St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

STEM REV ECHELON 12X190

Facility

$15,682.13

Service Code	HCPCS C1776
Hospital Charge Code	64903546
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$16,466.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,625.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$9,409.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,841.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,017.22
Rate for Payer: EmblemHealth Commercial	$7,841.06
Rate for Payer: Fidelis Medicare Advantage	$16,466.24
Rate for Payer: Group Health Inc Commercial	$7,841.06
Rate for Payer: Group Health Inc Medicare	$5,488.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,841.06
Rate for Payer: Hamaspik Choice Inc Medicare	$7,841.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,193.38

STEM REV ECHELON 12X190

Facility

$15,682.13

Service Code	HCPCS C1776
Hospital Charge Code	64903546
Hospital Revenue Code	278
Min. Negotiated Rate	$7,841.06
Max. Negotiated Rate	$7,841.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$7,841.06
Rate for Payer: Hamaspik Choice Inc Medicare	$7,841.06

STEM REV EXT FLTD 9MM 130MM

Facility

$5,824.00

Service Code	HCPCS C1776
Hospital Charge Code	64906413
Hospital Revenue Code	278
Min. Negotiated Rate	$2,912.00
Max. Negotiated Rate	$2,912.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,912.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,912.00

STEM REV EXT FLTD 9MM 130MM

Facility

$5,824.00

Service Code	HCPCS C1776
Hospital Charge Code	64906413
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,115.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,203.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,494.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,912.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,348.80
Rate for Payer: EmblemHealth Commercial	$2,912.00
Rate for Payer: Fidelis Medicare Advantage	$6,115.20
Rate for Payer: Group Health Inc Commercial	$2,912.00
Rate for Payer: Group Health Inc Medicare	$2,038.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,912.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,912.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,785.60

STEM SECR-FX MAX NECK ANG HIP

Facility

$16,301.25

Service Code	HCPCS C1776
Hospital Charge Code	64901784
Hospital Revenue Code	278
Min. Negotiated Rate	$8,150.62
Max. Negotiated Rate	$8,150.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,150.62
Rate for Payer: Hamaspik Choice Inc Medicare	$8,150.62

STEM SECR-FX MAX NECK ANG HIP

Facility

$16,301.25

Service Code	HCPCS C1776
Hospital Charge Code	64901784
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,116.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8,965.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$9,780.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,150.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,373.22
Rate for Payer: EmblemHealth Commercial	$8,150.62
Rate for Payer: Fidelis Medicare Advantage	$17,116.31
Rate for Payer: Group Health Inc Commercial	$8,150.62
Rate for Payer: Group Health Inc Medicare	$5,705.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,150.62
Rate for Payer: Hamaspik Choice Inc Medicare	$8,150.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10,595.81

STEM SHOULDER PRIMARY 7 X 122MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64906972
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$8,925.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,675.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$5,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,887.50
Rate for Payer: EmblemHealth Commercial	$4,250.00
Rate for Payer: Fidelis Medicare Advantage	$8,925.00
Rate for Payer: Group Health Inc Commercial	$4,250.00
Rate for Payer: Group Health Inc Medicare	$2,975.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,525.00

STEM SHOULDER PRIMARY 7 X 122MM

Facility

$8,500.00

Service Code	HCPCS C1776
Hospital Charge Code	64906972
Hospital Revenue Code	278
Min. Negotiated Rate	$4,250.00
Max. Negotiated Rate	$4,250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,250.00

STEM SIZE 5 ACCOLA II 132 DEG

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64905740
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$17,971.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9,413.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$10,269.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8,557.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$9,841.56
Rate for Payer: EmblemHealth Commercial	$8,557.88
Rate for Payer: Fidelis Medicare Advantage	$17,971.54
Rate for Payer: Group Health Inc Commercial	$8,557.88
Rate for Payer: Group Health Inc Medicare	$5,990.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11,125.24

STEM SIZE 5 ACCOLA II 132 DEG

Facility

$17,115.75

Service Code	HCPCS C1776
Hospital Charge Code	64905740
Hospital Revenue Code	278
Min. Negotiated Rate	$8,557.88
Max. Negotiated Rate	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$8,557.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8,557.88

STEM STD 12 ECH

Facility

$9,999.25

Service Code	HCPCS C1713
Hospital Charge Code	64903640
Hospital Revenue Code	278
Min. Negotiated Rate	$4,999.62
Max. Negotiated Rate	$4,999.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,999.62
Rate for Payer: Hamaspik Choice Inc Medicare	$4,999.62

