St. Barnabas Hospital

All Charges

Charge

Type

Price

BLADE OSTEMTOME-ZIMMER

Facility OP

$400.00

Service Code	HCPCS C1713
Hospital Charge Code	64907044
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$420.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
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	$200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$230.00
Rate for Payer: Fidelis Medicare Advantage	$420.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.00

BLADE OSTEO SHORT 8MM WIDE

Facility OP

$400.00

Hospital Charge Code	64906179
Hospital Revenue Code	270
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.00
Rate for Payer: Aetna Government	$200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

BLADE OSTEOTOME FLEX

Facility OP

$2,250.00

Hospital Charge Code	64907163
Hospital Revenue Code	270
Min. Negotiated Rate	$787.50
Max. Negotiated Rate	$1,800.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,237.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,125.00
Rate for Payer: Aetna Government	$1,125.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,530.00
Rate for Payer: Group Health Inc Commercial	$1,125.00
Rate for Payer: Group Health Inc Medicare	$787.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,125.00

BLADE OSTEOTOM SHORT 12MM WIDE

Facility OP

$400.00

Hospital Charge Code	64906198
Hospital Revenue Code	270
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.00
Rate for Payer: Aetna Government	$200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00

BLADE PATELLA 46MM W/PILOT

Facility OP

$408.00

Hospital Charge Code	64905000
Hospital Revenue Code	270
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$326.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$204.00
Rate for Payer: Aetna Government	$204.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$326.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$277.44
Rate for Payer: Group Health Inc Commercial	$204.00
Rate for Payer: Group Health Inc Medicare	$142.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00

BLADE PATELLA SZ38 W/PILOT H

Facility OP

$408.00

Hospital Charge Code	64904438
Hospital Revenue Code	270
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$326.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$204.00
Rate for Payer: Aetna Government	$204.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$326.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$277.44
Rate for Payer: Group Health Inc Commercial	$204.00
Rate for Payer: Group Health Inc Medicare	$142.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00

BLADE PATELLA SZ41 W/PILOT H

Facility OP

$326.40

Service Code	HCPCS C1776
Hospital Charge Code	40205060
Hospital Revenue Code	278
Min. Negotiated Rate	$114.24
Max. Negotiated Rate	$342.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.52
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	$163.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.68
Rate for Payer: Fidelis Medicare Advantage	$342.72
Rate for Payer: Group Health Inc Commercial	$163.20
Rate for Payer: Group Health Inc Medicare	$114.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.20
Rate for Payer: Hamaspik Choice Inc Medicare	$163.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$212.16

BLADE PATELLA SZ41 W/PILOT H

Facility OP

$408.00

Hospital Charge Code	64904440
Hospital Revenue Code	270
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$326.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$204.00
Rate for Payer: Aetna Government	$204.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$326.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$277.44
Rate for Payer: Group Health Inc Commercial	$204.00
Rate for Payer: Group Health Inc Medicare	$142.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00

BLADE PATELLA SZ41 W/PILOT H

Facility IP

$326.40

Service Code	HCPCS C1776
Hospital Charge Code	40205060
Hospital Revenue Code	278
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$163.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.20
Rate for Payer: Hamaspik Choice Inc Medicare	$163.20

BLADE QUADCUT

Facility OP

$2,675.00

Hospital Charge Code	64905976
Hospital Revenue Code	270
Min. Negotiated Rate	$936.25
Max. Negotiated Rate	$2,140.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,471.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,337.50
Rate for Payer: Aetna Government	$1,337.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,140.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,819.00
Rate for Payer: Group Health Inc Commercial	$1,337.50
Rate for Payer: Group Health Inc Medicare	$936.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,337.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,337.50

BLADE REAMER PATELLA 35MM

Facility IP

$408.00

Service Code	HCPCS C1776
Hospital Charge Code	64901307
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$204.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00

BLADE REAMER PATELLA 35MM

Facility OP

$326.40

Service Code	HCPCS C1776
Hospital Charge Code	40205086
Hospital Revenue Code	278
Min. Negotiated Rate	$114.24
Max. Negotiated Rate	$342.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.52
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	$163.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.68
Rate for Payer: Fidelis Medicare Advantage	$342.72
Rate for Payer: Group Health Inc Commercial	$163.20
Rate for Payer: Group Health Inc Medicare	$114.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.20
Rate for Payer: Hamaspik Choice Inc Medicare	$163.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$212.16

BLADE REAMER PATELLA 35MM

Facility OP

$408.00

Service Code	HCPCS C1776
Hospital Charge Code	64901307
Hospital Revenue Code	278
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$428.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.40
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	$204.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Fidelis Medicare Advantage	$428.40
Rate for Payer: Group Health Inc Commercial	$204.00
Rate for Payer: Group Health Inc Medicare	$142.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.20

