St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SPACER OMNIFIT CEMENT 12MM

Facility

$180.00

Service Code	HCPCS C1776
Hospital Charge Code	64906267
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00

SPACER OMNIFT CEMNT 10MM-10670010

Facility

$180.00

Service Code	HCPCS C1776
Hospital Charge Code	64906405
Hospital Revenue Code	278
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$108.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$90.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$103.50
Rate for Payer: EmblemHealth Commercial	$90.00
Rate for Payer: Fidelis Medicare Advantage	$189.00
Rate for Payer: Group Health Inc Commercial	$90.00
Rate for Payer: Group Health Inc Medicare	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$117.00

SPACER OMNIFT CEMNT 10MM-10670010

Facility

$180.00

Service Code	HCPCS C1776
Hospital Charge Code	64906405
Hospital Revenue Code	278
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$90.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00

SPACER SPINAL 11X11 9MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64904366
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,725.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,475.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,700.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,587.50
Rate for Payer: EmblemHealth Commercial	$2,250.00
Rate for Payer: Fidelis Medicare Advantage	$4,725.00
Rate for Payer: Group Health Inc Commercial	$2,250.00
Rate for Payer: Group Health Inc Medicare	$1,575.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,925.00

SPACER SPINAL 11X11 9MM

Facility

$4,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64904366
Hospital Revenue Code	278
Min. Negotiated Rate	$2,250.00
Max. Negotiated Rate	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,250.00

SPACER SPINAL 12MM X 22MM X 28

Facility

$18,741.75

Service Code	HCPCS C1776
Hospital Charge Code	64904642
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$19,678.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10,307.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$11,245.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9,370.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$10,776.51
Rate for Payer: EmblemHealth Commercial	$9,370.88
Rate for Payer: Fidelis Medicare Advantage	$19,678.84
Rate for Payer: Group Health Inc Commercial	$9,370.88
Rate for Payer: Group Health Inc Medicare	$6,559.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,370.88
Rate for Payer: Hamaspik Choice Inc Medicare	$9,370.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12,182.14

SPACER SPINAL 12MM X 22MM X 28

Facility

$18,741.75

Service Code	HCPCS C1776
Hospital Charge Code	64904642
Hospital Revenue Code	278
Min. Negotiated Rate	$9,370.88
Max. Negotiated Rate	$9,370.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,370.88
Rate for Payer: Hamaspik Choice Inc Medicare	$9,370.88

SPACER SPINAL 13MM X 15MM X 7

Facility

$5,812.50

Service Code	HCPCS C1776
Hospital Charge Code	64904837
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,103.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,196.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,487.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,906.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,342.19
Rate for Payer: EmblemHealth Commercial	$2,906.25
Rate for Payer: Fidelis Medicare Advantage	$6,103.12
Rate for Payer: Group Health Inc Commercial	$2,906.25
Rate for Payer: Group Health Inc Medicare	$2,034.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,906.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,778.12

SPACER SPINAL 13MM X 15MM X 7

Facility

$5,812.50

Service Code	HCPCS C1776
Hospital Charge Code	64904837
Hospital Revenue Code	278
Min. Negotiated Rate	$2,906.25
Max. Negotiated Rate	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,906.25
Rate for Payer: Hamaspik Choice Inc Medicare	$2,906.25

SPACER SPINAL 24MMX32MMX12

Facility

$9,082.50

Service Code	HCPCS C1776
Hospital Charge Code	64904675
Hospital Revenue Code	278
Min. Negotiated Rate	$4,541.25
Max. Negotiated Rate	$4,541.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,541.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,541.25

SPACER SPINAL 24MMX32MMX12

Facility

$9,082.50

Service Code	HCPCS C1776
Hospital Charge Code	64904675
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$9,536.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,995.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,449.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,541.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,222.44
Rate for Payer: EmblemHealth Commercial	$4,541.25
Rate for Payer: Fidelis Medicare Advantage	$9,536.62
Rate for Payer: Group Health Inc Commercial	$4,541.25
Rate for Payer: Group Health Inc Medicare	$3,178.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,541.25
Rate for Payer: Hamaspik Choice Inc Medicare	$4,541.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,903.62

SPACER SPINAL 26MMX9MMX8MM

Facility

$11,541.25

Service Code	HCPCS C1776
Hospital Charge Code	64904508
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$12,118.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,347.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$6,924.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,770.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,636.22
Rate for Payer: EmblemHealth Commercial	$5,770.62
Rate for Payer: Fidelis Medicare Advantage	$12,118.31
Rate for Payer: Group Health Inc Commercial	$5,770.62
Rate for Payer: Group Health Inc Medicare	$4,039.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,770.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5,770.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,501.81

SPACER SPINAL 26MMX9MMX8MM

Facility

$11,541.25

Service Code	HCPCS C1776
Hospital Charge Code	64904508
Hospital Revenue Code	278
Min. Negotiated Rate	$5,770.62
Max. Negotiated Rate	$5,770.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,770.62
Rate for Payer: Hamaspik Choice Inc Medicare	$5,770.62

