St. Barnabas Hospital

All Charges

Charge

Type

Price

DEPUY PINNACLE SECTOR 54 CUP

Facility IP

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	40029545
Hospital Revenue Code	278
Min. Negotiated Rate	$2,125.00
Max. Negotiated Rate	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00

DEPUY PIN ORTHOSORB #84-1070

Facility OP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40029573
Hospital Revenue Code	278
Min. Negotiated Rate	$98.70
Max. Negotiated Rate	$296.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.10
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	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: Fidelis Medicare Advantage	$296.10
Rate for Payer: Group Health Inc Commercial	$141.00
Rate for Payer: Group Health Inc Medicare	$98.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$183.30

DEPUY PIN ORTHOSORB #84-1070

Facility IP

$282.00

Service Code	HCPCS C1713
Hospital Charge Code	40029573
Hospital Revenue Code	278
Min. Negotiated Rate	$141.00
Max. Negotiated Rate	$141.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.00
Rate for Payer: Hamaspik Choice Inc Medicare	$141.00

DEPUY PLATE 20 MM

Facility IP

$3,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40205361
Hospital Revenue Code	278
Min. Negotiated Rate	$1,800.00
Max. Negotiated Rate	$1,800.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,800.00

DEPUY PLATE 20 MM

Facility OP

$3,600.00

Service Code	HCPCS C1713
Hospital Charge Code	40205361
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,780.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,980.00
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	$1,800.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,070.00
Rate for Payer: Fidelis Medicare Advantage	$3,780.00
Rate for Payer: Group Health Inc Commercial	$1,800.00
Rate for Payer: Group Health Inc Medicare	$1,260.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,800.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,800.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,340.00

DE PUY POLY SCREW 6X45MM

Facility OP

$3,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40205636
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,727.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,952.50
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	$1,775.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,041.25
Rate for Payer: Fidelis Medicare Advantage	$3,727.50
Rate for Payer: Group Health Inc Commercial	$1,775.00
Rate for Payer: Group Health Inc Medicare	$1,242.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,775.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,307.50

DE PUY POLY SCREW 6X45MM

Facility IP

$3,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40205636
Hospital Revenue Code	278
Min. Negotiated Rate	$1,775.00
Max. Negotiated Rate	$1,775.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,775.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,775.00

DEPUY REDUCED DIST HOOK

Facility OP

$1,403.33

Hospital Charge Code	40024019
Hospital Revenue Code	279
Min. Negotiated Rate	$491.17
Max. Negotiated Rate	$1,122.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$771.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$701.66
Rate for Payer: Aetna Government	$701.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,122.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$954.26
Rate for Payer: Group Health Inc Commercial	$701.66
Rate for Payer: Group Health Inc Medicare	$491.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$701.66
Rate for Payer: Hamaspik Choice Inc Medicare	$701.66

DEPUY ROD 30CM 5.0 (1745-72)

Facility OP

$760.00

Service Code	HCPCS C1713
Hospital Charge Code	40029567
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$798.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$418.00
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	$380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$437.00
Rate for Payer: Fidelis Medicare Advantage	$798.00
Rate for Payer: Group Health Inc Commercial	$380.00
Rate for Payer: Group Health Inc Medicare	$266.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.00
Rate for Payer: Hamaspik Choice Inc Medicare	$380.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$494.00

DEPUY ROD 30CM 5.0 (1745-72)

Facility IP

$760.00

Service Code	HCPCS C1713
Hospital Charge Code	40029567
Hospital Revenue Code	278
Min. Negotiated Rate	$380.00
Max. Negotiated Rate	$380.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$380.00
Rate for Payer: Hamaspik Choice Inc Medicare	$380.00

DEPUY ROD-LONG

Facility IP

$1,134.00

Service Code	HCPCS C1713
Hospital Charge Code	40024026
Hospital Revenue Code	278
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$567.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$567.00
Rate for Payer: Hamaspik Choice Inc Medicare	$567.00

DEPUY ROD-LONG

Facility OP

$1,134.00

Service Code	HCPCS C1713
Hospital Charge Code	40024026
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,190.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$623.70
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	$567.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$652.05
Rate for Payer: Fidelis Medicare Advantage	$1,190.70
Rate for Payer: Group Health Inc Commercial	$567.00
Rate for Payer: Group Health Inc Medicare	$396.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$567.00
Rate for Payer: Hamaspik Choice Inc Medicare	$567.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$737.10

