St. Barnabas Hospital

All Charges

Charge

Type

Price

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

STEM PSN REV

Facility OP

$8,450.00

Service Code	HCPCS C1776
Hospital Charge Code	64907168
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,872.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,647.50
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	$4,225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,858.75
Rate for Payer: Fidelis Medicare Advantage	$8,872.50
Rate for Payer: Group Health Inc Commercial	$4,225.00
Rate for Payer: Group Health Inc Medicare	$2,957.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,492.50

STEM PSN REV

Facility IP

$8,450.00

Service Code	HCPCS C1776
Hospital Charge Code	64907168
Hospital Revenue Code	278
Min. Negotiated Rate	$4,225.00
Max. Negotiated Rate	$4,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,225.00

STEM RADIAL SZ 2

Facility IP

$7,570.00

Service Code	HCPCS C1713
Hospital Charge Code	64905300
Hospital Revenue Code	278
Min. Negotiated Rate	$3,785.00
Max. Negotiated Rate	$3,785.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,785.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,785.00

STEM RADIAL SZ 2

Facility OP

$7,570.00

Service Code	HCPCS C1713
Hospital Charge Code	64905300
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,948.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,163.50
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	$3,785.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,352.75
Rate for Payer: Fidelis Medicare Advantage	$7,948.50
Rate for Payer: Group Health Inc Commercial	$3,785.00
Rate for Payer: Group Health Inc Medicare	$2,649.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,785.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,785.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,920.50

STEM RADIAL SZ 3

Facility OP

$4,602.50

Service Code	HCPCS C1713
Hospital Charge Code	64905298
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,832.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,531.38
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	$2,301.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,646.44
Rate for Payer: Fidelis Medicare Advantage	$4,832.62
Rate for Payer: Group Health Inc Commercial	$2,301.25
Rate for Payer: Group Health Inc Medicare	$1,610.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,301.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,301.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,991.62

STEM RADIAL SZ 3

Facility IP

$4,602.50

Service Code	HCPCS C1713
Hospital Charge Code	64905298
Hospital Revenue Code	278
Min. Negotiated Rate	$2,301.25
Max. Negotiated Rate	$2,301.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,301.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,301.25

STEM REV ECHELON 12X190

Facility OP

$15,682.13

Service Code	HCPCS C1776
Hospital Charge Code	64903546
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$16,466.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,625.17
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	$7,841.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,017.22
Rate for Payer: Fidelis Medicare Advantage	$16,466.24
Rate for Payer: Group Health Inc Commercial	$7,841.06
Rate for Payer: Group Health Inc Medicare	$5,488.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,841.06
Rate for Payer: Hamaspik Choice Inc Medicare	$7,841.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,193.38

STEM REV ECHELON 12X190

Facility IP

$15,682.13

Service Code	HCPCS C1776
Hospital Charge Code	64903546
Hospital Revenue Code	278
Min. Negotiated Rate	$7,841.06
Max. Negotiated Rate	$7,841.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,841.06
Rate for Payer: Hamaspik Choice Inc Medicare	$7,841.06

STEM REV EXT FLTD 9MM 130MM

Facility OP

$5,824.00

Service Code	HCPCS C1776
Hospital Charge Code	64906413
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,115.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,203.20
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	$2,912.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,348.80
Rate for Payer: Fidelis Medicare Advantage	$6,115.20
Rate for Payer: Group Health Inc Commercial	$2,912.00
Rate for Payer: Group Health Inc Medicare	$2,038.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,912.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,912.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,785.60

STEM REV EXT FLTD 9MM 130MM

Facility IP

$5,824.00

Service Code	HCPCS C1776
Hospital Charge Code	64906413
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$2,912.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,912.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,912.00

STEM SECR-FX MAX NECK ANG HIP

Facility OP

$16,301.25

Service Code	HCPCS C1776
Hospital Charge Code	64901784
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,116.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,965.69
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	$8,150.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,373.22
Rate for Payer: Fidelis Medicare Advantage	$17,116.31
Rate for Payer: Group Health Inc Commercial	$8,150.62
Rate for Payer: Group Health Inc Medicare	$5,705.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,150.62
Rate for Payer: Hamaspik Choice Inc Medicare	$8,150.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,595.81

