St. Barnabas Hospital

All Charges

Charge

Type

Price

DEPUY SCREW 3.5MM X12

Facility OP

$3,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40208162
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,570.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
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 INNER 5.0

Facility IP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40029577
Hospital Revenue Code	278
Min. Negotiated Rate	$85.00
Max. Negotiated Rate	$85.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00

DEPUY SCREW INNER 5.0

Facility OP

$170.00

Service Code	HCPCS C1713
Hospital Charge Code	40029577
Hospital Revenue Code	278
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$178.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
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	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: Fidelis Medicare Advantage	$178.50
Rate for Payer: Group Health Inc Commercial	$85.00
Rate for Payer: Group Health Inc Medicare	$59.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.00
Rate for Payer: Hamaspik Choice Inc Medicare	$85.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$110.50

DEPUY SCREW S/D 14MM

Facility IP

$960.00

Service Code	HCPCS C1713
Hospital Charge Code	40205392
Hospital Revenue Code	278
Min. Negotiated Rate	$480.00
Max. Negotiated Rate	$480.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$480.00
Rate for Payer: Hamaspik Choice Inc Medicare	$480.00

DEPUY SCREW S/D 14MM

Facility OP

$960.00

Service Code	HCPCS C1713
Hospital Charge Code	40205392
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,008.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$528.00
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	$480.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.00
Rate for Payer: Fidelis Medicare Advantage	$1,008.00
Rate for Payer: Group Health Inc Commercial	$480.00
Rate for Payer: Group Health Inc Medicare	$336.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$480.00
Rate for Payer: Hamaspik Choice Inc Medicare	$480.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$624.00

DEPUY SCREW SELF DRILLING 12MM

Facility OP

$1,040.00

Service Code	HCPCS C1776
Hospital Charge Code	40208138
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,092.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$572.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$598.00
Rate for Payer: Fidelis Medicare Advantage	$1,092.00
Rate for Payer: Group Health Inc Commercial	$520.00
Rate for Payer: Group Health Inc Medicare	$364.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$520.00
Rate for Payer: Hamaspik Choice Inc Medicare	$520.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$676.00

DEPUY SCREW SELF DRILLING 12MM

Facility IP

$1,040.00

Service Code	HCPCS C1776
Hospital Charge Code	40208138
Hospital Revenue Code	278
Min. Negotiated Rate	$520.00
Max. Negotiated Rate	$520.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$520.00
Rate for Payer: Hamaspik Choice Inc Medicare	$520.00

DEPUY SCRW MENISCAL CLEFX 2X10MM

Facility OP

$626.00

Service Code	HCPCS C1776
Hospital Charge Code	40207400
Hospital Revenue Code	278
Min. Negotiated Rate	$219.10
Max. Negotiated Rate	$657.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$344.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$313.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$359.95
Rate for Payer: Fidelis Medicare Advantage	$657.30
Rate for Payer: Group Health Inc Commercial	$313.00
Rate for Payer: Group Health Inc Medicare	$219.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.00
Rate for Payer: Hamaspik Choice Inc Medicare	$313.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$406.90

DEPUY SCRW MENISCAL CLEFX 2X10MM

Facility IP

$626.00

Service Code	HCPCS C1776
Hospital Charge Code	40207400
Hospital Revenue Code	278
Min. Negotiated Rate	$313.00
Max. Negotiated Rate	$313.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$313.00
Rate for Payer: Hamaspik Choice Inc Medicare	$313.00

DEPUY SET SCREW

Facility IP

$360.00

Service Code	HCPCS C1713
Hospital Charge Code	40205778
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00

DEPUY SET SCREW

Facility OP

$360.00

Service Code	HCPCS C1713
Hospital Charge Code	40205778
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$378.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.00
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	$180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.00
Rate for Payer: Fidelis Medicare Advantage	$378.00
Rate for Payer: Group Health Inc Commercial	$180.00
Rate for Payer: Group Health Inc Medicare	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$234.00

DEPUY SET SCREW

Facility IP

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40029579
Hospital Revenue Code	278
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00

DEPUY SET SCREW

Facility OP

$140.00

Service Code	HCPCS C1713
Hospital Charge Code	40029579
Hospital Revenue Code	278
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$147.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.00
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	$70.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.50
Rate for Payer: Fidelis Medicare Advantage	$147.00
Rate for Payer: Group Health Inc Commercial	$70.00
Rate for Payer: Group Health Inc Medicare	$49.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.00
Rate for Payer: Hamaspik Choice Inc Medicare	$70.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$91.00

DEPUY SLOTTED HOOK

Facility OP

$530.00

Hospital Charge Code	40029572
Hospital Revenue Code	279
Min. Negotiated Rate	$185.50
Max. Negotiated Rate	$424.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$291.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$265.00
Rate for Payer: Aetna Government	$265.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$424.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$360.40
Rate for Payer: Group Health Inc Commercial	$265.00
Rate for Payer: Group Health Inc Medicare	$185.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$265.00
Rate for Payer: Hamaspik Choice Inc Medicare	$265.00