BLADE REAMER PATELLA 35MM

Facility IP

$326.40

Service Code	HCPCS C1776
Hospital Charge Code	40205086
Hospital Revenue Code	278
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$163.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.20
Rate for Payer: Hamaspik Choice Inc Medicare	$163.20

BLADE REAMER PATELLA 46MM

Facility IP

$408.00

Service Code	HCPCS C1776
Hospital Charge Code	64907004
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$204.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00

BLADE REAMER PATELLA 46MM

Facility OP

$408.00

Service Code	HCPCS C1776
Hospital Charge Code	64907004
Hospital Revenue Code	278
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$428.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.40
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	$204.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Fidelis Medicare Advantage	$428.40
Rate for Payer: Group Health Inc Commercial	$204.00
Rate for Payer: Group Health Inc Medicare	$142.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.20

BLADE REAMER PATEL W/PIL38MM

Facility OP

$408.00

Service Code	HCPCS C1776
Hospital Charge Code	64905814
Hospital Revenue Code	278
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$428.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$224.40
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	$204.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$234.60
Rate for Payer: Fidelis Medicare Advantage	$428.40
Rate for Payer: Group Health Inc Commercial	$204.00
Rate for Payer: Group Health Inc Medicare	$142.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$265.20

BLADE REAMER PATEL W/PIL38MM

Facility IP

$408.00

Service Code	HCPCS C1776
Hospital Charge Code	64905814
Hospital Revenue Code	278
Min. Negotiated Rate	$204.00
Max. Negotiated Rate	$204.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$204.00
Rate for Payer: Hamaspik Choice Inc Medicare	$204.00

BLADE RECIPROCATING 12.5X89X1.5

Facility OP

$62.50

Hospital Charge Code	64903057
Hospital Revenue Code	270
Min. Negotiated Rate	$21.88
Max. Negotiated Rate	$50.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.25
Rate for Payer: Aetna Government	$31.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$42.50
Rate for Payer: Group Health Inc Commercial	$31.25
Rate for Payer: Group Health Inc Medicare	$21.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.25
Rate for Payer: Hamaspik Choice Inc Medicare	$31.25

BLADE SAGITAL SAW MEDIUM

Facility OP

$21.45

Hospital Charge Code	64904214
Hospital Revenue Code	270
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$17.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.72
Rate for Payer: Aetna Government	$10.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.59
Rate for Payer: Group Health Inc Commercial	$10.72
Rate for Payer: Group Health Inc Medicare	$7.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.72
Rate for Payer: Hamaspik Choice Inc Medicare	$10.72

BLADE SAGITTAL MEDIUM LONG

Facility OP

$191.40

Hospital Charge Code	64903938
Hospital Revenue Code	270
Min. Negotiated Rate	$66.99
Max. Negotiated Rate	$153.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.70
Rate for Payer: Aetna Government	$95.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$153.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$130.15
Rate for Payer: Group Health Inc Commercial	$95.70
Rate for Payer: Group Health Inc Medicare	$66.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.70
Rate for Payer: Hamaspik Choice Inc Medicare	$95.70

BLADE SAW INTRA ORAL 32TH/IN

Facility OP

$514.80

Hospital Charge Code	64904389
Hospital Revenue Code	270
Min. Negotiated Rate	$180.18
Max. Negotiated Rate	$411.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$283.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$257.40
Rate for Payer: Aetna Government	$257.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$411.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$350.06
Rate for Payer: Group Health Inc Commercial	$257.40
Rate for Payer: Group Health Inc Medicare	$180.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$257.40
Rate for Payer: Hamaspik Choice Inc Medicare	$257.40

BLADE SAW LARGE BONE

Facility OP

$60.00

Hospital Charge Code	64905358
Hospital Revenue Code	270
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$48.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$33.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$30.00
Rate for Payer: Aetna Government	$30.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.80
Rate for Payer: Group Health Inc Commercial	$30.00
Rate for Payer: Group Health Inc Medicare	$21.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$30.00
Rate for Payer: Hamaspik Choice Inc Medicare	$30.00

BLADE SAW OSCILATING 15.0X9MM

Facility OP

$21.45

Hospital Charge Code	64904119
Hospital Revenue Code	270
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$17.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.72
Rate for Payer: Aetna Government	$10.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.59
Rate for Payer: Group Health Inc Commercial	$10.72
Rate for Payer: Group Health Inc Medicare	$7.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.72
Rate for Payer: Hamaspik Choice Inc Medicare	$10.72

BLADE SAW OSCILATING 15.0X9MM

Facility OP

$15.00

Hospital Charge Code	40201011
Hospital Revenue Code	270
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$12.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.50
Rate for Payer: Aetna Government	$7.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.20
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50

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