St. Barnabas Hospital

All Charges

Charge

Type

Price

STEMMED TIBIAL COMPT SZ 5

Facility OP

$4,312.90

Service Code	HCPCS C1776
Hospital Charge Code	40209913
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 COMPT SZ 5

Facility IP

$4,312.90

Service Code	HCPCS C1776
Hospital Charge Code	40209913
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

STEM MODULAR REJUV SPT SZ 7

Facility OP

$12,048.75

Service Code	HCPCS C1713
Hospital Charge Code	64902208
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$12,651.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,626.81
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	$6,024.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,928.03
Rate for Payer: Fidelis Medicare Advantage	$12,651.19
Rate for Payer: Group Health Inc Commercial	$6,024.38
Rate for Payer: Group Health Inc Medicare	$4,217.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,024.38
Rate for Payer: Hamaspik Choice Inc Medicare	$6,024.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,831.69

STEM MODULAR REJUV SPT SZ 7

Facility IP

$12,048.75

Service Code	HCPCS C1713
Hospital Charge Code	64902208
Hospital Revenue Code	278
Min. Negotiated Rate	$6,024.38
Max. Negotiated Rate	$6,024.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,024.38
Rate for Payer: Hamaspik Choice Inc Medicare	$6,024.38

STEM NEXG 12 X 145MM 100MM

Facility IP

$4,460.00

Service Code	HCPCS C1713
Hospital Charge Code	64905874
Hospital Revenue Code	278
Min. Negotiated Rate	$2,230.00
Max. Negotiated Rate	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,230.00

STEM NEXG 12 X 145MM 100MM

Facility OP

$4,460.00

Service Code	HCPCS C1713
Hospital Charge Code	64905874
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,683.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,453.00
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	$2,230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,564.50
Rate for Payer: Fidelis Medicare Advantage	$4,683.00
Rate for Payer: Group Health Inc Commercial	$2,230.00
Rate for Payer: Group Health Inc Medicare	$1,561.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,899.00

STEM NEXGEN 100MM REV

Facility OP

$3,031.93

Service Code	HCPCS C1776
Hospital Charge Code	64906990
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,183.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,667.56
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	$1,515.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,743.36
Rate for Payer: Fidelis Medicare Advantage	$3,183.53
Rate for Payer: Group Health Inc Commercial	$1,515.96
Rate for Payer: Group Health Inc Medicare	$1,061.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,515.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1,515.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,970.75

STEM NEXGEN 100MM REV

Facility IP

$3,031.93

Service Code	HCPCS C1776
Hospital Charge Code	64906990
Hospital Revenue Code	278
Min. Negotiated Rate	$1,515.96
Max. Negotiated Rate	$1,515.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,515.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1,515.96

STEM NEXGEN 13 X 145MM 100

Facility OP

$4,460.00

Service Code	HCPCS C1713
Hospital Charge Code	64905872
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,683.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,453.00
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	$2,230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,564.50
Rate for Payer: Fidelis Medicare Advantage	$4,683.00
Rate for Payer: Group Health Inc Commercial	$2,230.00
Rate for Payer: Group Health Inc Medicare	$1,561.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,899.00

STEM NEXGEN 13 X 145MM 100

Facility IP

$4,460.00

Service Code	HCPCS C1713
Hospital Charge Code	64905872
Hospital Revenue Code	278
Min. Negotiated Rate	$2,230.00
Max. Negotiated Rate	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,230.00

STEM NEXGEN EXT 13MM OFFSET-2013

Facility OP

$1,582.04

Service Code	HCPCS C1776
Hospital Charge Code	64906492
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,661.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$870.12
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	$791.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$909.67
Rate for Payer: Fidelis Medicare Advantage	$1,661.14
Rate for Payer: Group Health Inc Commercial	$791.02
Rate for Payer: Group Health Inc Medicare	$553.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$791.02
Rate for Payer: Hamaspik Choice Inc Medicare	$791.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,028.33

STEM NEXGEN EXT 13MM OFFSET-2013

Facility IP

$1,582.04

Service Code	HCPCS C1776
Hospital Charge Code	64906492
Hospital Revenue Code	278
Min. Negotiated Rate	$791.02
Max. Negotiated Rate	$791.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$791.02
Rate for Payer: Hamaspik Choice Inc Medicare	$791.02

STEM NEXGEN EXT 17MM OFFSET-2017

Facility OP

$1,582.04

Service Code	HCPCS C1776
Hospital Charge Code	64906493
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,661.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$870.12
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	$791.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$909.67
Rate for Payer: Fidelis Medicare Advantage	$1,661.14
Rate for Payer: Group Health Inc Commercial	$791.02
Rate for Payer: Group Health Inc Medicare	$553.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$791.02
Rate for Payer: Hamaspik Choice Inc Medicare	$791.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,028.33

