St. Barnabas Hospital

All Charges

Charge

Type

Price

ZIMMER FEM COMP POROUS SZF RGHT

Facility OP

$8,686.00

Service Code	HCPCS C1776
Hospital Charge Code	40208125
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,120.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,777.30
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	$4,343.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,994.45
Rate for Payer: Fidelis Medicare Advantage	$9,120.30
Rate for Payer: Group Health Inc Commercial	$4,343.00
Rate for Payer: Group Health Inc Medicare	$3,040.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,343.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,343.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,645.90

ZIMMER FEM COMP POROUS SZF RGHT

Facility IP

$8,686.00

Service Code	HCPCS C1776
Hospital Charge Code	40208125
Hospital Revenue Code	278
Min. Negotiated Rate	$4,343.00
Max. Negotiated Rate	$4,343.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,343.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,343.00

ZIMMER FEMORAL COMP CEMENTED

Facility IP

$7,232.09

Service Code	HCPCS C1776
Hospital Charge Code	40024012
Hospital Revenue Code	278
Min. Negotiated Rate	$3,616.04
Max. Negotiated Rate	$3,616.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,616.04
Rate for Payer: Hamaspik Choice Inc Medicare	$3,616.04

ZIMMER FEMORAL COMP CEMENTED

Facility OP

$7,232.09

Service Code	HCPCS C1776
Hospital Charge Code	40024012
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,593.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,977.65
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	$3,616.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,158.45
Rate for Payer: Fidelis Medicare Advantage	$7,593.69
Rate for Payer: Group Health Inc Commercial	$3,616.04
Rate for Payer: Group Health Inc Medicare	$2,531.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,616.04
Rate for Payer: Hamaspik Choice Inc Medicare	$3,616.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,700.86

ZIMMER FEMORAL COMP NON CEMENTED

Facility OP

$9,208.08

Service Code	HCPCS C1776
Hospital Charge Code	40024013
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,668.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,064.44
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	$4,604.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,294.65
Rate for Payer: Fidelis Medicare Advantage	$9,668.48
Rate for Payer: Group Health Inc Commercial	$4,604.04
Rate for Payer: Group Health Inc Medicare	$3,222.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,604.04
Rate for Payer: Hamaspik Choice Inc Medicare	$4,604.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,985.25

ZIMMER FEMORAL COMP NON CEMENTED

Facility IP

$9,208.08

Service Code	HCPCS C1776
Hospital Charge Code	40024013
Hospital Revenue Code	278
Min. Negotiated Rate	$4,604.04
Max. Negotiated Rate	$4,604.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,604.04
Rate for Payer: Hamaspik Choice Inc Medicare	$4,604.04

ZIMMER FEMORAL COMPONENT SZC LEFT

Facility OP

$6,907.10

Service Code	HCPCS C1776
Hospital Charge Code	40209109
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,252.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,798.90
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	$3,453.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,971.58
Rate for Payer: Fidelis Medicare Advantage	$7,252.46
Rate for Payer: Group Health Inc Commercial	$3,453.55
Rate for Payer: Group Health Inc Medicare	$2,417.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,453.55
Rate for Payer: Hamaspik Choice Inc Medicare	$3,453.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,489.62

ZIMMER FEMORAL COMPONENT SZC LEFT

Facility IP

$6,907.10

Service Code	HCPCS C1776
Hospital Charge Code	40209109
Hospital Revenue Code	278
Min. Negotiated Rate	$3,453.55
Max. Negotiated Rate	$3,453.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,453.55
Rate for Payer: Hamaspik Choice Inc Medicare	$3,453.55

ZIMMER FEMORAL COMP/POROUS SZ G L

Facility IP

$8,374.70

Service Code	HCPCS C1776
Hospital Charge Code	40205822
Hospital Revenue Code	278
Min. Negotiated Rate	$4,187.35
Max. Negotiated Rate	$4,187.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,187.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,187.35

ZIMMER FEMORAL COMP/POROUS SZ G L

Facility OP

$8,374.70

Service Code	HCPCS C1776
Hospital Charge Code	40205822
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,793.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,606.08
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	$4,187.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,815.45
Rate for Payer: Fidelis Medicare Advantage	$8,793.44
Rate for Payer: Group Health Inc Commercial	$4,187.35
Rate for Payer: Group Health Inc Medicare	$2,931.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,187.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,187.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,443.56

ZIMMER FEMORAL COMP/POROUS SZ G R

Facility IP

$8,374.70

Service Code	HCPCS C1776
Hospital Charge Code	40205821
Hospital Revenue Code	278
Min. Negotiated Rate	$4,187.35
Max. Negotiated Rate	$4,187.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,187.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,187.35

