St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TIB/HUM CALI DRILL-4.3MM STR

Facility

$250.56

Service Code	HCPCS C1713
Hospital Charge Code	40006469
Hospital Revenue Code	278
Min. Negotiated Rate	$87.70
Max. Negotiated Rate	$263.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$137.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$150.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$125.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$144.07
Rate for Payer: EmblemHealth Commercial	$125.28
Rate for Payer: Fidelis Medicare Advantage	$263.09
Rate for Payer: Group Health Inc Commercial	$125.28
Rate for Payer: Group Health Inc Medicare	$87.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$125.28
Rate for Payer: Hamaspik Choice Inc Medicare	$125.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$162.86

TIB/HUM CALI DRILL-4.4MMSTR

Facility

$223.20

Service Code	HCPCS C1713
Hospital Charge Code	40006468
Hospital Revenue Code	278
Min. Negotiated Rate	$111.60
Max. Negotiated Rate	$111.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.60
Rate for Payer: Hamaspik Choice Inc Medicare	$111.60

TIB/HUM CALI DRILL-4.4MMSTR

Facility

$223.20

Service Code	HCPCS C1713
Hospital Charge Code	40006468
Hospital Revenue Code	278
Min. Negotiated Rate	$78.12
Max. Negotiated Rate	$234.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$133.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$111.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$128.34
Rate for Payer: EmblemHealth Commercial	$111.60
Rate for Payer: Fidelis Medicare Advantage	$234.36
Rate for Payer: Group Health Inc Commercial	$111.60
Rate for Payer: Group Health Inc Medicare	$78.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.60
Rate for Payer: Hamaspik Choice Inc Medicare	$111.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$145.08

TIBIA INS ROT HNG

Facility

$2,161.88

Service Code	HCPCS C1776
Hospital Charge Code	64907302
Hospital Revenue Code	278
Min. Negotiated Rate	$1,080.94
Max. Negotiated Rate	$1,080.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.94

TIBIA INS ROT HNG

Facility

$2,161.88

Service Code	HCPCS C1776
Hospital Charge Code	64907302
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,269.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,189.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,297.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,080.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,243.08
Rate for Payer: EmblemHealth Commercial	$1,080.94
Rate for Payer: Fidelis Medicare Advantage	$2,269.97
Rate for Payer: Group Health Inc Commercial	$1,080.94
Rate for Payer: Group Health Inc Medicare	$756.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,080.94
Rate for Payer: Hamaspik Choice Inc Medicare	$1,080.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,405.22

TIBIA KRH POLY

Facility

$5,128.12

Service Code	HCPCS C1776
Hospital Charge Code	64907261
Hospital Revenue Code	278
Min. Negotiated Rate	$2,564.06
Max. Negotiated Rate	$2,564.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,564.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2,564.06

TIBIA KRH POLY

Facility

$5,128.12

Service Code	HCPCS C1776
Hospital Charge Code	64907261
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,384.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,820.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,076.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,564.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,948.67
Rate for Payer: EmblemHealth Commercial	$2,564.06
Rate for Payer: Fidelis Medicare Advantage	$5,384.53
Rate for Payer: Group Health Inc Commercial	$2,564.06
Rate for Payer: Group Health Inc Medicare	$1,794.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,564.06
Rate for Payer: Hamaspik Choice Inc Medicare	$2,564.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,333.28

TIBIAL 9 X 375

Facility

$3,466.13

Service Code	HCPCS C1713
Hospital Charge Code	64903220
Hospital Revenue Code	278
Min. Negotiated Rate	$1,733.06
Max. Negotiated Rate	$1,733.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,733.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,733.06

TIBIAL 9 X 375

Facility

$3,466.13

Service Code	HCPCS C1713
Hospital Charge Code	64903220
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,639.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,906.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,079.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,733.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,993.02
Rate for Payer: EmblemHealth Commercial	$1,733.06
Rate for Payer: Fidelis Medicare Advantage	$3,639.44
Rate for Payer: Group Health Inc Commercial	$1,733.06
Rate for Payer: Group Health Inc Medicare	$1,213.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,733.06
Rate for Payer: Hamaspik Choice Inc Medicare	$1,733.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,252.98

TIBIAL BASE ROTAT SZ 5 CEM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	40005151
Hospital Revenue Code	278
Min. Negotiated Rate	$1,750.00
Max. Negotiated Rate	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00

TIBIAL BASE ROTAT SZ 5 CEM

Facility

$4,375.00

Service Code	HCPCS C1776
Hospital Charge Code	64905240
Hospital Revenue Code	278
Min. Negotiated Rate	$2,187.50
Max. Negotiated Rate	$2,187.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,187.50

TIBIAL BASE ROTAT SZ 5 CEM

Facility

$4,375.00

Service Code	HCPCS C1776
Hospital Charge Code	64905240
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,593.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,406.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,625.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,187.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,515.62
Rate for Payer: EmblemHealth Commercial	$2,187.50
Rate for Payer: Fidelis Medicare Advantage	$4,593.75
Rate for Payer: Group Health Inc Commercial	$2,187.50
Rate for Payer: Group Health Inc Medicare	$1,531.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,187.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,187.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,843.75

