St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BIOLOX DELTA FEM HEAD 36MM -3.5

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40204615
Hospital Revenue Code	278
Min. Negotiated Rate	$2,672.00
Max. Negotiated Rate	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00

BIOLOX DELTA FEM HEAD 36MM -3.5

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40204615
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,611.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,939.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,206.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,672.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,072.80
Rate for Payer: EmblemHealth Commercial	$2,672.00
Rate for Payer: Fidelis Medicare Advantage	$5,611.20
Rate for Payer: Group Health Inc Commercial	$2,672.00
Rate for Payer: Group Health Inc Medicare	$1,870.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,473.60

BIOLOX DELTA FEMORAL HD 36MM -3.5

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40007534
Hospital Revenue Code	278
Min. Negotiated Rate	$2,672.00
Max. Negotiated Rate	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00

BIOLOX DELTA FEMORAL HD 36MM -3.5

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40007534
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,611.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,939.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,206.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,672.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,072.80
Rate for Payer: EmblemHealth Commercial	$2,672.00
Rate for Payer: Fidelis Medicare Advantage	$5,611.20
Rate for Payer: Group Health Inc Commercial	$2,672.00
Rate for Payer: Group Health Inc Medicare	$1,870.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,473.60

BIOLOX DELTA FEMORAL HEAD 36MM +0

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40204606
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,611.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,939.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,206.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,672.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,072.80
Rate for Payer: EmblemHealth Commercial	$2,672.00
Rate for Payer: Fidelis Medicare Advantage	$5,611.20
Rate for Payer: Group Health Inc Commercial	$2,672.00
Rate for Payer: Group Health Inc Medicare	$1,870.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,473.60

BIOLOX DELTA FEMORAL HEAD 36MM +0

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40007525
Hospital Revenue Code	278
Min. Negotiated Rate	$2,672.00
Max. Negotiated Rate	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00

BIOLOX DELTA FEMORAL HEAD 36MM +0

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40204606
Hospital Revenue Code	278
Min. Negotiated Rate	$2,672.00
Max. Negotiated Rate	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00

BIOLOX DELTA FEMORAL HEAD 36MM +0

Facility

$5,344.00

Service Code	HCPCS C1776
Hospital Charge Code	40007525
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,611.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,939.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,206.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,672.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,072.80
Rate for Payer: EmblemHealth Commercial	$2,672.00
Rate for Payer: Fidelis Medicare Advantage	$5,611.20
Rate for Payer: Group Health Inc Commercial	$2,672.00
Rate for Payer: Group Health Inc Medicare	$1,870.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,672.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,672.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,473.60

BIOLOX DELTA OPTION CERAMIC HD

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	64903194
Hospital Revenue Code	278
Min. Negotiated Rate	$2,382.50
Max. Negotiated Rate	$2,382.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,382.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,382.50

BIOLOX DELTA OPTION CERAMIC HD

Facility

$4,765.00

Service Code	HCPCS C1776
Hospital Charge Code	64903194
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,003.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,620.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,859.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,382.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,739.88
Rate for Payer: EmblemHealth Commercial	$2,382.50
Rate for Payer: Fidelis Medicare Advantage	$5,003.25
Rate for Payer: Group Health Inc Commercial	$2,382.50
Rate for Payer: Group Health Inc Medicare	$1,667.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,382.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,382.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,097.25

BIOLOX OPTION TAPER ADAP

Facility

$415.00

Hospital Charge Code	64904051
Hospital Revenue Code	270
Min. Negotiated Rate	$145.25
Max. Negotiated Rate	$332.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$207.50
Rate for Payer: Aetna Government	$207.50
Rate for Payer: Brighton Health Commercial	$311.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$332.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$282.20
Rate for Payer: Group Health Inc Commercial	$207.50
Rate for Payer: Group Health Inc Medicare	$145.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.50
Rate for Payer: Hamaspik Choice Inc Medicare	$207.50

BIOLOX OPTION TAPER ADAPTER

Facility

$415.00

Hospital Charge Code	64905573
Hospital Revenue Code	270
Min. Negotiated Rate	$145.25
Max. Negotiated Rate	$332.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$207.50
Rate for Payer: Aetna Government	$207.50
Rate for Payer: Brighton Health Commercial	$311.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$332.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$282.20
Rate for Payer: Group Health Inc Commercial	$207.50
Rate for Payer: Group Health Inc Medicare	$145.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$207.50
Rate for Payer: Hamaspik Choice Inc Medicare	$207.50

BIO MEN BEARING 6MM

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40009270
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,440.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,380.00
Rate for Payer: EmblemHealth Commercial	$1,200.00
Rate for Payer: Fidelis Medicare Advantage	$2,520.00
Rate for Payer: Group Health Inc Commercial	$1,200.00
Rate for Payer: Group Health Inc Medicare	$840.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,560.00

BIO MEN BEARING 6MM

Facility

$2,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40009270
Hospital Revenue Code	278
Min. Negotiated Rate	$1,200.00
Max. Negotiated Rate	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,200.00

