St. Barnabas Hospital

All Charges

Charge

Type

Price

BD DEXA BONE/AXIAL HIP/PELV/SPINE

Facility OP

$339.45

Service Code	HCPCS 77080 TC
Hospital Charge Code	41101000
Hospital Revenue Code	320
Min. Negotiated Rate	$32.12
Max. Negotiated Rate	$271.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$186.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.72
Rate for Payer: Aetna Government	$169.72
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$271.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$32.12
Rate for Payer: Group Health Inc Commercial	$169.72
Rate for Payer: Group Health Inc Medicare	$118.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$169.72
Rate for Payer: Hamaspik Choice Inc Medicare	$169.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35.69

BD DEXA BONE/PERI RAD/WRIST/HEEL

Facility OP

$241.73

Service Code	HCPCS 77081 TC
Hospital Charge Code	41101003
Hospital Revenue Code	320
Min. Negotiated Rate	$24.36
Max. Negotiated Rate	$193.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$132.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$120.86
Rate for Payer: Aetna Government	$120.86
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cash Price	$105.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$193.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$164.38
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24.36
Rate for Payer: Group Health Inc Commercial	$120.86
Rate for Payer: Group Health Inc Medicare	$84.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$120.86
Rate for Payer: Hamaspik Choice Inc Medicare	$120.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.07

BEACON TIP ROYAL FLUSH PLUS

Facility OP

$49.00

Hospital Charge Code	64905085
Hospital Revenue Code	270
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$39.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.50
Rate for Payer: Aetna Government	$24.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.32
Rate for Payer: Group Health Inc Commercial	$24.50
Rate for Payer: Group Health Inc Medicare	$17.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.50
Rate for Payer: Hamaspik Choice Inc Medicare	$24.50

BEARING 10MM VE L 4-11 EF

Facility OP

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905895
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

BEARING 10MM VE L 4-11 EF

Facility IP

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905895
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

BEARING ANATOMIC MENISCAL

Facility OP

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907423
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,650.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.00
Rate for Payer: Fidelis Medicare Advantage	$3,150.00
Rate for Payer: Group Health Inc Commercial	$1,500.00
Rate for Payer: Group Health Inc Medicare	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,950.00

BEARING ANATOMIC MENISCAL

Facility IP

$3,000.00

Service Code	HCPCS C1776
Hospital Charge Code	64907423
Hospital Revenue Code	278
Min. Negotiated Rate	$1,500.00
Max. Negotiated Rate	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,500.00

BEARING FXD VVCT RT SZ 10MM

Facility OP

$3,400.00

Hospital Charge Code	64906665
Hospital Revenue Code	279
Min. Negotiated Rate	$1,190.00
Max. Negotiated Rate	$2,720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,700.00
Rate for Payer: Aetna Government	$1,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,312.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

BEARING HMRS

Facility OP

$982.50

Service Code	HCPCS C1776
Hospital Charge Code	64907250
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,031.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$540.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$491.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$564.94
Rate for Payer: Fidelis Medicare Advantage	$1,031.62
Rate for Payer: Group Health Inc Commercial	$491.25
Rate for Payer: Group Health Inc Medicare	$343.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$491.25
Rate for Payer: Hamaspik Choice Inc Medicare	$491.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$638.62

BEARING HMRS

Facility IP

$982.50

Service Code	HCPCS C1776
Hospital Charge Code	64907250
Hospital Revenue Code	278
Min. Negotiated Rate	$491.25
Max. Negotiated Rate	$491.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$491.25
Rate for Payer: Hamaspik Choice Inc Medicare	$491.25

BEARING INSERT

Facility OP

$269.68

Hospital Charge Code	40202230
Hospital Revenue Code	270
Min. Negotiated Rate	$94.39
Max. Negotiated Rate	$215.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$148.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.84
Rate for Payer: Aetna Government	$134.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$215.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$183.38
Rate for Payer: Group Health Inc Commercial	$134.84
Rate for Payer: Group Health Inc Medicare	$94.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$134.84
Rate for Payer: Hamaspik Choice Inc Medicare	$134.84

BEARING KNEE PSN L 13MM 6-9

Facility OP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906339
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

BEARING KNEE PSN L 13MM 6-9

Facility IP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906339
Hospital Revenue Code	278
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

BEARING KNEE TIB

Facility IP

$9,620.62

Service Code	HCPCS C1776
Hospital Charge Code	64907252
Hospital Revenue Code	278
Min. Negotiated Rate	$4,810.31
Max. Negotiated Rate	$4,810.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,810.31
Rate for Payer: Hamaspik Choice Inc Medicare	$4,810.31

BEARING KNEE TIB

Facility OP

$9,620.62

Service Code	HCPCS C1776
Hospital Charge Code	64907252
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$10,101.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,291.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,810.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,531.86
Rate for Payer: Fidelis Medicare Advantage	$10,101.65
Rate for Payer: Group Health Inc Commercial	$4,810.31
Rate for Payer: Group Health Inc Medicare	$3,367.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,810.31
Rate for Payer: Hamaspik Choice Inc Medicare	$4,810.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,253.40

BEARING PSN 12MM VE 6-9 EF

Facility OP

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905890
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

BEARING PSN 12MM VE 6-9 EF

Facility IP

$4,250.00

Service Code	HCPCS C1713
Hospital Charge Code	64905890
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

BEARING PSN ASF FIXED LT

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906767
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

BEARING PSN ASF FIXED LT

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	64906767
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

BEARING PSN FIXED LEFT SZ 10

Facility OP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906291
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

BEARING PSN FIXED LEFT SZ 10

Facility IP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906291
Hospital Revenue Code	278
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

BEARING PSN FIXED RGT 10MM

Facility IP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906270
Hospital Revenue Code	278
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

BEARING PSN FIXED RGT 10MM

Facility OP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906270
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

BEARING PSN FX L 10 C-D,3-5

Facility IP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906482
Hospital Revenue Code	278
Min. Negotiated Rate	$850.00
Max. Negotiated Rate	$850.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00

BEARING PSN FX L 10 C-D,3-5

Facility OP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	64906482
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
Rate for Payer: Group Health Inc Commercial	$850.00
Rate for Payer: Group Health Inc Medicare	$595.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$850.00
Rate for Payer: Hamaspik Choice Inc Medicare	$850.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

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