TIBIAL BASE ROTAT SZ 5 CEM

Facility

$3,500.00

Service Code	HCPCS C1776
Hospital Charge Code	40005151
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,675.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,925.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,012.50
Rate for Payer: EmblemHealth Commercial	$1,750.00
Rate for Payer: Fidelis Medicare Advantage	$3,675.00
Rate for Payer: Group Health Inc Commercial	$1,750.00
Rate for Payer: Group Health Inc Medicare	$1,225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,275.00

TIBIAL BEARING 12MMX71/75MM

Facility

$3,015.00

Service Code	HCPCS C1776
Hospital Charge Code	64903853
Hospital Revenue Code	278
Min. Negotiated Rate	$1,507.50
Max. Negotiated Rate	$1,507.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,507.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,507.50

TIBIAL BEARING 12MMX71/75MM

Facility

$3,015.00

Service Code	HCPCS C1776
Hospital Charge Code	64903853
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,165.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,658.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,809.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,507.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,733.62
Rate for Payer: EmblemHealth Commercial	$1,507.50
Rate for Payer: Fidelis Medicare Advantage	$3,165.75
Rate for Payer: Group Health Inc Commercial	$1,507.50
Rate for Payer: Group Health Inc Medicare	$1,055.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,507.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,507.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,959.75

TIBIAL BEARING INSERT 3X9MM

Facility

$6,040.00

Service Code	HCPCS C1776
Hospital Charge Code	40200358
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,342.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,322.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,624.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,020.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,473.00
Rate for Payer: EmblemHealth Commercial	$3,020.00
Rate for Payer: Fidelis Medicare Advantage	$6,342.00
Rate for Payer: Group Health Inc Commercial	$3,020.00
Rate for Payer: Group Health Inc Medicare	$2,114.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,020.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,020.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,926.00

TIBIAL BEARING INSERT 3X9MM

Facility

$6,040.00

Service Code	HCPCS C1776
Hospital Charge Code	40200358
Hospital Revenue Code	278
Min. Negotiated Rate	$3,020.00
Max. Negotiated Rate	$3,020.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,020.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,020.00

TIBIAL INSERT ROTAT SZ5 6MM

Facility

$2,100.00

Service Code	HCPCS C1776
Hospital Charge Code	40005152
Hospital Revenue Code	278
Min. Negotiated Rate	$1,050.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00

TIBIAL INSERT ROTAT SZ5 6MM

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	64905242
Hospital Revenue Code	278
Min. Negotiated Rate	$1,312.50
Max. Negotiated Rate	$1,312.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,312.50

TIBIAL INSERT ROTAT SZ5 6MM

Facility

$2,100.00

Service Code	HCPCS C1776
Hospital Charge Code	40005152
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,205.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,155.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,260.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,050.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,207.50
Rate for Payer: EmblemHealth Commercial	$1,050.00
Rate for Payer: Fidelis Medicare Advantage	$2,205.00
Rate for Payer: Group Health Inc Commercial	$1,050.00
Rate for Payer: Group Health Inc Medicare	$735.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,050.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,365.00

TIBIAL INSERT ROTAT SZ5 6MM

Facility

$2,625.00

Service Code	HCPCS C1776
Hospital Charge Code	64905242
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,756.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,443.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,575.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,312.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,509.38
Rate for Payer: EmblemHealth Commercial	$1,312.50
Rate for Payer: Fidelis Medicare Advantage	$2,756.25
Rate for Payer: Group Health Inc Commercial	$1,312.50
Rate for Payer: Group Health Inc Medicare	$918.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,312.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,312.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,706.25

TIBIAL NAIL, STANDARD

Facility

$2,683.00

Hospital Charge Code	40202155
Hospital Revenue Code	270
Min. Negotiated Rate	$939.05
Max. Negotiated Rate	$2,146.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,475.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,341.50
Rate for Payer: Aetna Government	$1,341.50
Rate for Payer: Brighton Health Commercial	$2,012.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,146.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,824.44
Rate for Payer: Group Health Inc Commercial	$1,341.50
Rate for Payer: Group Health Inc Medicare	$939.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,341.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,341.50

TIBIAL SLEEVE

Facility

$1,738.12

Service Code	HCPCS C1776
Hospital Charge Code	64907305
Hospital Revenue Code	278
Min. Negotiated Rate	$869.06
Max. Negotiated Rate	$869.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$869.06
Rate for Payer: Hamaspik Choice Inc Medicare	$869.06

TIBIAL SLEEVE

Facility

$1,738.12

Service Code	HCPCS C1776
Hospital Charge Code	64907305
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,825.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$955.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,042.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$869.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$999.42
Rate for Payer: EmblemHealth Commercial	$869.06
Rate for Payer: Fidelis Medicare Advantage	$1,825.03
Rate for Payer: Group Health Inc Commercial	$869.06
Rate for Payer: Group Health Inc Medicare	$608.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$869.06
Rate for Payer: Hamaspik Choice Inc Medicare	$869.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,129.78

TIBIA NCB-PT 3H, 13H, LEFT

Facility

$3,615.30

Service Code	HCPCS C1713
Hospital Charge Code	64905606
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,796.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,988.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,169.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,807.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,078.80
Rate for Payer: EmblemHealth Commercial	$1,807.65
Rate for Payer: Fidelis Medicare Advantage	$3,796.06
Rate for Payer: Group Health Inc Commercial	$1,807.65
Rate for Payer: Group Health Inc Medicare	$1,265.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,807.65
Rate for Payer: Hamaspik Choice Inc Medicare	$1,807.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,349.94

Know your out-of-pocket cost for care.

All Charges