St. Barnabas Hospital

All Charges

Charge

Type

Price

ZIM NCB 14 HOLE PERI PLT

Facility IP

$1,409.04

Service Code	HCPCS C1713
Hospital Charge Code	40008330
Hospital Revenue Code	278
Min. Negotiated Rate	$704.52
Max. Negotiated Rate	$704.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$704.52
Rate for Payer: Hamaspik Choice Inc Medicare	$704.52

ZIM NCB 14 HOLE PERI PLT

Facility OP

$1,409.04

Service Code	HCPCS C1713
Hospital Charge Code	40008330
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,479.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$774.97
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	$704.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$810.20
Rate for Payer: Fidelis Medicare Advantage	$1,479.49
Rate for Payer: Group Health Inc Commercial	$704.52
Rate for Payer: Group Health Inc Medicare	$493.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$704.52
Rate for Payer: Hamaspik Choice Inc Medicare	$704.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$915.88

ZIM NEUT LINER 36MM SIZE JJ

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40009276
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

ZIM NEUT LINER 36MM SIZE JJ

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40009276
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

ZIM NEX COMP KNEE SZ C D 14MM

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40001782
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

ZIM NEX COMP KNEE SZ C D 14MM

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40001782
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

ZIM NEX COMPL KNEE 32MMX10MM

Facility OP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40203390
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

ZIM NEX COMPL KNEE 32MMX10MM

Facility IP

$3,171.20

Service Code	HCPCS C1776
Hospital Charge Code	40203390
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

ZIM ORTHO SAL LCK PIN

Facility OP

$660.00

Service Code	HCPCS C1776
Hospital Charge Code	40008334
Hospital Revenue Code	278
Min. Negotiated Rate	$231.00
Max. Negotiated Rate	$693.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$363.00
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	$330.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$379.50
Rate for Payer: Fidelis Medicare Advantage	$693.00
Rate for Payer: Group Health Inc Commercial	$330.00
Rate for Payer: Group Health Inc Medicare	$231.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$330.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$429.00

ZIM ORTHO SAL LCK PIN

Facility IP

$660.00

Service Code	HCPCS C1776
Hospital Charge Code	40008334
Hospital Revenue Code	278
Min. Negotiated Rate	$330.00
Max. Negotiated Rate	$330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$330.00
Rate for Payer: Hamaspik Choice Inc Medicare	$330.00

ZIM ORTHO SAL SYS AXLE

Facility IP

$1,335.00

Service Code	HCPCS C1776
Hospital Charge Code	40008333
Hospital Revenue Code	278
Min. Negotiated Rate	$667.50
Max. Negotiated Rate	$667.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$667.50
Rate for Payer: Hamaspik Choice Inc Medicare	$667.50

ZIM ORTHO SAL SYS AXLE

Facility OP

$1,335.00

Service Code	HCPCS C1776
Hospital Charge Code	40008333
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,401.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$734.25
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	$667.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$767.62
Rate for Payer: Fidelis Medicare Advantage	$1,401.75
Rate for Payer: Group Health Inc Commercial	$667.50
Rate for Payer: Group Health Inc Medicare	$467.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$667.50
Rate for Payer: Hamaspik Choice Inc Medicare	$667.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$867.75

ZIM ORTHO SAL YOKE

Facility OP

$3,090.00

Service Code	HCPCS C1776
Hospital Charge Code	40008332
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,244.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,699.50
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	$1,545.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,776.75
Rate for Payer: Fidelis Medicare Advantage	$3,244.50
Rate for Payer: Group Health Inc Commercial	$1,545.00
Rate for Payer: Group Health Inc Medicare	$1,081.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,545.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,545.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,008.50

ZIM ORTHO SAL YOKE

Facility IP

$3,090.00

Service Code	HCPCS C1776
Hospital Charge Code	40008332
Hospital Revenue Code	278
Min. Negotiated Rate	$1,545.00
Max. Negotiated Rate	$1,545.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,545.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,545.00

ZIM PATEL REAM BLD W/PLT HOLE 38M

Facility IP

$163.00

Service Code	HCPCS C1713
Hospital Charge Code	40005243
Hospital Revenue Code	278
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$81.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.50
Rate for Payer: Hamaspik Choice Inc Medicare	$81.50

ZIM PATEL REAM BLD W/PLT HOLE 38M

Facility OP

$163.00

Service Code	HCPCS C1713
Hospital Charge Code	40005243
Hospital Revenue Code	278
Min. Negotiated Rate	$57.05
Max. Negotiated Rate	$171.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.65
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	$81.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.72
Rate for Payer: Fidelis Medicare Advantage	$171.15
Rate for Payer: Group Health Inc Commercial	$81.50
Rate for Payer: Group Health Inc Medicare	$57.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.50
Rate for Payer: Hamaspik Choice Inc Medicare	$81.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.95

ZIM PER ART BEAR RT 13MM

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40203383
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$1,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,955.00
Rate for Payer: Fidelis Medicare Advantage	$3,570.00
Rate for Payer: Group Health Inc Commercial	$1,700.00
Rate for Payer: Group Health Inc Medicare	$1,190.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,210.00

ZIM PER ART BEAR RT 13MM

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40203383
Hospital Revenue Code	278
Min. Negotiated Rate	$1,700.00
Max. Negotiated Rate	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.00

ZIM PER FEM POST RT SZ 5

Facility IP

$6,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40203385
Hospital Revenue Code	278
Min. Negotiated Rate	$3,100.00
Max. Negotiated Rate	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,100.00

ZIM PER FEM POST RT SZ 5

Facility OP

$6,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40203385
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,510.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,410.00
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	$3,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,565.00
Rate for Payer: Fidelis Medicare Advantage	$6,510.00
Rate for Payer: Group Health Inc Commercial	$3,100.00
Rate for Payer: Group Health Inc Medicare	$2,170.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,030.00

ZIM PER KNEE SYS PLY 32MM-8.5

Facility IP

$1,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40203382
Hospital Revenue Code	278
Min. Negotiated Rate	$800.00
Max. Negotiated Rate	$800.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$800.00

ZIM PER KNEE SYS PLY 32MM-8.5

Facility OP

$1,600.00

Service Code	HCPCS C1776
Hospital Charge Code	40203382
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,680.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$880.00
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	$800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$920.00
Rate for Payer: Fidelis Medicare Advantage	$1,680.00
Rate for Payer: Group Health Inc Commercial	$800.00
Rate for Payer: Group Health Inc Medicare	$560.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$800.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,040.00

ZIM PER KNEE SYS STAB RT SZ 5

Facility IP

$6,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40203380
Hospital Revenue Code	278
Min. Negotiated Rate	$3,100.00
Max. Negotiated Rate	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,100.00

ZIM PER KNEE SYS STAB RT SZ 5

Facility OP

$6,200.00

Service Code	HCPCS C1776
Hospital Charge Code	40203380
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,510.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,410.00
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	$3,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,565.00
Rate for Payer: Fidelis Medicare Advantage	$6,510.00
Rate for Payer: Group Health Inc Commercial	$3,100.00
Rate for Payer: Group Health Inc Medicare	$2,170.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,030.00

ZIM PER NAT TIBIA SZ D

Facility OP

$4,000.00

Service Code	HCPCS C1776
Hospital Charge Code	40203384
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

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