ZIMMER FEMORAL COMP/POROUS SZ G R

Facility OP

$8,374.70

Service Code	HCPCS C1776
Hospital Charge Code	40205821
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,793.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,606.08
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	$4,187.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,815.45
Rate for Payer: Fidelis Medicare Advantage	$8,793.44
Rate for Payer: Group Health Inc Commercial	$4,187.35
Rate for Payer: Group Health Inc Medicare	$2,931.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,187.35
Rate for Payer: Hamaspik Choice Inc Medicare	$4,187.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,443.56

ZIMMER KNEE FEMUR SZ 9

Facility OP

$8,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40008295
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,610.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,510.00
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	$4,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,715.00
Rate for Payer: Fidelis Medicare Advantage	$8,610.00
Rate for Payer: Group Health Inc Commercial	$4,100.00
Rate for Payer: Group Health Inc Medicare	$2,870.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,330.00

ZIMMER KNEE FEMUR SZ 9

Facility IP

$8,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40008295
Hospital Revenue Code	278
Min. Negotiated Rate	$4,100.00
Max. Negotiated Rate	$4,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,100.00

ZIMMER KNEE NEX PAT 10X32MM

Facility IP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40205400
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.60
Max. Negotiated Rate	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60

ZIMMER KNEE NEX PAT 10X32MM

Facility OP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40205400
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,329.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,744.16
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	$1,585.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,823.44
Rate for Payer: Fidelis Medicare Advantage	$3,329.76
Rate for Payer: Group Health Inc Commercial	$1,585.60
Rate for Payer: Group Health Inc Medicare	$1,109.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,061.28

ZIMMER KNEE TIBIA 5 CEM LT SZ F

Facility OP

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40008296
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,200.00
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	$2,000.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,300.00
Rate for Payer: Fidelis Medicare Advantage	$4,200.00
Rate for Payer: Group Health Inc Commercial	$2,000.00
Rate for Payer: Group Health Inc Medicare	$1,400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,600.00

ZIMMER KNEE TIBIA 5 CEM LT SZ F

Facility IP

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40008296
Hospital Revenue Code	278
Min. Negotiated Rate	$2,000.00
Max. Negotiated Rate	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,000.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,000.00

ZIMMER MOTIONLOC SCREW CADDY

Facility OP

$1,587.04

Hospital Charge Code	40006863
Hospital Revenue Code	272
Min. Negotiated Rate	$555.46
Max. Negotiated Rate	$1,269.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$872.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$793.52
Rate for Payer: Aetna Government	$793.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,269.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,079.19
Rate for Payer: Group Health Inc Commercial	$793.52
Rate for Payer: Group Health Inc Medicare	$555.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$793.52
Rate for Payer: Hamaspik Choice Inc Medicare	$793.52

ZIMMER NEXGEN 32MM PRIMARY PATELL

Facility IP

$3,170.00

Service Code	HCPCS C1776
Hospital Charge Code	40004692
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.00
Max. Negotiated Rate	$1,585.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.00

ZIMMER NEXGEN 32MM PRIMARY PATELL

Facility OP

$3,170.00

Service Code	HCPCS C1776
Hospital Charge Code	40004692
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,328.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,743.50
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	$1,585.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,822.75
Rate for Payer: Fidelis Medicare Advantage	$3,328.50
Rate for Payer: Group Health Inc Commercial	$1,585.00
Rate for Payer: Group Health Inc Medicare	$1,109.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,060.50

ZIMMER NEXGEN COMP. KNEE SZ 32MM

Facility OP

$3,170.00

Service Code	HCPCS C1776
Hospital Charge Code	40206281
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,328.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,743.50
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	$1,585.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,822.75
Rate for Payer: Fidelis Medicare Advantage	$3,328.50
Rate for Payer: Group Health Inc Commercial	$1,585.00
Rate for Payer: Group Health Inc Medicare	$1,109.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,060.50

ZIMMER NEXGEN COMP. KNEE SZ 32MM

Facility IP

$3,170.00

Service Code	HCPCS C1776
Hospital Charge Code	40206281
Hospital Revenue Code	278
Min. Negotiated Rate	$1,585.00
Max. Negotiated Rate	$1,585.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,585.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,585.00

ZIMMER PATELLA COMPONENT

Facility IP

$1,933.47

Service Code	HCPCS C1776
Hospital Charge Code	40024011
Hospital Revenue Code	278
Min. Negotiated Rate	$966.74
Max. Negotiated Rate	$966.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$966.74
Rate for Payer: Hamaspik Choice Inc Medicare	$966.74

ZIMMER PATELLA COMPONENT

Facility OP

$1,933.47

Service Code	HCPCS C1776
Hospital Charge Code	40024011
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,030.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,063.41
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	$966.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,111.75
Rate for Payer: Fidelis Medicare Advantage	$2,030.14
Rate for Payer: Group Health Inc Commercial	$966.74
Rate for Payer: Group Health Inc Medicare	$676.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$966.74
Rate for Payer: Hamaspik Choice Inc Medicare	$966.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,256.76

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