St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DEPUY SLOTTED HOOK

Facility

$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: Brighton Health Commercial	$397.50
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

$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: Brighton Health Commercial	$1,260.00
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

$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 SUMMIT STEM STDZ

Facility

$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: Brighton Health Commercial	$6,552.00
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: EmblemHealth Commercial	$5,460.00
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 SYMPHONY GRFT DELVY

Facility

$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: Brighton Health Commercial	$412.50
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

$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: Brighton Health Commercial	$967.50
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

$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: Brighton Health Commercial	$967.50
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

$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: Brighton Health Commercial	$967.50
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

$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: Brighton Health Commercial	$967.50
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

$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: Brighton Health Commercial	$135.00
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

$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: Brighton Health Commercial	$384.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$368.00
Rate for Payer: EmblemHealth Commercial	$320.00
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

$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

DEPUY TOTAL HIP CUP

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	40029542
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 TOTAL HIP CUP

Facility

$4,250.00

Service Code	HCPCS C1776
Hospital Charge Code	40029542
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 TOTAL HIP FEM HEAD

Facility

$2,090.00

Service Code	HCPCS C1776
Hospital Charge Code	40029540
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$2,194.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,149.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,254.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,045.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,201.75
Rate for Payer: EmblemHealth Commercial	$1,045.00
Rate for Payer: Fidelis Medicare Advantage	$2,194.50
Rate for Payer: Group Health Inc Commercial	$1,045.00
Rate for Payer: Group Health Inc Medicare	$731.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,358.50

DEPUY TOTAL HIP FEM HEAD

Facility

$2,090.00

Service Code	HCPCS C1776
Hospital Charge Code	40029540
Hospital Revenue Code	278
Min. Negotiated Rate	$1,045.00
Max. Negotiated Rate	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,045.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,045.00

DEPUY TOTAL HIP LINER

Facility

$2,830.00

Service Code	HCPCS C1776
Hospital Charge Code	40029543
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 TOTAL HIP LINER

Facility

$2,830.00

Service Code	HCPCS C1776
Hospital Charge Code	40029543
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 TOTAL HIP STEM

Facility

$11,920.00

Service Code	HCPCS C1776
Hospital Charge Code	40029541
Hospital Revenue Code	278
Min. Negotiated Rate	$5,960.00
Max. Negotiated Rate	$5,960.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,960.00

DEPUY TOTAL HIP STEM

Facility

$11,920.00

Service Code	HCPCS C1776
Hospital Charge Code	40029541
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$12,516.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6,556.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$7,152.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,854.00
Rate for Payer: EmblemHealth Commercial	$5,960.00
Rate for Payer: Fidelis Medicare Advantage	$12,516.00
Rate for Payer: Group Health Inc Commercial	$5,960.00
Rate for Payer: Group Health Inc Medicare	$4,172.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5,960.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5,960.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7,748.00

DEPUY TRANS ROD 110

Facility

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40029570
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$609.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$319.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$348.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$290.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$333.50
Rate for Payer: EmblemHealth Commercial	$290.00
Rate for Payer: Fidelis Medicare Advantage	$609.00
Rate for Payer: Group Health Inc Commercial	$290.00
Rate for Payer: Group Health Inc Medicare	$203.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$377.00

DEPUY TRANS ROD 110

Facility

$580.00

Service Code	HCPCS C1713
Hospital Charge Code	40029570
Hospital Revenue Code	278
Min. Negotiated Rate	$290.00
Max. Negotiated Rate	$290.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$290.00
Rate for Payer: Hamaspik Choice Inc Medicare	$290.00

DEPUY TRANSVERSE CONNECTOR

Facility

$1,800.23

Hospital Charge Code	40024027
Hospital Revenue Code	279
Min. Negotiated Rate	$630.08
Max. Negotiated Rate	$1,440.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$990.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$900.12
Rate for Payer: Aetna Government	$900.12
Rate for Payer: Brighton Health Commercial	$1,350.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,440.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,224.16
Rate for Payer: Group Health Inc Commercial	$900.12
Rate for Payer: Group Health Inc Medicare	$630.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$900.12
Rate for Payer: Hamaspik Choice Inc Medicare	$900.12

DEPUY UNIPLATE 14MM

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40209924
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,677.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,402.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,530.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,275.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,466.25
Rate for Payer: EmblemHealth Commercial	$1,275.00
Rate for Payer: Fidelis Medicare Advantage	$2,677.50
Rate for Payer: Group Health Inc Commercial	$1,275.00
Rate for Payer: Group Health Inc Medicare	$892.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,657.50

DEPUY UNIPLATE 14MM

Facility

$2,550.00

Service Code	HCPCS C1713
Hospital Charge Code	40209924
Hospital Revenue Code	278
Min. Negotiated Rate	$1,275.00
Max. Negotiated Rate	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,275.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,275.00

Know your out-of-pocket cost for care.

All Charges