STEM STD 12 ECH

Facility

$9,999.25

Service Code	HCPCS C1713
Hospital Charge Code	64903640
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$10,499.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,499.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,999.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,999.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,749.57
Rate for Payer: EmblemHealth Commercial	$4,999.62
Rate for Payer: Fidelis Medicare Advantage	$10,499.21
Rate for Payer: Group Health Inc Commercial	$4,999.62
Rate for Payer: Group Health Inc Medicare	$3,499.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,999.62
Rate for Payer: Hamaspik Choice Inc Medicare	$4,999.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6,499.51

STEM_STD AVENIR NULR 12/14-010601

Facility

$4,668.00

Service Code	HCPCS C1776
Hospital Charge Code	64906408
Hospital Revenue Code	278
Min. Negotiated Rate	$2,334.00
Max. Negotiated Rate	$2,334.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,334.00

STEM_STD AVENIR NULR 12/14-010601

Facility

$4,668.00

Service Code	HCPCS C1776
Hospital Charge Code	64906408
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,901.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,567.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,800.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,334.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,684.10
Rate for Payer: EmblemHealth Commercial	$2,334.00
Rate for Payer: Fidelis Medicare Advantage	$4,901.40
Rate for Payer: Group Health Inc Commercial	$2,334.00
Rate for Payer: Group Health Inc Medicare	$1,633.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,334.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,334.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,034.20

STEM STRGT 15DIA 145MM 100

Facility

$4,460.00

Service Code	HCPCS C1713
Hospital Charge Code	64905888
Hospital Revenue Code	278
Min. Negotiated Rate	$2,230.00
Max. Negotiated Rate	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,230.00

STEM STRGT 15DIA 145MM 100

Facility

$4,460.00

Service Code	HCPCS C1713
Hospital Charge Code	64905888
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$4,683.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,453.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,676.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,230.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,564.50
Rate for Payer: EmblemHealth Commercial	$2,230.00
Rate for Payer: Fidelis Medicare Advantage	$4,683.00
Rate for Payer: Group Health Inc Commercial	$2,230.00
Rate for Payer: Group Health Inc Medicare	$1,561.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,230.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,230.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,899.00

STEM STS ARCOS W-SCW DIST

Facility

$9,952.00

Hospital Charge Code	64906707
Hospital Revenue Code	279
Min. Negotiated Rate	$3,483.20
Max. Negotiated Rate	$7,961.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,473.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,976.00
Rate for Payer: Aetna Government	$4,976.00
Rate for Payer: Brighton Health Commercial	$7,464.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,961.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,767.36
Rate for Payer: Group Health Inc Commercial	$4,976.00
Rate for Payer: Group Health Inc Medicare	$3,483.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,976.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,976.00

STEM STS DISTAL

Facility

$12,440.00

Service Code	HCPCS C1776
Hospital Charge Code	64907130
Hospital Revenue Code	278
Min. Negotiated Rate	$6,220.00
Max. Negotiated Rate	$6,220.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,220.00

STEM STS DISTAL

Facility

$12,440.00

Service Code	HCPCS C1776
Hospital Charge Code	64907130
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$13,062.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,842.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$7,464.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6,220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$7,153.00
Rate for Payer: EmblemHealth Commercial	$6,220.00
Rate for Payer: Fidelis Medicare Advantage	$13,062.00
Rate for Payer: Group Health Inc Commercial	$6,220.00
Rate for Payer: Group Health Inc Medicare	$4,354.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6,220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6,220.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,086.00

STEM TAPER ZMR XL 17X135MM

Facility

$11,220.00

Service Code	HCPCS C1776
Hospital Charge Code	64905851
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$11,781.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,171.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$6,732.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,451.50
Rate for Payer: EmblemHealth Commercial	$5,610.00
Rate for Payer: Fidelis Medicare Advantage	$11,781.00
Rate for Payer: Group Health Inc Commercial	$5,610.00
Rate for Payer: Group Health Inc Medicare	$3,927.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,293.00

STEM TAPER ZMR XL 17X135MM

Facility

$11,220.00

Service Code	HCPCS C1776
Hospital Charge Code	64905851
Hospital Revenue Code	278
Min. Negotiated Rate	$5,610.00
Max. Negotiated Rate	$5,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,610.00

STEM TIB CMNTD SZ E NON-POR

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905779
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: EmblemHealth Commercial	$2,500.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

STEM TIB CMNTD SZ E NON-POR

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905779
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

STEM TIBIAL CMNTED SZ D NON

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905754
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: EmblemHealth Commercial	$2,500.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

STEM TIBIAL CMNTED SZ D NON

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905754
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

Know your out-of-pocket cost for care.

All Charges