DEPUY ROD-MEDIUM

Facility OP

$1,134.00

Service Code	HCPCS C1713
Hospital Charge Code	40024025
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,190.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$623.70
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	$567.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$652.05
Rate for Payer: Fidelis Medicare Advantage	$1,190.70
Rate for Payer: Group Health Inc Commercial	$567.00
Rate for Payer: Group Health Inc Medicare	$396.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$567.00
Rate for Payer: Hamaspik Choice Inc Medicare	$567.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$737.10

DEPUY ROD-MEDIUM

Facility IP

$1,134.00

Service Code	HCPCS C1713
Hospital Charge Code	40024025
Hospital Revenue Code	278
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$567.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$567.00
Rate for Payer: Hamaspik Choice Inc Medicare	$567.00

DEPUY RODS 3.5MM

Facility OP

$730.00

Service Code	HCPCS C1713
Hospital Charge Code	40029568
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$766.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$401.50
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	$365.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$419.75
Rate for Payer: Fidelis Medicare Advantage	$766.50
Rate for Payer: Group Health Inc Commercial	$365.00
Rate for Payer: Group Health Inc Medicare	$255.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$365.00
Rate for Payer: Hamaspik Choice Inc Medicare	$365.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$474.50

DEPUY RODS 3.5MM

Facility IP

$730.00

Service Code	HCPCS C1713
Hospital Charge Code	40029568
Hospital Revenue Code	278
Min. Negotiated Rate	$365.00
Max. Negotiated Rate	$365.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$365.00
Rate for Payer: Hamaspik Choice Inc Medicare	$365.00

DEPUY ROD-SHORT

Facility OP

$850.50

Service Code	HCPCS C1713
Hospital Charge Code	40024024
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$893.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$467.78
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	$425.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$489.04
Rate for Payer: Fidelis Medicare Advantage	$893.02
Rate for Payer: Group Health Inc Commercial	$425.25
Rate for Payer: Group Health Inc Medicare	$297.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$425.25
Rate for Payer: Hamaspik Choice Inc Medicare	$425.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$552.82

DEPUY ROD-SHORT

Facility IP

$850.50

Service Code	HCPCS C1713
Hospital Charge Code	40024024
Hospital Revenue Code	278
Min. Negotiated Rate	$425.25
Max. Negotiated Rate	$425.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$425.25
Rate for Payer: Hamaspik Choice Inc Medicare	$425.25

DEPUY SCREW 3.5MM X 10

Facility IP

$2,410.00

Service Code	HCPCS C1713
Hospital Charge Code	40029548
Hospital Revenue Code	278
Min. Negotiated Rate	$1,205.00
Max. Negotiated Rate	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,205.00

DEPUY SCREW 3.5MM X 10

Facility OP

$2,410.00

Service Code	HCPCS C1713
Hospital Charge Code	40029548
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,530.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,325.50
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	$1,205.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,385.75
Rate for Payer: Fidelis Medicare Advantage	$2,530.50
Rate for Payer: Group Health Inc Commercial	$1,205.00
Rate for Payer: Group Health Inc Medicare	$843.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,205.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,566.50

DEPUY SCREW 3.5MMX10

Facility IP

$3,400.00

Service Code	HCPCS C1713
Hospital Charge Code	40205459
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

DEPUY SCREW 3.5MMX10

Facility OP

$3,400.00

Service Code	HCPCS C1713
Hospital Charge Code	40205459
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
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	$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

DEPUY SCREW 3.5MM X 12

Facility OP

$2,410.00

Service Code	HCPCS C1713
Hospital Charge Code	40029547
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,530.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,325.50
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	$1,205.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,385.75
Rate for Payer: Fidelis Medicare Advantage	$2,530.50
Rate for Payer: Group Health Inc Commercial	$1,205.00
Rate for Payer: Group Health Inc Medicare	$843.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,205.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,566.50

DEPUY SCREW 3.5MM X 12

Facility IP

$2,410.00

Service Code	HCPCS C1713
Hospital Charge Code	40029547
Hospital Revenue Code	278
Min. Negotiated Rate	$1,205.00
Max. Negotiated Rate	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,205.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,205.00

DEPUY SCREW 3.5MM X12

Facility IP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40208162
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

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