SPACER SPINE 10X22X28 8DEG

Facility

$17,040.20

Service Code	HCPCS C1776
Hospital Charge Code	64904643
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,892.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,372.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$10,224.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,520.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,798.12
Rate for Payer: EmblemHealth Commercial	$8,520.10
Rate for Payer: Fidelis Medicare Advantage	$17,892.21
Rate for Payer: Group Health Inc Commercial	$8,520.10
Rate for Payer: Group Health Inc Medicare	$5,964.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,520.10
Rate for Payer: Hamaspik Choice Inc Medicare	$8,520.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,076.13

SPACER SPINE 10X22X28 8DEG

Facility

$17,040.20

Service Code	HCPCS C1776
Hospital Charge Code	64904643
Hospital Revenue Code	278
Min. Negotiated Rate	$8,520.10
Max. Negotiated Rate	$8,520.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,520.10
Rate for Payer: Hamaspik Choice Inc Medicare	$8,520.10

SPACER SPINE 8X25X10 PEEK

Facility

$15,724.95

Service Code	HCPCS C1776
Hospital Charge Code	64904802
Hospital Revenue Code	278
Min. Negotiated Rate	$7,862.48
Max. Negotiated Rate	$7,862.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,862.48
Rate for Payer: Hamaspik Choice Inc Medicare	$7,862.48

SPACER SPINE 8X25X10 PEEK

Facility

$15,724.95

Service Code	HCPCS C1776
Hospital Charge Code	64904802
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$16,511.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,648.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$9,434.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,862.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,041.85
Rate for Payer: EmblemHealth Commercial	$7,862.48
Rate for Payer: Fidelis Medicare Advantage	$16,511.20
Rate for Payer: Group Health Inc Commercial	$7,862.48
Rate for Payer: Group Health Inc Medicare	$5,503.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,862.48
Rate for Payer: Hamaspik Choice Inc Medicare	$7,862.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,221.22

SPACER VERTEBRAL 14X25X35X12D

Facility

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905309
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$24,381.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,771.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$13,932.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,351.50
Rate for Payer: EmblemHealth Commercial	$11,610.00
Rate for Payer: Fidelis Medicare Advantage	$24,381.00
Rate for Payer: Group Health Inc Commercial	$11,610.00
Rate for Payer: Group Health Inc Medicare	$8,127.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,093.00

SPACER VERTEBRAL 14X25X35X12D

Facility

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905309
Hospital Revenue Code	278
Min. Negotiated Rate	$11,610.00
Max. Negotiated Rate	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00

SPACER VERTEBRAL 14X25X35X4D

Facility

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905310
Hospital Revenue Code	278
Min. Negotiated Rate	$11,610.00
Max. Negotiated Rate	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00

SPACER VERTEBRAL 14X25X35X4D

Facility

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905310
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$24,381.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,771.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$13,932.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,351.50
Rate for Payer: EmblemHealth Commercial	$11,610.00
Rate for Payer: Fidelis Medicare Advantage	$24,381.00
Rate for Payer: Group Health Inc Commercial	$11,610.00
Rate for Payer: Group Health Inc Medicare	$8,127.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,093.00

SP ACTIVATED CLOTTING TIME

Facility

$10.70

Service Code	HCPCS 85347 TC
Hospital Charge Code	41546011
Hospital Revenue Code	300
Min. Negotiated Rate	$3.74
Max. Negotiated Rate	$8.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.35
Rate for Payer: Aetna Government	$5.35
Rate for Payer: Brighton Health Commercial	$8.02
Rate for Payer: Cash Price	$4.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.28
Rate for Payer: Group Health Inc Commercial	$5.35
Rate for Payer: Group Health Inc Medicare	$3.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.35
Rate for Payer: Hamaspik Choice Inc Medicare	$5.35

SP ACTIVATED CLOTTING TIME

Facility

$10.70

Service Code	HCPCS 85347 TC
Hospital Charge Code	41546011
Hospital Revenue Code	300
Rate for Payer: Cash Price	$4.28

SPANAIDS

Facility

$51.39

Service Code	HCPCS C1713
Hospital Charge Code	40205726
Hospital Revenue Code	270
Min. Negotiated Rate	$17.99
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$28.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$38.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.95
Rate for Payer: Group Health Inc Commercial	$25.70
Rate for Payer: Group Health Inc Medicare	$17.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.70
Rate for Payer: Hamaspik Choice Inc Medicare	$25.70

SP ANKLE ARTHROGRAM

Facility

$447.40

Service Code	HCPCS 27648 TC
Hospital Charge Code	41547464
Hospital Revenue Code	361
Min. Negotiated Rate	$156.59
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$246.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.70
Rate for Payer: Aetna Government	$223.70
Rate for Payer: Brighton Health Commercial	$335.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Group Health Inc Commercial	$223.70
Rate for Payer: Group Health Inc Medicare	$156.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.70
Rate for Payer: Hamaspik Choice Inc Medicare	$223.70

Know your out-of-pocket cost for care.

All Charges