St. Barnabas Hospital

All Charges

Charge

Type

Price

BIOMET TIBIAL COMPONENT

Facility OP

$4,876.20

Service Code	HCPCS C1776
Hospital Charge Code	40024009
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,120.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,681.91
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	$2,438.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,803.82
Rate for Payer: Fidelis Medicare Advantage	$5,120.01
Rate for Payer: Group Health Inc Commercial	$2,438.10
Rate for Payer: Group Health Inc Medicare	$1,706.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,438.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2,438.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,169.53

BIOMET TIBIAL COMPONENT

Facility IP

$4,876.20

Service Code	HCPCS C1776
Hospital Charge Code	40024009
Hospital Revenue Code	278
Min. Negotiated Rate	$2,438.10
Max. Negotiated Rate	$2,438.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,438.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2,438.10

BIOMET TIBIAL POLY

Facility OP

$2,679.08

Service Code	HCPCS C1776
Hospital Charge Code	40024010
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,813.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,473.49
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	$1,339.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,540.47
Rate for Payer: Fidelis Medicare Advantage	$2,813.03
Rate for Payer: Group Health Inc Commercial	$1,339.54
Rate for Payer: Group Health Inc Medicare	$937.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,339.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1,339.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,741.40

BIOMET TIBIAL POLY

Facility IP

$2,679.08

Service Code	HCPCS C1776
Hospital Charge Code	40024010
Hospital Revenue Code	278
Min. Negotiated Rate	$1,339.54
Max. Negotiated Rate	$1,339.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,339.54
Rate for Payer: Hamaspik Choice Inc Medicare	$1,339.54

BIOMET TRI CORTICAL BLCK

Facility OP

$1,544.00

Service Code	HCPCS C1713
Hospital Charge Code	40205756
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,621.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$849.20
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	$772.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$887.80
Rate for Payer: Fidelis Medicare Advantage	$1,621.20
Rate for Payer: Group Health Inc Commercial	$772.00
Rate for Payer: Group Health Inc Medicare	$540.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$772.00
Rate for Payer: Hamaspik Choice Inc Medicare	$772.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,003.60

BIOMET TRI CORTICAL BLCK

Facility IP

$1,544.00

Service Code	HCPCS C1713
Hospital Charge Code	40205756
Hospital Revenue Code	278
Min. Negotiated Rate	$772.00
Max. Negotiated Rate	$772.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$772.00
Rate for Payer: Hamaspik Choice Inc Medicare	$772.00

BIOMET UNIPLATE 13MM

Facility IP

$2,920.00

Service Code	HCPCS C1776
Hospital Charge Code	40208109
Hospital Revenue Code	278
Min. Negotiated Rate	$1,460.00
Max. Negotiated Rate	$1,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,460.00

BIOMET UNIPLATE 13MM

Facility OP

$2,920.00

Service Code	HCPCS C1776
Hospital Charge Code	40208109
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,066.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,606.00
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	$1,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,679.00
Rate for Payer: Fidelis Medicare Advantage	$3,066.00
Rate for Payer: Group Health Inc Commercial	$1,460.00
Rate for Payer: Group Health Inc Medicare	$1,022.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,898.00

BIOMET UNIV B/P HEAD COMP 54X26MM

Facility OP

$3,010.00

Service Code	HCPCS C1776
Hospital Charge Code	40206255
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,160.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,655.50
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	$1,505.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,730.75
Rate for Payer: Fidelis Medicare Advantage	$3,160.50
Rate for Payer: Group Health Inc Commercial	$1,505.00
Rate for Payer: Group Health Inc Medicare	$1,053.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,505.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,505.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,956.50

BIOMET UNIV B/P HEAD COMP 54X26MM

Facility IP

$3,010.00

Service Code	HCPCS C1776
Hospital Charge Code	40206255
Hospital Revenue Code	278
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$1,505.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,505.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,505.00

BIOMET VAN CR FEM 67.5MM IN/LK

Facility IP

$6,898.00

Service Code	HCPCS C1776
Hospital Charge Code	40202217
Hospital Revenue Code	278
Min. Negotiated Rate	$3,449.00
Max. Negotiated Rate	$3,449.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,449.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,449.00

BIOMET VAN CR FEM 67.5MM IN/LK

Facility OP

$6,898.00

Service Code	HCPCS C1776
Hospital Charge Code	40202217
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,242.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,793.90
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	$3,449.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,966.35
Rate for Payer: Fidelis Medicare Advantage	$7,242.90
Rate for Payer: Group Health Inc Commercial	$3,449.00
Rate for Payer: Group Health Inc Medicare	$2,414.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,449.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,449.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,483.70

