St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEPUY ROD-MEDIUM

Facility

$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: 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 RODS 3.5MM

Facility

$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: Brighton Health Commercial	$438.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$365.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$419.75
Rate for Payer: EmblemHealth Commercial	$365.00
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

$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

$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: Brighton Health Commercial	$510.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$425.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$489.04
Rate for Payer: EmblemHealth Commercial	$425.25
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

$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

$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: Brighton Health Commercial	$1,446.00
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: EmblemHealth Commercial	$1,205.00
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 10

Facility

$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 3.5MMX10

Facility

$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

$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: Brighton Health Commercial	$2,040.00
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: EmblemHealth Commercial	$1,700.00
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

$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 X 12

Facility

$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: Brighton Health Commercial	$1,446.00
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: EmblemHealth Commercial	$1,205.00
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 X12

Facility

$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

DEPUY SCREW 3.5MM X12

Facility

$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: Brighton Health Commercial	$2,040.00
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: EmblemHealth Commercial	$1,700.00
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

$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: Brighton Health Commercial	$102.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$85.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$97.75
Rate for Payer: EmblemHealth Commercial	$85.00
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 INNER 5.0

Facility

$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 S/D 14MM

Facility

$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: Brighton Health Commercial	$576.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$480.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$552.00
Rate for Payer: EmblemHealth Commercial	$480.00
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 S/D 14MM

Facility

$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 SELF DRILLING 12MM

Facility

$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 SCREW SELF DRILLING 12MM

Facility

$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: Brighton Health Commercial	$624.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$520.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$598.00
Rate for Payer: EmblemHealth Commercial	$520.00
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 SCRW MENISCAL CLEFX 2X10MM

Facility

$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 SCRW MENISCAL CLEFX 2X10MM

Facility

$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: Brighton Health Commercial	$375.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$313.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$359.95
Rate for Payer: EmblemHealth Commercial	$313.00
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 SET SCREW

Facility

$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: Brighton Health Commercial	$84.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$80.50
Rate for Payer: EmblemHealth Commercial	$70.00
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 SET SCREW

Facility

$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: Brighton Health Commercial	$216.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.00
Rate for Payer: EmblemHealth Commercial	$180.00
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

$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

$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

Know your out-of-pocket cost for care.

All Charges