STEM NEXGEN EXT 17MM OFFSET-2017

Facility IP

$1,582.04

Service Code	HCPCS C1776
Hospital Charge Code	64906493
Hospital Revenue Code	278
Min. Negotiated Rate	$791.02
Max. Negotiated Rate	$791.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$791.02
Rate for Payer: Hamaspik Choice Inc Medicare	$791.02

STEM OMNIFIT EON #10 40MM

Facility OP

$4,289.00

Service Code	HCPCS C1776
Hospital Charge Code	64906264
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,503.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,358.95
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	$2,144.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,466.18
Rate for Payer: Fidelis Medicare Advantage	$4,503.45
Rate for Payer: Group Health Inc Commercial	$2,144.50
Rate for Payer: Group Health Inc Medicare	$1,501.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,144.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,144.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,787.85

STEM OMNIFIT EON #10 40MM

Facility IP

$4,289.00

Service Code	HCPCS C1776
Hospital Charge Code	64906264
Hospital Revenue Code	278
Min. Negotiated Rate	$2,144.50
Max. Negotiated Rate	$2,144.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,144.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,144.50

STEM OMNIFIT EON 132DEG #6 30MM

Facility IP

$4,288.50

Service Code	HCPCS C1776
Hospital Charge Code	64906487
Hospital Revenue Code	278
Min. Negotiated Rate	$2,144.25
Max. Negotiated Rate	$2,144.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,144.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,144.25

STEM OMNIFIT EON 132DEG #6 30MM

Facility OP

$4,288.50

Service Code	HCPCS C1776
Hospital Charge Code	64906487
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,502.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,358.68
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	$2,144.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,465.89
Rate for Payer: Fidelis Medicare Advantage	$4,502.92
Rate for Payer: Group Health Inc Commercial	$2,144.25
Rate for Payer: Group Health Inc Medicare	$1,500.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,144.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,144.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,787.52

STEM OMNIFIT EON #7 35MM

Facility OP

$4,288.50

Service Code	HCPCS C1713
Hospital Charge Code	64906377
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,502.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,358.68
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	$2,144.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,465.89
Rate for Payer: Fidelis Medicare Advantage	$4,502.92
Rate for Payer: Group Health Inc Commercial	$2,144.25
Rate for Payer: Group Health Inc Medicare	$1,500.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,144.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,144.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,787.52

STEM OMNIFIT EON #7 35MM

Facility IP

$4,288.50

Service Code	HCPCS C1713
Hospital Charge Code	64906377
Hospital Revenue Code	278
Min. Negotiated Rate	$2,144.25
Max. Negotiated Rate	$2,144.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,144.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,144.25

STEM P/F FLUTED

Facility IP

$15,418.12

Service Code	HCPCS C1776
Hospital Charge Code	64907275
Hospital Revenue Code	278
Min. Negotiated Rate	$7,709.06
Max. Negotiated Rate	$7,709.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,709.06
Rate for Payer: Hamaspik Choice Inc Medicare	$7,709.06

STEM P/F FLUTED

Facility OP

$15,418.12

Service Code	HCPCS C1776
Hospital Charge Code	64907275
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$16,189.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,479.97
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	$7,709.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$8,865.42
Rate for Payer: Fidelis Medicare Advantage	$16,189.03
Rate for Payer: Group Health Inc Commercial	$7,709.06
Rate for Payer: Group Health Inc Medicare	$5,396.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,709.06
Rate for Payer: Hamaspik Choice Inc Medicare	$7,709.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,021.78

STEM P-F TRI

Facility OP

$4,528.13

Service Code	HCPCS C1776
Hospital Charge Code	64907227
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,754.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,490.47
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	$2,264.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,603.67
Rate for Payer: Fidelis Medicare Advantage	$4,754.54
Rate for Payer: Group Health Inc Commercial	$2,264.06
Rate for Payer: Group Health Inc Medicare	$1,584.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,264.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2,264.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,943.28

STEM P-F TRI

Facility IP

$4,528.13

Service Code	HCPCS C1776
Hospital Charge Code	64907227
Hospital Revenue Code	278
Min. Negotiated Rate	$2,264.06
Max. Negotiated Rate	$2,264.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,264.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2,264.06

STEM PRESSFIT 16MM X 120MM

Facility OP

$3,840.00

Service Code	HCPCS C1713
Hospital Charge Code	64903975
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,032.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,112.00
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	$1,920.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,208.00
Rate for Payer: Fidelis Medicare Advantage	$4,032.00
Rate for Payer: Group Health Inc Commercial	$1,920.00
Rate for Payer: Group Health Inc Medicare	$1,344.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,920.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,920.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,496.00

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