BIOMET 1-5CM CD MECHANISM

Facility

$1,400.00

Hospital Charge Code	40205833
Hospital Revenue Code	279
Min. Negotiated Rate	$490.00
Max. Negotiated Rate	$1,120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$770.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$700.00
Rate for Payer: Aetna Government	$700.00
Rate for Payer: Brighton Health Commercial	$1,050.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,120.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$952.00
Rate for Payer: Group Health Inc Commercial	$700.00
Rate for Payer: Group Health Inc Medicare	$490.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$700.00
Rate for Payer: Hamaspik Choice Inc Medicare	$700.00

BIOMET 220MM 1/3 RING

Facility

$410.00

Hospital Charge Code	40203835
Hospital Revenue Code	270
Min. Negotiated Rate	$143.50
Max. Negotiated Rate	$328.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$225.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$205.00
Rate for Payer: Aetna Government	$205.00
Rate for Payer: Brighton Health Commercial	$307.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$278.80
Rate for Payer: Group Health Inc Commercial	$205.00
Rate for Payer: Group Health Inc Medicare	$143.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$205.00

BIOMET 3.5 SCREW 26-50

Facility

$94.00

Service Code	HCPCS C1713
Hospital Charge Code	40205835
Hospital Revenue Code	278
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$56.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$54.05
Rate for Payer: EmblemHealth Commercial	$47.00
Rate for Payer: Fidelis Medicare Advantage	$98.70
Rate for Payer: Group Health Inc Commercial	$47.00
Rate for Payer: Group Health Inc Medicare	$32.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$61.10

BIOMET 3.5 SCREW 26-50

Facility

$94.00

Service Code	HCPCS C1713
Hospital Charge Code	40205835
Hospital Revenue Code	278
Min. Negotiated Rate	$47.00
Max. Negotiated Rate	$47.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$47.00
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00

BIOMET ACTBLR SHELL 50MM/24MM

Facility

$3,360.00

Service Code	HCPCS C1776
Hospital Charge Code	40206242
Hospital Revenue Code	278
Min. Negotiated Rate	$1,680.00
Max. Negotiated Rate	$1,680.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,680.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,680.00

BIOMET ACTBLR SHELL 50MM/24MM

Facility

$3,360.00

Service Code	HCPCS C1776
Hospital Charge Code	40206242
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,528.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,848.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,016.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,680.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,932.00
Rate for Payer: EmblemHealth Commercial	$1,680.00
Rate for Payer: Fidelis Medicare Advantage	$3,528.00
Rate for Payer: Group Health Inc Commercial	$1,680.00
Rate for Payer: Group Health Inc Medicare	$1,176.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,680.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,680.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,184.00

BIOMET ARTHOTEK 11MM MENI SCRW

Facility

$480.00

Service Code	HCPCS C1713
Hospital Charge Code	40205806
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$504.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$264.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$288.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$240.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$276.00
Rate for Payer: EmblemHealth Commercial	$240.00
Rate for Payer: Fidelis Medicare Advantage	$504.00
Rate for Payer: Group Health Inc Commercial	$240.00
Rate for Payer: Group Health Inc Medicare	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$240.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$312.00

BIOMET ARTHOTEK 11MM MENI SCRW

Facility

$480.00

Service Code	HCPCS C1713
Hospital Charge Code	40205806
Hospital Revenue Code	278
Min. Negotiated Rate	$240.00
Max. Negotiated Rate	$240.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$240.00
Rate for Payer: Hamaspik Choice Inc Medicare	$240.00

BIOMET BIPOLAR CUP

Facility

$2,194.00

Hospital Charge Code	40024000
Hospital Revenue Code	270
Min. Negotiated Rate	$767.90
Max. Negotiated Rate	$1,755.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,206.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,097.00
Rate for Payer: Aetna Government	$1,097.00
Rate for Payer: Brighton Health Commercial	$1,645.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,755.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,491.92
Rate for Payer: Group Health Inc Commercial	$1,097.00
Rate for Payer: Group Health Inc Medicare	$767.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,097.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,097.00

BIOMET BIPOLAR LINER

Facility

$2,384.24

Service Code	HCPCS C1776
Hospital Charge Code	40024005
Hospital Revenue Code	278
Min. Negotiated Rate	$1,192.12
Max. Negotiated Rate	$1,192.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,192.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,192.12

BIOMET BIPOLAR LINER

Facility

$2,384.24

Service Code	HCPCS C1776
Hospital Charge Code	40024005
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,503.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,311.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,430.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,192.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,370.94
Rate for Payer: EmblemHealth Commercial	$1,192.12
Rate for Payer: Fidelis Medicare Advantage	$2,503.45
Rate for Payer: Group Health Inc Commercial	$1,192.12
Rate for Payer: Group Health Inc Medicare	$834.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,192.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,192.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,549.76

Know your out-of-pocket cost for care.

All Charges