St. Barnabas Hospital

All Charges

Charge

Type

Price

ANCHOR

Facility OP

$458.00

Service Code	HCPCS C1713
Hospital Charge Code	40209648
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$480.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$251.90
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	$229.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$263.35
Rate for Payer: Fidelis Medicare Advantage	$480.90
Rate for Payer: Group Health Inc Commercial	$229.00
Rate for Payer: Group Health Inc Medicare	$160.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$229.00
Rate for Payer: Hamaspik Choice Inc Medicare	$229.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$297.70

ANCHOR 5.5MM REELX STT

Facility OP

$1,118.53

Service Code	HCPCS C1713
Hospital Charge Code	64902736
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,174.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$615.19
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	$559.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$643.15
Rate for Payer: Fidelis Medicare Advantage	$1,174.46
Rate for Payer: Group Health Inc Commercial	$559.26
Rate for Payer: Group Health Inc Medicare	$391.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$559.26
Rate for Payer: Hamaspik Choice Inc Medicare	$559.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$727.04

ANCHOR 5.5MM REELX STT

Facility IP

$1,118.53

Service Code	HCPCS C1713
Hospital Charge Code	64902736
Hospital Revenue Code	278
Min. Negotiated Rate	$559.26
Max. Negotiated Rate	$559.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$559.26
Rate for Payer: Hamaspik Choice Inc Medicare	$559.26

ANCHORAGE UTIL PLATE STR 4 HOLE

Facility IP

$3,572.00

Service Code	HCPCS C1713
Hospital Charge Code	40005918
Hospital Revenue Code	278
Min. Negotiated Rate	$1,786.00
Max. Negotiated Rate	$1,786.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,786.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,786.00

ANCHORAGE UTIL PLATE STR 4 HOLE

Facility OP

$3,572.00

Service Code	HCPCS C1713
Hospital Charge Code	40005918
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,750.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,964.60
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	$1,786.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,053.90
Rate for Payer: Fidelis Medicare Advantage	$3,750.60
Rate for Payer: Group Health Inc Commercial	$1,786.00
Rate for Payer: Group Health Inc Medicare	$1,250.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,786.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,786.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,321.80

ANCHOR C 7 X 12 X 14 -48321074

Facility OP

$9,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64906588
Hospital Revenue Code	279
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$7,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,950.00
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	$7,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,120.00
Rate for Payer: Group Health Inc Commercial	$4,500.00
Rate for Payer: Group Health Inc Medicare	$3,150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,500.00

ANCHORLOCK LEADING EDGE SOFT

Facility IP

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	40200247
Hospital Revenue Code	278
Min. Negotiated Rate	$395.00
Max. Negotiated Rate	$395.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$395.00

ANCHORLOCK LEADING EDGE SOFT

Facility OP

$790.00

Service Code	HCPCS C1713
Hospital Charge Code	40200247
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$829.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$434.50
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	$395.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$454.25
Rate for Payer: Fidelis Medicare Advantage	$829.50
Rate for Payer: Group Health Inc Commercial	$395.00
Rate for Payer: Group Health Inc Medicare	$276.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$395.00
Rate for Payer: Hamaspik Choice Inc Medicare	$395.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$513.50

ANCHOR LUNBAR SA 10X22X30MMX12

Facility IP

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905080
Hospital Revenue Code	278
Min. Negotiated Rate	$11,610.00
Max. Negotiated Rate	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00

ANCHOR LUNBAR SA 10X22X30MMX12

Facility OP

$23,220.00

Service Code	HCPCS C1713
Hospital Charge Code	64905080
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$24,381.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12,771.00
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	$11,610.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$13,351.50
Rate for Payer: Fidelis Medicare Advantage	$24,381.00
Rate for Payer: Group Health Inc Commercial	$11,610.00
Rate for Payer: Group Health Inc Medicare	$8,127.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$11,610.00
Rate for Payer: Hamaspik Choice Inc Medicare	$11,610.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15,093.00

ANCHOR MENISCAL REPAIR 0-DEG

Facility OP

$910.00

Service Code	HCPCS C1713
Hospital Charge Code	64902440
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$955.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$500.50
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	$455.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$523.25
Rate for Payer: Fidelis Medicare Advantage	$955.50
Rate for Payer: Group Health Inc Commercial	$455.00
Rate for Payer: Group Health Inc Medicare	$318.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$455.00
Rate for Payer: Hamaspik Choice Inc Medicare	$455.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$591.50

ANCHOR MENISCAL REPAIR 0-DEG

Facility IP

$910.00

Service Code	HCPCS C1713
Hospital Charge Code	64902440
Hospital Revenue Code	278
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$455.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$455.00
Rate for Payer: Hamaspik Choice Inc Medicare	$455.00

ANCHOR MENISCAL REPAIR 12-DEG

Facility IP

$910.00

Service Code	HCPCS C1713
Hospital Charge Code	64902436
Hospital Revenue Code	278
Min. Negotiated Rate	$455.00
Max. Negotiated Rate	$455.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$455.00
Rate for Payer: Hamaspik Choice Inc Medicare	$455.00

