St. Barnabas Hospital

All Charges

Charge

Type

Price

STEM HIP LONG CMNTD

Facility OP

$19,567.50

Service Code	HCPCS C1776
Hospital Charge Code	64907329
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$20,545.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,762.12
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	$9,783.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$11,251.31
Rate for Payer: Fidelis Medicare Advantage	$20,545.88
Rate for Payer: Group Health Inc Commercial	$9,783.75
Rate for Payer: Group Health Inc Medicare	$6,848.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,783.75
Rate for Payer: Hamaspik Choice Inc Medicare	$9,783.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,718.88

STEM HIP LONG CMNTD

Facility IP

$19,567.50

Service Code	HCPCS C1776
Hospital Charge Code	64907329
Hospital Revenue Code	278
Min. Negotiated Rate	$9,783.75
Max. Negotiated Rate	$9,783.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,783.75
Rate for Payer: Hamaspik Choice Inc Medicare	$9,783.75

STEM HIP POROUS PRS FIT 11X135MM

Facility OP

$8,736.00

Service Code	HCPCS C1776
Hospital Charge Code	40205032
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,172.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,804.80
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	$4,368.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,023.20
Rate for Payer: Fidelis Medicare Advantage	$9,172.80
Rate for Payer: Group Health Inc Commercial	$4,368.00
Rate for Payer: Group Health Inc Medicare	$3,057.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,368.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,368.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,678.40

STEM HIP POROUS PRS FIT 11X135MM

Facility IP

$8,736.00

Service Code	HCPCS C1776
Hospital Charge Code	40205032
Hospital Revenue Code	278
Min. Negotiated Rate	$4,368.00
Max. Negotiated Rate	$4,368.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,368.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,368.00

STEM HIP PORUS MOD REVIS 23MM

Facility IP

$8,386.00

Service Code	HCPCS C1776
Hospital Charge Code	40209105
Hospital Revenue Code	278
Min. Negotiated Rate	$4,193.00
Max. Negotiated Rate	$4,193.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,193.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,193.00

STEM HIP PORUS MOD REVIS 23MM

Facility OP

$8,386.00

Service Code	HCPCS C1776
Hospital Charge Code	40209105
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,805.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,612.30
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	$4,193.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,821.95
Rate for Payer: Fidelis Medicare Advantage	$8,805.30
Rate for Payer: Group Health Inc Commercial	$4,193.00
Rate for Payer: Group Health Inc Medicare	$2,935.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,193.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,193.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,450.90

STEM HIP REVISN WGNR12/14-0102622

Facility OP

$6,116.34

Service Code	HCPCS C1776
Hospital Charge Code	64906418
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,422.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,363.99
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	$3,058.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,516.90
Rate for Payer: Fidelis Medicare Advantage	$6,422.16
Rate for Payer: Group Health Inc Commercial	$3,058.17
Rate for Payer: Group Health Inc Medicare	$2,140.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,058.17
Rate for Payer: Hamaspik Choice Inc Medicare	$3,058.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,975.62

STEM HIP REVISN WGNR12/14-0102622

Facility IP

$6,116.34

Service Code	HCPCS C1776
Hospital Charge Code	64906418
Hospital Revenue Code	278
Min. Negotiated Rate	$3,058.17
Max. Negotiated Rate	$3,058.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,058.17
Rate for Payer: Hamaspik Choice Inc Medicare	$3,058.17

STEM HIP REVISN WGNR12/14-0102624

Facility IP

$6,116.34

Service Code	HCPCS C1776
Hospital Charge Code	64906419
Hospital Revenue Code	278
Min. Negotiated Rate	$3,058.17
Max. Negotiated Rate	$3,058.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,058.17
Rate for Payer: Hamaspik Choice Inc Medicare	$3,058.17

STEM HIP REVISN WGNR12/14-0102624

Facility OP

$6,116.34

Service Code	HCPCS C1776
Hospital Charge Code	64906419
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,422.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,363.99
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	$3,058.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,516.90
Rate for Payer: Fidelis Medicare Advantage	$6,422.16
Rate for Payer: Group Health Inc Commercial	$3,058.17
Rate for Payer: Group Health Inc Medicare	$2,140.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,058.17
Rate for Payer: Hamaspik Choice Inc Medicare	$3,058.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,975.62

STEM HUMERAL 10MM

Facility IP

$8,978.13

Service Code	HCPCS C1713
Hospital Charge Code	64903606
Hospital Revenue Code	278
Min. Negotiated Rate	$4,489.06
Max. Negotiated Rate	$4,489.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,489.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4,489.06

STEM HUMERAL 10MM

Facility OP

$8,978.13

Service Code	HCPCS C1713
Hospital Charge Code	64903606
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,427.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,937.97
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	$4,489.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,162.42
Rate for Payer: Fidelis Medicare Advantage	$9,427.04
Rate for Payer: Group Health Inc Commercial	$4,489.06
Rate for Payer: Group Health Inc Medicare	$3,142.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,489.06
Rate for Payer: Hamaspik Choice Inc Medicare	$4,489.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,835.78