BIOMET VAN CRFEM 70MM RGHT IN/LK

Facility OP

$6,140.00

Service Code	HCPCS C1776
Hospital Charge Code	40205576
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,447.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,377.00
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	$3,070.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,530.50
Rate for Payer: Fidelis Medicare Advantage	$6,447.00
Rate for Payer: Group Health Inc Commercial	$3,070.00
Rate for Payer: Group Health Inc Medicare	$2,149.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,070.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,070.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,991.00

BIOMET VAN CRFEM 70MM RGHT IN/LK

Facility IP

$6,140.00

Service Code	HCPCS C1776
Hospital Charge Code	40205576
Hospital Revenue Code	278
Min. Negotiated Rate	$3,070.00
Max. Negotiated Rate	$3,070.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,070.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,070.00

BIOMET VAN TM CR FEM 65MM LFT I/L

Facility IP

$6,570.00

Service Code	HCPCS C1776
Hospital Charge Code	40205450
Hospital Revenue Code	278
Min. Negotiated Rate	$3,285.00
Max. Negotiated Rate	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.00

BIOMET VAN TM CR FEM 65MM LFT I/L

Facility OP

$6,570.00

Service Code	HCPCS C1776
Hospital Charge Code	40205450
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,898.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,613.50
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	$3,285.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,777.75
Rate for Payer: Fidelis Medicare Advantage	$6,898.50
Rate for Payer: Group Health Inc Commercial	$3,285.00
Rate for Payer: Group Health Inc Medicare	$2,299.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,270.50

BIOMET VAN TM CR FEM 65MM R IN/LK

Facility IP

$6,570.00

Service Code	HCPCS C1776
Hospital Charge Code	40205358
Hospital Revenue Code	278
Min. Negotiated Rate	$3,285.00
Max. Negotiated Rate	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.00

BIOMET VAN TM CR FEM 65MM R IN/LK

Facility OP

$6,570.00

Service Code	HCPCS C1776
Hospital Charge Code	40205358
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,898.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,613.50
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	$3,285.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,777.75
Rate for Payer: Fidelis Medicare Advantage	$6,898.50
Rate for Payer: Group Health Inc Commercial	$3,285.00
Rate for Payer: Group Health Inc Medicare	$2,299.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,270.50

BIOMET V B/S CARRIAGE

Facility OP

$1,700.00

Hospital Charge Code	40205831
Hospital Revenue Code	270
Min. Negotiated Rate	$595.00
Max. Negotiated Rate	$1,360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$850.00
Rate for Payer: Aetna Government	$850.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,156.00
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

BIOMET VHS LAG SCREW 60MM

Facility OP

$1,498.00

Service Code	HCPCS C1713
Hospital Charge Code	40205836
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,572.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$823.90
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	$749.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$861.35
Rate for Payer: Fidelis Medicare Advantage	$1,572.90
Rate for Payer: Group Health Inc Commercial	$749.00
Rate for Payer: Group Health Inc Medicare	$524.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$749.00
Rate for Payer: Hamaspik Choice Inc Medicare	$749.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$973.70

BIOMET VHS LAG SCREW 60MM

Facility IP

$1,498.00

Service Code	HCPCS C1713
Hospital Charge Code	40205836
Hospital Revenue Code	278
Min. Negotiated Rate	$749.00
Max. Negotiated Rate	$749.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$749.00
Rate for Payer: Hamaspik Choice Inc Medicare	$749.00

BIOMET VHS PEDIATRIC PLATE 8 HOLE

Facility IP

$2,130.00

Service Code	HCPCS C1713
Hospital Charge Code	40205837
Hospital Revenue Code	278
Min. Negotiated Rate	$1,065.00
Max. Negotiated Rate	$1,065.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,065.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,065.00

BIOMET VHS PEDIATRIC PLATE 8 HOLE

Facility OP

$2,130.00

Service Code	HCPCS C1713
Hospital Charge Code	40205837
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,236.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,171.50
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	$1,065.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,224.75
Rate for Payer: Fidelis Medicare Advantage	$2,236.50
Rate for Payer: Group Health Inc Commercial	$1,065.00
Rate for Payer: Group Health Inc Medicare	$745.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,065.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,065.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,384.50

BIOMET VNGRD CR FEM 60MM R INLK

Facility IP

$6,570.00

Service Code	HCPCS C1776
Hospital Charge Code	40208081
Hospital Revenue Code	278
Min. Negotiated Rate	$3,285.00
Max. Negotiated Rate	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.00

BIOMET VNGRD CR FEM 60MM R INLK

Facility OP

$6,570.00

Service Code	HCPCS C1776
Hospital Charge Code	40208081
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,898.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,613.50
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	$3,285.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,777.75
Rate for Payer: Fidelis Medicare Advantage	$6,898.50
Rate for Payer: Group Health Inc Commercial	$3,285.00
Rate for Payer: Group Health Inc Medicare	$2,299.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,285.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,285.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,270.50

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