ANCHOR MENISCAL REPAIR 12-DEG

Facility OP

$910.00

Service Code	HCPCS C1713
Hospital Charge Code	64902436
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$955.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$500.50
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	$455.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$523.25
Rate for Payer: Fidelis Medicare Advantage	$955.50
Rate for Payer: Group Health Inc Commercial	$455.00
Rate for Payer: Group Health Inc Medicare	$318.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$455.00
Rate for Payer: Hamaspik Choice Inc Medicare	$455.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$591.50

ANCHOR MENISCAL REPAIR 27-DEG

Facility IP

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	64902438
Hospital Revenue Code	278
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50

ANCHOR MENISCAL REPAIR 27-DEG

Facility OP

$875.00

Service Code	HCPCS C1713
Hospital Charge Code	64902438
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$918.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$481.25
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	$437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.12
Rate for Payer: Fidelis Medicare Advantage	$918.75
Rate for Payer: Group Health Inc Commercial	$437.50
Rate for Payer: Group Health Inc Medicare	$306.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$568.75

ANCHOR MINI QUICK PLUS W/2/0 CORD

Facility OP

$1,210.00

Service Code	HCPCS C1713
Hospital Charge Code	64902319
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,270.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$665.50
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	$605.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$695.75
Rate for Payer: Fidelis Medicare Advantage	$1,270.50
Rate for Payer: Group Health Inc Commercial	$605.00
Rate for Payer: Group Health Inc Medicare	$423.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$605.00
Rate for Payer: Hamaspik Choice Inc Medicare	$605.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$786.50

ANCHOR MINI QUICK PLUS W/2/0 CORD

Facility IP

$1,210.00

Service Code	HCPCS C1713
Hospital Charge Code	64902319
Hospital Revenue Code	278
Min. Negotiated Rate	$605.00
Max. Negotiated Rate	$605.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$605.00
Rate for Payer: Hamaspik Choice Inc Medicare	$605.00

ANCHOR, Q11 QA PLUS, O/C

Facility IP

$1,212.50

Service Code	HCPCS C1713
Hospital Charge Code	64905609
Hospital Revenue Code	278
Min. Negotiated Rate	$606.25
Max. Negotiated Rate	$606.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$606.25
Rate for Payer: Hamaspik Choice Inc Medicare	$606.25

ANCHOR, Q11 QA PLUS, O/C

Facility OP

$1,212.50

Service Code	HCPCS C1713
Hospital Charge Code	64905609
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,273.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$666.88
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	$606.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$697.19
Rate for Payer: Fidelis Medicare Advantage	$1,273.12
Rate for Payer: Group Health Inc Commercial	$606.25
Rate for Payer: Group Health Inc Medicare	$424.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$606.25
Rate for Payer: Hamaspik Choice Inc Medicare	$606.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$788.12

ANCHOR QUICK GII W/2 ETHIBOND

Facility OP

$1,212.50

Service Code	HCPCS C1713
Hospital Charge Code	64901606
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,273.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$666.88
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	$606.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$697.19
Rate for Payer: Fidelis Medicare Advantage	$1,273.12
Rate for Payer: Group Health Inc Commercial	$606.25
Rate for Payer: Group Health Inc Medicare	$424.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$606.25
Rate for Payer: Hamaspik Choice Inc Medicare	$606.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$788.12

ANCHOR QUICK GII W/2 ETHIBOND

Facility IP

$1,212.50

Service Code	HCPCS C1713
Hospital Charge Code	64901606
Hospital Revenue Code	278
Min. Negotiated Rate	$606.25
Max. Negotiated Rate	$606.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$606.25
Rate for Payer: Hamaspik Choice Inc Medicare	$606.25

ANCHOR, SUPER QA PLUS, DS O/C

Facility OP

$1,212.50

Service Code	HCPCS C1713
Hospital Charge Code	64905608
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,273.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$666.88
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	$606.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$697.19
Rate for Payer: Fidelis Medicare Advantage	$1,273.12
Rate for Payer: Group Health Inc Commercial	$606.25
Rate for Payer: Group Health Inc Medicare	$424.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$606.25
Rate for Payer: Hamaspik Choice Inc Medicare	$606.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$788.12

ANCHOR, SUPER QA PLUS, DS O/C

Facility IP

$1,212.50

Service Code	HCPCS C1713
Hospital Charge Code	64905608
Hospital Revenue Code	278
Min. Negotiated Rate	$606.25
Max. Negotiated Rate	$606.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$606.25
Rate for Payer: Hamaspik Choice Inc Medicare	$606.25

Anderson Tube

Facility OP

$90.02

Hospital Charge Code	40200338
Hospital Revenue Code	270
Min. Negotiated Rate	$31.51
Max. Negotiated Rate	$72.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.01
Rate for Payer: Aetna Government	$45.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.21
Rate for Payer: Group Health Inc Commercial	$45.01
Rate for Payer: Group Health Inc Medicare	$31.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.01
Rate for Payer: Hamaspik Choice Inc Medicare	$45.01

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