STEM HUM REUNION

Facility IP

$7,187.50

Service Code	HCPCS C1889
Hospital Charge Code	64907489
Hospital Revenue Code	278
Min. Negotiated Rate	$3,593.75
Max. Negotiated Rate	$3,593.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,593.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,593.75

STEM HUM REUNION

Facility OP

$7,187.50

Service Code	HCPCS C1889
Hospital Charge Code	64907489
Hospital Revenue Code	278
Min. Negotiated Rate	$2,515.62
Max. Negotiated Rate	$7,546.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,953.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,593.75
Rate for Payer: Aetna Government	$3,593.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,593.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,132.81
Rate for Payer: Fidelis Medicare Advantage	$7,546.88
Rate for Payer: Group Health Inc Commercial	$3,593.75
Rate for Payer: Group Health Inc Medicare	$2,515.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,593.75
Rate for Payer: Hamaspik Choice Inc Medicare	$3,593.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,671.88

STEM L2L RADIAL 7MM +0MM

Facility OP

$6,320.00

Hospital Charge Code	64906694
Hospital Revenue Code	279
Min. Negotiated Rate	$2,212.00
Max. Negotiated Rate	$5,056.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,476.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,160.00
Rate for Payer: Aetna Government	$3,160.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,056.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,297.60
Rate for Payer: Group Health Inc Commercial	$3,160.00
Rate for Payer: Group Health Inc Medicare	$2,212.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,160.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,160.00

STEMMED TIBIA

Facility IP

$4,720.00

Service Code	HCPCS C1776
Hospital Charge Code	40202129
Hospital Revenue Code	278
Min. Negotiated Rate	$2,360.00
Max. Negotiated Rate	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,360.00

STEMMED TIBIA

Facility OP

$4,720.00

Service Code	HCPCS C1776
Hospital Charge Code	40202129
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,956.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,596.00
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	$2,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,714.00
Rate for Payer: Fidelis Medicare Advantage	$4,956.00
Rate for Payer: Group Health Inc Commercial	$2,360.00
Rate for Payer: Group Health Inc Medicare	$1,652.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,360.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,068.00

STEMMED TIBIAL COMPONENT

Facility OP

$5,391.13

Service Code	HCPCS C1713
Hospital Charge Code	64903999
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,660.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,965.12
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	$2,695.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,099.90
Rate for Payer: Fidelis Medicare Advantage	$5,660.69
Rate for Payer: Group Health Inc Commercial	$2,695.56
Rate for Payer: Group Health Inc Medicare	$1,886.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2,695.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,504.23

STEMMED TIBIAL COMPONENT

Facility IP

$5,391.13

Service Code	HCPCS C1713
Hospital Charge Code	64903999
Hospital Revenue Code	278
Min. Negotiated Rate	$2,695.56
Max. Negotiated Rate	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,695.56
Rate for Payer: Hamaspik Choice Inc Medicare	$2,695.56

STEMMED TIBIAL COMPONENT SIZE 3

Facility IP

$4,720.00

Service Code	HCPCS C1776
Hospital Charge Code	40202131
Hospital Revenue Code	278
Min. Negotiated Rate	$2,360.00
Max. Negotiated Rate	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,360.00

STEMMED TIBIAL COMPONENT SIZE 3

Facility OP

$4,720.00

Service Code	HCPCS C1776
Hospital Charge Code	40202131
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,956.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,596.00
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	$2,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,714.00
Rate for Payer: Fidelis Medicare Advantage	$4,956.00
Rate for Payer: Group Health Inc Commercial	$2,360.00
Rate for Payer: Group Health Inc Medicare	$1,652.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,360.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,360.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,068.00

STEMMED TIBIAL COMPONENT SZ 2

Facility IP

$4,550.90

Service Code	HCPCS C1776
Hospital Charge Code	40200251
Hospital Revenue Code	278
Min. Negotiated Rate	$2,275.45
Max. Negotiated Rate	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,275.45

STEMMED TIBIAL COMPONENT SZ 2

Facility OP

$4,550.90

Service Code	HCPCS C1776
Hospital Charge Code	40200251
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,778.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,503.00
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	$2,275.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,616.77
Rate for Payer: Fidelis Medicare Advantage	$4,778.44
Rate for Payer: Group Health Inc Commercial	$2,275.45
Rate for Payer: Group Health Inc Medicare	$1,592.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,275.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,275.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,958.08

STEMMED TIBIAL COMPONENT SZ4

Facility OP

$4,312.90

Service Code	HCPCS C1776
Hospital Charge Code	40200064
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,528.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,372.10
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	$2,156.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,479.92
Rate for Payer: Fidelis Medicare Advantage	$4,528.54
Rate for Payer: Group Health Inc Commercial	$2,156.45
Rate for Payer: Group Health Inc Medicare	$1,509.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,156.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,156.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,803.38

STEMMED TIBIAL COMPONENT SZ4

Facility IP

$4,312.90

Service Code	HCPCS C1776
Hospital Charge Code	40200064
Hospital Revenue Code	278
Min. Negotiated Rate	$2,156.45
Max. Negotiated Rate	$2,156.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,156.45
Rate for Payer: Hamaspik Choice Inc Medicare	$2,156.45

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