St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEPUY MITEK BIO ANCHOR W/ORTHOCRD

Facility

$706.00

Service Code	HCPCS C1713
Hospital Charge Code	40205927
Hospital Revenue Code	278
Min. Negotiated Rate	$353.00
Max. Negotiated Rate	$353.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.00
Rate for Payer: Hamaspik Choice Inc Medicare	$353.00

DEPUY MITEK LUP BR ANCH W/DS ORTH

Facility

$1,054.00

Service Code	HCPCS C1713
Hospital Charge Code	40204710
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,106.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$579.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$632.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$527.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$606.05
Rate for Payer: EmblemHealth Commercial	$527.00
Rate for Payer: Fidelis Medicare Advantage	$1,106.70
Rate for Payer: Group Health Inc Commercial	$527.00
Rate for Payer: Group Health Inc Medicare	$368.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$527.00
Rate for Payer: Hamaspik Choice Inc Medicare	$527.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$685.10

DEPUY MITEK LUP BR ANCH W/DS ORTH

Facility

$1,054.00

Service Code	HCPCS C1713
Hospital Charge Code	40204710
Hospital Revenue Code	278
Min. Negotiated Rate	$527.00
Max. Negotiated Rate	$527.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$527.00
Rate for Payer: Hamaspik Choice Inc Medicare	$527.00

DEPUY MITEK OMIN MENISCL SYSTEM

Facility

$600.00

Service Code	HCPCS C1776
Hospital Charge Code	40205667
Hospital Revenue Code	278
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$630.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$330.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$360.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$300.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$345.00
Rate for Payer: EmblemHealth Commercial	$300.00
Rate for Payer: Fidelis Medicare Advantage	$630.00
Rate for Payer: Group Health Inc Commercial	$300.00
Rate for Payer: Group Health Inc Medicare	$210.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$300.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$390.00

DEPUY MITEK OMIN MENISCL SYSTEM

Facility

$600.00

Service Code	HCPCS C1776
Hospital Charge Code	40205667
Hospital Revenue Code	278
Min. Negotiated Rate	$300.00
Max. Negotiated Rate	$300.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$300.00
Rate for Payer: Hamaspik Choice Inc Medicare	$300.00

DEPUY NARROW HOOK

Facility

$1,403.33

Hospital Charge Code	40024020
Hospital Revenue Code	270
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: Brighton Health Commercial	$1,052.50
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 NUT OUTER 5.0

Facility

$170.00

Hospital Charge Code	40029578
Hospital Revenue Code	270
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.00
Rate for Payer: Aetna Government	$85.00
Rate for Payer: Brighton Health Commercial	$127.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.60
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

DEPUY OUTER NUT

Facility

$170.10

Hospital Charge Code	40024023
Hospital Revenue Code	270
Min. Negotiated Rate	$59.54
Max. Negotiated Rate	$136.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$85.05
Rate for Payer: Aetna Government	$85.05
Rate for Payer: Brighton Health Commercial	$127.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$136.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.67
Rate for Payer: Group Health Inc Commercial	$85.05
Rate for Payer: Group Health Inc Medicare	$59.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$85.05
Rate for Payer: Hamaspik Choice Inc Medicare	$85.05

DEPUY PEDICLE HOOK

Facility

$1,403.33

Hospital Charge Code	40024021
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: Brighton Health Commercial	$1,052.50
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 PINNACLE LINER 28-54

Facility

$2,830.00

Service Code	HCPCS C1776
Hospital Charge Code	40029546
Hospital Revenue Code	278
Min. Negotiated Rate	$1,415.00
Max. Negotiated Rate	$1,415.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,415.00

DEPUY PINNACLE LINER 28-54

Facility

$2,830.00

Service Code	HCPCS C1776
Hospital Charge Code	40029546
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,971.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,556.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,698.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,415.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,627.25
Rate for Payer: EmblemHealth Commercial	$1,415.00
Rate for Payer: Fidelis Medicare Advantage	$2,971.50
Rate for Payer: Group Health Inc Commercial	$1,415.00
Rate for Payer: Group Health Inc Medicare	$990.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,415.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,415.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,839.50

DEPUY PINNACLE SECTOR 54 CUP

Facility

$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 PINNACLE SECTOR 54 CUP

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	40029545
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,462.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,337.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,550.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,125.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,443.75
Rate for Payer: EmblemHealth Commercial	$2,125.00
Rate for Payer: Fidelis Medicare Advantage	$4,462.50
Rate for Payer: Group Health Inc Commercial	$2,125.00
Rate for Payer: Group Health Inc Medicare	$1,487.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,125.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,125.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,762.50

DEPUY PIN ORTHOSORB #84-1070

Facility

$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 PIN ORTHOSORB #84-1070

Facility

$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: Brighton Health Commercial	$169.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$141.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$162.15
Rate for Payer: EmblemHealth Commercial	$141.00
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 PLATE 20 MM

Facility

$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

$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: Brighton Health Commercial	$2,160.00
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: EmblemHealth Commercial	$1,800.00
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

$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: Brighton Health Commercial	$2,130.00
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: EmblemHealth Commercial	$1,775.00
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

$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

$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: Brighton Health Commercial	$1,052.50
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

$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 30CM 5.0 (1745-72)

Facility

$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: Brighton Health Commercial	$456.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$380.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$437.00
Rate for Payer: EmblemHealth Commercial	$380.00
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-LONG

Facility

$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

$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: Brighton Health Commercial	$680.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$567.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$652.05
Rate for Payer: EmblemHealth Commercial	$567.00
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

$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

Know your out-of-pocket cost for care.

All Charges