St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HEAD FEMORAL 12/14 36MM 0

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905658
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 FEMORAL 12/14 36MM 0

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905658
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 7

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905656
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 7

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905656
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,FEMORAL 12/14 COC 36MM

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905558
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 COC 36MM

Facility

$2,385.00

Service Code	HCPCS C1776
Hospital Charge Code	64905558
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 FEMORAL 12/14 COCR 36MM +0

Facility

$2,544.00

Service Code	HCPCS C1776
Hospital Charge Code	40204649
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,671.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,399.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,526.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,272.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,462.80
Rate for Payer: EmblemHealth Commercial	$1,272.00
Rate for Payer: Fidelis Medicare Advantage	$2,671.20
Rate for Payer: Group Health Inc Commercial	$1,272.00
Rate for Payer: Group Health Inc Medicare	$890.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,272.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,272.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,653.60

HEAD FEMORAL 12/14 COCR 36MM +0

Facility

$2,544.00

Service Code	HCPCS C1776
Hospital Charge Code	40204649
Hospital Revenue Code	278
Min. Negotiated Rate	$1,272.00
Max. Negotiated Rate	$1,272.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,272.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,272.00

HEAD FEMORAL 12/14 COCR 36MM +7

Facility

$2,544.00

Service Code	HCPCS C1713
Hospital Charge Code	40204646
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,671.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,399.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,526.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,272.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,462.80
Rate for Payer: EmblemHealth Commercial	$1,272.00
Rate for Payer: Fidelis Medicare Advantage	$2,671.20
Rate for Payer: Group Health Inc Commercial	$1,272.00
Rate for Payer: Group Health Inc Medicare	$890.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,272.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,272.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,653.60

HEAD FEMORAL 12/14 COCR 36MM +7

Facility

$2,544.00

Service Code	HCPCS C1713
Hospital Charge Code	40204646
Hospital Revenue Code	278
Min. Negotiated Rate	$1,272.00
Max. Negotiated Rate	$1,272.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,272.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,272.00

HEAD FEMORAL26M C-TAPR LFIT062600

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	64906444
Hospital Revenue Code	278
Min. Negotiated Rate	$450.00
Max. Negotiated Rate	$450.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

HEAD FEMORAL26M C-TAPR LFIT062600

Facility

$900.00

Service Code	HCPCS C1713
Hospital Charge Code	64906444
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$945.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$540.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$450.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$517.50
Rate for Payer: EmblemHealth Commercial	$450.00
Rate for Payer: Fidelis Medicare Advantage	$945.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$585.00

HEAD FEMORAL 28MM C-TAPER LFIT

Facility

$3,035.00

Service Code	HCPCS C1713
Hospital Charge Code	64902041
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 FEMORAL 28MM C-TAPER LFIT

Facility

$3,035.00

Service Code	HCPCS C1713
Hospital Charge Code	64902041
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,186.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,669.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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 FEMORAL 28MM DIA 0MML NE

Facility

$1,680.25

Service Code	HCPCS C1776
Hospital Charge Code	64903536
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

HEAD FEMORAL 28MM DIA 0MML NE

Facility

$1,680.25

Service Code	HCPCS C1776
Hospital Charge Code	64903536
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

HEAD FEMORAL 28MM DIA -3MML

Facility

$1,680.25

Service Code	HCPCS C1713
Hospital Charge Code	64903542
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,764.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$924.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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

HEAD FEMORAL 28MM DIA -3MML

Facility

$1,680.25

Service Code	HCPCS C1713
Hospital Charge Code	64903542
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

HEAD FEMORAL 32MM DIA 0MML NE

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64903148
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,166.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,706.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,952.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,829.00
Rate for Payer: EmblemHealth Commercial	$2,460.00
Rate for Payer: Fidelis Medicare Advantage	$5,166.00
Rate for Payer: Group Health Inc Commercial	$2,460.00
Rate for Payer: Group Health Inc Medicare	$1,722.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,198.00

HEAD FEMORAL 32MM DIA 0MML NE

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64903148
Hospital Revenue Code	278
Min. Negotiated Rate	$2,460.00
Max. Negotiated Rate	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00

HEAD FEMORAL 32MM DIA -3MML

Facility

$1,838.88

Service Code	HCPCS C1713
Hospital Charge Code	64903239
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,930.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,011.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,103.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$919.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,057.36
Rate for Payer: EmblemHealth Commercial	$919.44
Rate for Payer: Fidelis Medicare Advantage	$1,930.82
Rate for Payer: Group Health Inc Commercial	$919.44
Rate for Payer: Group Health Inc Medicare	$643.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$919.44
Rate for Payer: Hamaspik Choice Inc Medicare	$919.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,195.27

HEAD FEMORAL 32MM DIA -3MML

Facility

$1,838.88

Service Code	HCPCS C1713
Hospital Charge Code	64903239
Hospital Revenue Code	278
Min. Negotiated Rate	$919.44
Max. Negotiated Rate	$919.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$919.44
Rate for Payer: Hamaspik Choice Inc Medicare	$919.44

HEAD FEMORAL 32MM DIA -3MML NE

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64903159
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,166.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,706.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,952.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,829.00
Rate for Payer: EmblemHealth Commercial	$2,460.00
Rate for Payer: Fidelis Medicare Advantage	$5,166.00
Rate for Payer: Group Health Inc Commercial	$2,460.00
Rate for Payer: Group Health Inc Medicare	$1,722.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,198.00

HEAD FEMORAL 32MM DIA -3MML NE

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64903159
Hospital Revenue Code	278
Min. Negotiated Rate	$2,460.00
Max. Negotiated Rate	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00

HEAD FEMORAL 32MM DIA 4MML NE

Facility

$4,920.00

Service Code	HCPCS C1713
Hospital Charge Code	64903540
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,166.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,706.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,952.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,829.00
Rate for Payer: EmblemHealth Commercial	$2,460.00
Rate for Payer: Fidelis Medicare Advantage	$5,166.00
Rate for Payer: Group Health Inc Commercial	$2,460.00
Rate for Payer: Group Health Inc Medicare	$1,722.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,198.00

Know your out-of-pocket cost for care.

All Charges