St. Barnabas Hospital

All Charges

Charge

Type

Price

ZIM STEM STAND 4 TAPER 12/14

Facility OP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40204255
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,134.80
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	$4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,368.20
Rate for Payer: Fidelis Medicare Advantage	$9,802.80
Rate for Payer: Group Health Inc Commercial	$4,668.00
Rate for Payer: Group Health Inc Medicare	$3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,068.40

ZIM STEM STAND 4 TAPER 12/14

Facility IP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40204255
Hospital Revenue Code	278
Min. Negotiated Rate	$4,668.00
Max. Negotiated Rate	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00

ZIM STEM STAND UNCE 5 TAPER 12/14

Facility IP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40009279
Hospital Revenue Code	278
Min. Negotiated Rate	$4,668.00
Max. Negotiated Rate	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00

ZIM STEM STAND UNCE 5 TAPER 12/14

Facility OP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40009279
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,134.80
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	$4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,368.20
Rate for Payer: Fidelis Medicare Advantage	$9,802.80
Rate for Payer: Group Health Inc Commercial	$4,668.00
Rate for Payer: Group Health Inc Medicare	$3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,068.40

ZIM STEM UNCEM HA 5 TAPER 12/14

Facility IP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40204433
Hospital Revenue Code	278
Min. Negotiated Rate	$4,668.00
Max. Negotiated Rate	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00

ZIM STEM UNCEM HA 5 TAPER 12/14

Facility OP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40204433
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,134.80
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	$4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,368.20
Rate for Payer: Fidelis Medicare Advantage	$9,802.80
Rate for Payer: Group Health Inc Commercial	$4,668.00
Rate for Payer: Group Health Inc Medicare	$3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,068.40

ZIM STEM UNCEM HA 6 TAPER 12/14

Facility OP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40204432
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,134.80
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	$4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,368.20
Rate for Payer: Fidelis Medicare Advantage	$9,802.80
Rate for Payer: Group Health Inc Commercial	$4,668.00
Rate for Payer: Group Health Inc Medicare	$3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,068.40

ZIM STEM UNCEM HA 6 TAPER 12/14

Facility IP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40204432
Hospital Revenue Code	278
Min. Negotiated Rate	$4,668.00
Max. Negotiated Rate	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00

ZIM STEM UNCEM HA 8 TAPER 12/14

Facility IP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40204431
Hospital Revenue Code	278
Min. Negotiated Rate	$4,668.00
Max. Negotiated Rate	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00

ZIM STEM UNCEM HA 8 TAPER 12/14

Facility OP

$9,336.00

Service Code	HCPCS C1776
Hospital Charge Code	40204431
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,802.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,134.80
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	$4,668.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,368.20
Rate for Payer: Fidelis Medicare Advantage	$9,802.80
Rate for Payer: Group Health Inc Commercial	$4,668.00
Rate for Payer: Group Health Inc Medicare	$3,267.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,668.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,668.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,068.40

ZIM SZ D 5MM AUG 2/SCREW

Facility OP

$4,398.00

Service Code	HCPCS C1713
Hospital Charge Code	40001793
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,617.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,418.90
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	$2,199.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,528.85
Rate for Payer: Fidelis Medicare Advantage	$4,617.90
Rate for Payer: Group Health Inc Commercial	$2,199.00
Rate for Payer: Group Health Inc Medicare	$1,539.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,199.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,199.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,858.70

ZIM SZ D 5MM AUG 2/SCREW

Facility IP

$4,398.00

Service Code	HCPCS C1713
Hospital Charge Code	40001793
Hospital Revenue Code	278
Min. Negotiated Rate	$2,199.00
Max. Negotiated Rate	$2,199.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,199.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,199.00

ZIM TIBIAL BRUSH

Facility IP

$885.00

Service Code	HCPCS C1776
Hospital Charge Code	40008338
Hospital Revenue Code	278
Min. Negotiated Rate	$442.50
Max. Negotiated Rate	$442.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$442.50
Rate for Payer: Hamaspik Choice Inc Medicare	$442.50