DEPUY SLOT TRANSVERSE CONNECTOR

Facility OP

$1,680.00

Hospital Charge Code	40029557
Hospital Revenue Code	279
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$1,344.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$924.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$840.00
Rate for Payer: Aetna Government	$840.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,344.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,142.40
Rate for Payer: Group Health Inc Commercial	$840.00
Rate for Payer: Group Health Inc Medicare	$588.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$840.00
Rate for Payer: Hamaspik Choice Inc Medicare	$840.00

DEPUY SUMMIT STEM STDZ

Facility OP

$10,920.00

Service Code	HCPCS C1713
Hospital Charge Code	40029544
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$11,466.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,006.00
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	$5,460.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,279.00
Rate for Payer: Fidelis Medicare Advantage	$11,466.00
Rate for Payer: Group Health Inc Commercial	$5,460.00
Rate for Payer: Group Health Inc Medicare	$3,822.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,460.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,098.00

DEPUY SUMMIT STEM STDZ

Facility IP

$10,920.00

Service Code	HCPCS C1713
Hospital Charge Code	40029544
Hospital Revenue Code	278
Min. Negotiated Rate	$5,460.00
Max. Negotiated Rate	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,460.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,460.00

DEPUY SYMPHONY GRFT DELVY

Facility OP

$550.00

Hospital Charge Code	40029571
Hospital Revenue Code	279
Min. Negotiated Rate	$192.50
Max. Negotiated Rate	$440.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$302.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$275.00
Rate for Payer: Aetna Government	$275.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$374.00
Rate for Payer: Group Health Inc Commercial	$275.00
Rate for Payer: Group Health Inc Medicare	$192.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$275.00

DEPUY SYMPHONY PRCS (2761-02-120)

Facility OP

$1,290.00

Hospital Charge Code	40029565
Hospital Revenue Code	279
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$1,032.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$709.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$645.00
Rate for Payer: Aetna Government	$645.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,032.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$877.20
Rate for Payer: Group Health Inc Commercial	$645.00
Rate for Payer: Group Health Inc Medicare	$451.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$645.00
Rate for Payer: Hamaspik Choice Inc Medicare	$645.00

DEPUY SYMPHONY PRCS DISPO

Facility OP

$1,290.00

Hospital Charge Code	40029560
Hospital Revenue Code	279
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$1,032.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$709.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$645.00
Rate for Payer: Aetna Government	$645.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,032.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$877.20
Rate for Payer: Group Health Inc Commercial	$645.00
Rate for Payer: Group Health Inc Medicare	$451.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$645.00
Rate for Payer: Hamaspik Choice Inc Medicare	$645.00

DEPUY SYMPHONY PROCESS DISPOSE

Facility OP

$1,290.00

Hospital Charge Code	40203343
Hospital Revenue Code	272
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$1,032.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$709.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$645.00
Rate for Payer: Aetna Government	$645.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,032.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$877.20
Rate for Payer: Group Health Inc Commercial	$645.00
Rate for Payer: Group Health Inc Medicare	$451.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$645.00
Rate for Payer: Hamaspik Choice Inc Medicare	$645.00

DEPUY SYMPHONY PROCESS DISPOSE

Facility OP

$1,290.00

Hospital Charge Code	40009325
Hospital Revenue Code	272
Min. Negotiated Rate	$451.50
Max. Negotiated Rate	$1,032.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$709.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$645.00
Rate for Payer: Aetna Government	$645.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,032.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$877.20
Rate for Payer: Group Health Inc Commercial	$645.00
Rate for Payer: Group Health Inc Medicare	$451.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$645.00
Rate for Payer: Hamaspik Choice Inc Medicare	$645.00

DEPUY SYMPHONY SPRAY APPLICATOR

Facility OP

$180.00

Hospital Charge Code	40029576
Hospital Revenue Code	270
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$144.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90.00
Rate for Payer: Aetna Government	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.40
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

DEPUY TAP 3.0

Facility OP

$640.00

Service Code	HCPCS C1713
Hospital Charge Code	40029569
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$672.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$352.00
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	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$368.00
Rate for Payer: Fidelis Medicare Advantage	$672.00
Rate for Payer: Group Health Inc Commercial	$320.00
Rate for Payer: Group Health Inc Medicare	$224.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$320.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$416.00

DEPUY TAP 3.0

Facility IP

$640.00

Service Code	HCPCS C1713
Hospital Charge Code	40029569
Hospital Revenue Code	278
Min. Negotiated Rate	$320.00
Max. Negotiated Rate	$320.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.00
Rate for Payer: Hamaspik Choice Inc Medicare	$320.00

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