STEM SECR-FX MAX NECK ANG HIP

Facility IP

$16,301.25

Service Code	HCPCS C1776
Hospital Charge Code	64901784
Hospital Revenue Code	278
Min. Negotiated Rate	$8,150.62
Max. Negotiated Rate	$8,150.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,150.62
Rate for Payer: Hamaspik Choice Inc Medicare	$8,150.62

STEM SHOULDER PRIMARY 7 X 122MM

Facility OP

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64906972
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,925.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,675.00
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	$4,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,887.50
Rate for Payer: Fidelis Medicare Advantage	$8,925.00
Rate for Payer: Group Health Inc Commercial	$4,250.00
Rate for Payer: Group Health Inc Medicare	$2,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,525.00

STEM SHOULDER PRIMARY 7 X 122MM

Facility IP

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64906972
Hospital Revenue Code	278
Min. Negotiated Rate	$4,250.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,250.00

STEM SIZE 5 ACCOLA II 132 DEG

Facility IP

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64905740
Hospital Revenue Code	278
Min. Negotiated Rate	$8,557.88
Max. Negotiated Rate	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88

STEM SIZE 5 ACCOLA II 132 DEG

Facility OP

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64905740
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,971.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,413.66
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	$8,557.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,841.56
Rate for Payer: Fidelis Medicare Advantage	$17,971.54
Rate for Payer: Group Health Inc Commercial	$8,557.88
Rate for Payer: Group Health Inc Medicare	$5,990.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,125.24

STEM STD 12 ECH

Facility IP

$9,999.25

Service Code	HCPCS C1713
Hospital Charge Code	64903640
Hospital Revenue Code	278
Min. Negotiated Rate	$4,999.62
Max. Negotiated Rate	$4,999.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,999.62
Rate for Payer: Hamaspik Choice Inc Medicare	$4,999.62

STEM STD 12 ECH

Facility OP

$9,999.25

Service Code	HCPCS C1713
Hospital Charge Code	64903640
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,499.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,499.59
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	$4,999.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,749.57
Rate for Payer: Fidelis Medicare Advantage	$10,499.21
Rate for Payer: Group Health Inc Commercial	$4,999.62
Rate for Payer: Group Health Inc Medicare	$3,499.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,999.62
Rate for Payer: Hamaspik Choice Inc Medicare	$4,999.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,499.51

STEM_STD AVENIR NULR 12/14-010601

Facility OP

$4,668.00

Service Code	HCPCS C1776
Hospital Charge Code	64906408
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,901.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,567.40
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	$2,334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,684.10
Rate for Payer: Fidelis Medicare Advantage	$4,901.40
Rate for Payer: Group Health Inc Commercial	$2,334.00
Rate for Payer: Group Health Inc Medicare	$1,633.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,034.20

STEM_STD AVENIR NULR 12/14-010601

Facility IP

$4,668.00

Service Code	HCPCS C1776
Hospital Charge Code	64906408
Hospital Revenue Code	278
Min. Negotiated Rate	$2,334.00
Max. Negotiated Rate	$2,334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,334.00

STEM STRGT 15DIA 145MM 100

Facility OP

$4,460.00

Service Code	HCPCS C1713
Hospital Charge Code	64905888
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 STRGT 15DIA 145MM 100

Facility IP

$4,460.00

Service Code	HCPCS C1713
Hospital Charge Code	64905888
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 STS ARCOS W-SCW DIST

Facility OP

$9,952.00

Hospital Charge Code	64906707
Hospital Revenue Code	279
Min. Negotiated Rate	$3,483.20
Max. Negotiated Rate	$7,961.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,473.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,976.00
Rate for Payer: Aetna Government	$4,976.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,961.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,767.36
Rate for Payer: Group Health Inc Commercial	$4,976.00
Rate for Payer: Group Health Inc Medicare	$3,483.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,976.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,976.00

STEM STS DISTAL

Facility OP

$12,440.00

Service Code	HCPCS C1776
Hospital Charge Code	64907130
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$13,062.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,842.00
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	$6,220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,153.00
Rate for Payer: Fidelis Medicare Advantage	$13,062.00
Rate for Payer: Group Health Inc Commercial	$6,220.00
Rate for Payer: Group Health Inc Medicare	$4,354.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,220.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,086.00

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