ZIM TIBIAL BRUSH

Facility OP

$885.00

Service Code	HCPCS C1776
Hospital Charge Code	40008338
Hospital Revenue Code	278
Min. Negotiated Rate	$309.75
Max. Negotiated Rate	$929.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$486.75
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	$442.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$508.88
Rate for Payer: Fidelis Medicare Advantage	$929.25
Rate for Payer: Group Health Inc Commercial	$442.50
Rate for Payer: Group Health Inc Medicare	$309.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$442.50
Rate for Payer: Hamaspik Choice Inc Medicare	$442.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$575.25

ZIM TRABEC SHELL 52MM OD SZ II

Facility IP

$3,800.00

Service Code	HCPCS C1776
Hospital Charge Code	40003449
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

ZIM TRABEC SHELL 52MM OD SZ II

Facility OP

$3,800.00

Service Code	HCPCS C1776
Hospital Charge Code	40003449
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
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	$1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,185.00
Rate for Payer: Fidelis Medicare Advantage	$3,990.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,470.00

ZIM TRABEC SHOULDER SYS GLEN 36MM

Facility IP

$3,328.00

Service Code	HCPCS C1776
Hospital Charge Code	40008305
Hospital Revenue Code	278
Min. Negotiated Rate	$1,664.00
Max. Negotiated Rate	$1,664.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,664.00

ZIM TRABEC SHOULDER SYS GLEN 36MM

Facility OP

$3,328.00

Service Code	HCPCS C1776
Hospital Charge Code	40008305
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,494.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,830.40
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	$1,664.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,913.60
Rate for Payer: Fidelis Medicare Advantage	$3,494.40
Rate for Payer: Group Health Inc Commercial	$1,664.00
Rate for Payer: Group Health Inc Medicare	$1,164.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,664.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,664.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,163.20

ZIM TRAB METAL SHELL 58MM OD LL

Facility OP

$3,800.00

Service Code	HCPCS C1776
Hospital Charge Code	40009277
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,990.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,090.00
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	$1,900.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,185.00
Rate for Payer: Fidelis Medicare Advantage	$3,990.00
Rate for Payer: Group Health Inc Commercial	$1,900.00
Rate for Payer: Group Health Inc Medicare	$1,330.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,470.00

ZIM TRAB METAL SHELL 58MM OD LL

Facility IP

$3,800.00

Service Code	HCPCS C1776
Hospital Charge Code	40009277
Hospital Revenue Code	278
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,900.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,900.00

ZIM TRAE METAL SHELL 54MM OD JJ

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40009275
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 TRAE METAL SHELL 54MM OD JJ

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40009275
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 TRANSV PIN DEV 32MM LNG

Facility IP

$1,215.00

Service Code	HCPCS C1713
Hospital Charge Code	40008331
Hospital Revenue Code	278
Min. Negotiated Rate	$607.50
Max. Negotiated Rate	$607.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$607.50
Rate for Payer: Hamaspik Choice Inc Medicare	$607.50

ZIM TRANSV PIN DEV 32MM LNG

Facility OP

$1,215.00

Service Code	HCPCS C1713
Hospital Charge Code	40008331
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,275.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$668.25
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	$607.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$698.62
Rate for Payer: Fidelis Medicare Advantage	$1,275.75
Rate for Payer: Group Health Inc Commercial	$607.50
Rate for Payer: Group Health Inc Medicare	$425.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$607.50
Rate for Payer: Hamaspik Choice Inc Medicare	$607.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$789.75

ZIM TRILY ALFIT AETABLR SYS LG 36

Facility OP

$1,700.00

Service Code	HCPCS C1776
Hospital Charge Code	40202637
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,785.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$935.00
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	$850.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$977.50
Rate for Payer: Fidelis Medicare Advantage	$1,785.00
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,105.00

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