St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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 36M 12/14-0080183603

Facility

$954.00

Service Code	HCPCS C1776
Hospital Charge Code	64906455
Hospital Revenue Code	278
Min. Negotiated Rate	$333.90
Max. Negotiated Rate	$1,001.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$524.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$572.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$477.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$548.55
Rate for Payer: EmblemHealth Commercial	$477.00
Rate for Payer: Fidelis Medicare Advantage	$1,001.70
Rate for Payer: Group Health Inc Commercial	$477.00
Rate for Payer: Group Health Inc Medicare	$333.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$477.00
Rate for Payer: Hamaspik Choice Inc Medicare	$477.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$620.10

HEAD FEMORAL 36M 12/14-0080183603

Facility

$954.00

Service Code	HCPCS C1776
Hospital Charge Code	64906455
Hospital Revenue Code	278
Min. Negotiated Rate	$477.00
Max. Negotiated Rate	$477.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$477.00
Rate for Payer: Hamaspik Choice Inc Medicare	$477.00

HEAD FEMORAL 36MM DIA -3MML NE

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64902785
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 36MM DIA -3MML NE

Facility

$4,920.00

Service Code	HCPCS C1776
Hospital Charge Code	64902785
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 42MM

Facility

$1,660.00

Service Code	HCPCS C1713
Hospital Charge Code	64907110
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,743.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$913.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$996.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$830.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$954.50
Rate for Payer: EmblemHealth Commercial	$830.00
Rate for Payer: Fidelis Medicare Advantage	$1,743.00
Rate for Payer: Group Health Inc Commercial	$830.00
Rate for Payer: Group Health Inc Medicare	$581.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$830.00
Rate for Payer: Hamaspik Choice Inc Medicare	$830.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,079.00

HEAD FEMORAL 42MM

Facility

$1,660.00

Service Code	HCPCS C1713
Hospital Charge Code	64907110
Hospital Revenue Code	278
Min. Negotiated Rate	$830.00
Max. Negotiated Rate	$830.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$830.00
Rate for Payer: Hamaspik Choice Inc Medicare	$830.00

HEAD FEMORAL BI DE 36MM 7

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905680
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,875.00

HEAD FEMORAL BI DE 36MM 7

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905680
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,937.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,062.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,156.25
Rate for Payer: EmblemHealth Commercial	$1,875.00
Rate for Payer: Fidelis Medicare Advantage	$3,937.50
Rate for Payer: Group Health Inc Commercial	$1,875.00
Rate for Payer: Group Health Inc Medicare	$1,312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,437.50

HEAD FEMORAL BIO 36MM 3.5

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905702
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,875.00

HEAD FEMORAL BIO 36MM 3.5

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905702
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,937.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,062.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,156.25
Rate for Payer: EmblemHealth Commercial	$1,875.00
Rate for Payer: Fidelis Medicare Advantage	$3,937.50
Rate for Payer: Group Health Inc Commercial	$1,875.00
Rate for Payer: Group Health Inc Medicare	$1,312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,437.50

HEAD, FEMORAL BIO 36MM 3.5

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905569
Hospital Revenue Code	278
Min. Negotiated Rate	$1,875.00
Max. Negotiated Rate	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,875.00

HEAD, FEMORAL BIO 36MM 3.5

Facility

$3,750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905569
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,937.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,062.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,250.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,875.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,156.25
Rate for Payer: EmblemHealth Commercial	$1,875.00
Rate for Payer: Fidelis Medicare Advantage	$3,937.50
Rate for Payer: Group Health Inc Commercial	$1,875.00
Rate for Payer: Group Health Inc Medicare	$1,312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,875.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,875.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,437.50

HEAD, FEMORAL BIO DELT 36MM

Facility

$5,010.00

Service Code	HCPCS C1713
Hospital Charge Code	64905553
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,260.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,755.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,006.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,505.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,880.75
Rate for Payer: EmblemHealth Commercial	$2,505.00
Rate for Payer: Fidelis Medicare Advantage	$5,260.50
Rate for Payer: Group Health Inc Commercial	$2,505.00
Rate for Payer: Group Health Inc Medicare	$1,753.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,505.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,505.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,256.50

HEAD, FEMORAL BIO DELT 36MM

Facility

$5,010.00

Service Code	HCPCS C1713
Hospital Charge Code	64905553
Hospital Revenue Code	278
Min. Negotiated Rate	$2,505.00
Max. Negotiated Rate	$2,505.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,505.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,505.00

HEAD FEMORAL BIOLOX DELTA 36MM +7

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40204660
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 FEMORAL BIOLOX DELTA 36MM +7

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40204660
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, FEMORAL COCR 12/14 32 0

Facility

$1,838.88

Service Code	HCPCS C1776
Hospital Charge Code	64905718
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 COCR 12/14 32 0

Facility

$1,838.88

Service Code	HCPCS C1776
Hospital Charge Code	64905718
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,930.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,011.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
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 UNI

Facility

$2,799.00

Service Code	HCPCS C1713
Hospital Charge Code	64907447
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 FEMORAL UNI

Facility

$2,799.00

Service Code	HCPCS C1713
Hospital Charge Code	64907447
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,938.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,539.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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 FEMORAL V40 LFIT 26MM

Facility

$2,185.20

Service Code	HCPCS C1713
Hospital Charge Code	64906774
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,294.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,201.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,311.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,092.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,256.49
Rate for Payer: EmblemHealth Commercial	$1,092.60
Rate for Payer: Fidelis Medicare Advantage	$2,294.46
Rate for Payer: Group Health Inc Commercial	$1,092.60
Rate for Payer: Group Health Inc Medicare	$764.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,092.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,092.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,420.38

HEAD FEMORAL V40 LFIT 26MM

Facility

$2,185.20

Service Code	HCPCS C1713
Hospital Charge Code	64906774
Hospital Revenue Code	278
Min. Negotiated Rate	$1,092.60
Max. Negotiated Rate	$1,092.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,092.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,092.60

HEAD FEM STD 26MM COBALT V-40

Facility

$2,731.50

Service Code	HCPCS C1713
Hospital Charge Code	64901455
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 FEM STD 26MM COBALT V-40

Facility

$2,184.00

Service Code	HCPCS C1776
Hospital Charge Code	40202431
Hospital Revenue Code	278
Min. Negotiated Rate	$1,092.00
Max. Negotiated Rate	$1,092.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,092.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,092.00

Know your out-of-pocket cost for care.

All Charges