Payer: EmblemHealth Commercial	$954.00
Rate for Payer: Fidelis Medicare Advantage	$2,003.40
Rate for Payer: Group Health Inc Commercial	$954.00
Rate for Payer: Group Health Inc Medicare	$667.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.00
Rate for Payer: Hamaspik Choice Inc Medicare	$954.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,240.20

HEAD FEM 28MM V40 STD NEK LGNTH

Facility

$3,035.00

Service Code	HCPCS C1776
Hospital Charge Code	64902017
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,186.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,669.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,821.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,517.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,745.12
Rate for Payer: EmblemHealth Commercial	$1,517.50
Rate for Payer: Fidelis Medicare Advantage	$3,186.75
Rate for Payer: Group Health Inc Commercial	$1,517.50
Rate for Payer: Group Health Inc Medicare	$1,062.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,517.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,517.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,972.75

HEAD FEM 28MM V40 STD NEK LGNTH

Facility

$3,035.00

Service Code	HCPCS C1776
Hospital Charge Code	64902017
Hospital Revenue Code	278
Min. Negotiated Rate	$1,517.50
Max. Negotiated Rate	$1,517.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,517.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,517.50

HEAD FEM BIOLOX DELTA 36MM +3.5

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40204661
Hospital Revenue Code	278
Min. Negotiated Rate	$2,672.00
Max. Negotiated Rate	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00

HEAD FEM BIOLOX DELTA 36MM +3.5

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40204661
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,611.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,939.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,206.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,672.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,072.80
Rate for Payer: EmblemHealth Commercial	$2,672.00
Rate for Payer: Fidelis Medicare Advantage	$5,611.20
Rate for Payer: Group Health Inc Commercial	$2,672.00
Rate for Payer: Group Health Inc Medicare	$1,870.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,473.60

HEAD FEML V40 28MM COCR LFIT

Facility

$2,731.50

Service Code	HCPCS C1776
Hospital Charge Code	64902530
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,868.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,502.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,638.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,365.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,570.61
Rate for Payer: EmblemHealth Commercial	$1,365.75
Rate for Payer: Fidelis Medicare Advantage	$2,868.08
Rate for Payer: Group Health Inc Commercial	$1,365.75
Rate for Payer: Group Health Inc Medicare	$956.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,775.48

HEAD FEML V40 28MM COCR LFIT

Facility

$2,731.50

Service Code	HCPCS C1776
Hospital Charge Code	64902530
Hospital Revenue Code	278
Min. Negotiated Rate	$1,365.75
Max. Negotiated Rate	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,365.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,365.75

HEAD FEMO 12/14 36MM 10.5

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905846
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

HEAD FEMO 12/14 36MM 10.5

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905846
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

HEAD FEMORAL 12/14 36MM

Facility

$1,908.00

Service Code	HCPCS C1776
Hospital Charge Code	64906939
Hospital Revenue Code	278
Min. Negotiated Rate	$954.00
Max. Negotiated Rate	$954.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.00
Rate for Payer: Hamaspik Choice Inc Medicare	$954.00

HEAD FEMORAL 12/14 36MM

Facility

$1,908.00

Service Code	HCPCS C1776
Hospital Charge Code	64906939
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,003.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,049.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,144.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$954.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,097.10
Rate for Payer: EmblemHealth Commercial	$954.00
Rate for Payer: Fidelis Medicare Advantage	$2,003.40
Rate for Payer: Group Health Inc Commercial	$954.00
Rate for Payer: Group Health Inc Medicare	$667.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$954.00
Rate for Payer: Hamaspik Choice Inc Medicare	$954.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,240.20

Know your out-of-pocket cost for care.

All Charges