St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

MRI SAFE CONNECTIONG ROD 8X200MM

Facility

$336.00

Service Code	HCPCS C1713
Hospital Charge Code	40202296
Hospital Revenue Code	278
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$352.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$201.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$168.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$193.20
Rate for Payer: EmblemHealth Commercial	$168.00
Rate for Payer: Fidelis Medicare Advantage	$352.80
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

MRI SAFE CONNECT ROD 8 X 10MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201368
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI SAFE CONNECT ROD 8 X 10MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201368
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI SAFE CONNECT ROD 8X150MM

Facility

$291.20

Service Code	HCPCS C1713
Hospital Charge Code	40209406
Hospital Revenue Code	278
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$305.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$174.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$145.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.44
Rate for Payer: EmblemHealth Commercial	$145.60
Rate for Payer: Fidelis Medicare Advantage	$305.76
Rate for Payer: Group Health Inc Commercial	$145.60
Rate for Payer: Group Health Inc Medicare	$101.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.60
Rate for Payer: Hamaspik Choice Inc Medicare	$145.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.28

MRI SAFE CONNECT ROD 8X150MM

Facility

$291.20

Service Code	HCPCS C1713
Hospital Charge Code	40209406
Hospital Revenue Code	278
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$145.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.60
Rate for Payer: Hamaspik Choice Inc Medicare	$145.60

MRI SAFE CONNECT ROD 8X150MM

Facility

$318.00

Service Code	HCPCS C1713
Hospital Charge Code	40201369
Hospital Revenue Code	278
Min. Negotiated Rate	$111.30
Max. Negotiated Rate	$333.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$174.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$190.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$159.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$182.85
Rate for Payer: EmblemHealth Commercial	$159.00
Rate for Payer: Fidelis Medicare Advantage	$333.90
Rate for Payer: Group Health Inc Commercial	$159.00
Rate for Payer: Group Health Inc Medicare	$111.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.00
Rate for Payer: Hamaspik Choice Inc Medicare	$159.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$206.70

MRI SAFE CONNECT ROD 8X150MM

Facility

$318.00

Service Code	HCPCS C1713
Hospital Charge Code	40201369
Hospital Revenue Code	278
Min. Negotiated Rate	$159.00
Max. Negotiated Rate	$159.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$159.00
Rate for Payer: Hamaspik Choice Inc Medicare	$159.00

MRI SAFE CONNECT ROD 8X200MM

Facility

$291.20

Service Code	HCPCS C1713
Hospital Charge Code	40209407
Hospital Revenue Code	278
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$305.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$174.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$145.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.44
Rate for Payer: EmblemHealth Commercial	$145.60
Rate for Payer: Fidelis Medicare Advantage	$305.76
Rate for Payer: Group Health Inc Commercial	$145.60
Rate for Payer: Group Health Inc Medicare	$101.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.60
Rate for Payer: Hamaspik Choice Inc Medicare	$145.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.28

MRI SAFE CONNECT ROD 8X200MM

Facility

$291.20

Service Code	HCPCS C1713
Hospital Charge Code	40209407
Hospital Revenue Code	278
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$145.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.60
Rate for Payer: Hamaspik Choice Inc Medicare	$145.60

MRI SAFE CONNECT ROD 8X250MM

Facility

$562.40

Service Code	HCPCS C1713
Hospital Charge Code	40201370
Hospital Revenue Code	278
Min. Negotiated Rate	$281.20
Max. Negotiated Rate	$281.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.20
Rate for Payer: Hamaspik Choice Inc Medicare	$281.20

MRI SAFE CONNECT ROD 8X250MM

Facility

$291.20

Service Code	HCPCS C1713
Hospital Charge Code	40209408
Hospital Revenue Code	278
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$145.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.60
Rate for Payer: Hamaspik Choice Inc Medicare	$145.60

MRI SAFE CONNECT ROD 8X250MM

Facility

$291.20

Service Code	HCPCS C1713
Hospital Charge Code	40209408
Hospital Revenue Code	278
Min. Negotiated Rate	$101.92
Max. Negotiated Rate	$305.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$160.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$174.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$145.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$167.44
Rate for Payer: EmblemHealth Commercial	$145.60
Rate for Payer: Fidelis Medicare Advantage	$305.76
Rate for Payer: Group Health Inc Commercial	$145.60
Rate for Payer: Group Health Inc Medicare	$101.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$145.60
Rate for Payer: Hamaspik Choice Inc Medicare	$145.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$189.28

MRI SAFE CONNECT ROD 8X250MM

Facility

$562.40

Service Code	HCPCS C1713
Hospital Charge Code	40201370
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$590.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$309.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$337.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$281.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$323.38
Rate for Payer: EmblemHealth Commercial	$281.20
Rate for Payer: Fidelis Medicare Advantage	$590.52
Rate for Payer: Group Health Inc Commercial	$281.20
Rate for Payer: Group Health Inc Medicare	$196.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$281.20
Rate for Payer: Hamaspik Choice Inc Medicare	$281.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$365.56

MRI SAFE CONNECT ROD 8X300MM

Facility

$446.60

Service Code	HCPCS C1713
Hospital Charge Code	40209360
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$468.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$245.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$267.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$223.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$256.80
Rate for Payer: EmblemHealth Commercial	$223.30
Rate for Payer: Fidelis Medicare Advantage	$468.93
Rate for Payer: Group Health Inc Commercial	$223.30
Rate for Payer: Group Health Inc Medicare	$156.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.30
Rate for Payer: Hamaspik Choice Inc Medicare	$223.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$290.29

MRI SAFE CONNECT ROD 8X300MM

Facility

$446.60

Service Code	HCPCS C1713
Hospital Charge Code	40209360
Hospital Revenue Code	278
Min. Negotiated Rate	$223.30
Max. Negotiated Rate	$223.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$223.30
Rate for Payer: Hamaspik Choice Inc Medicare	$223.30

MRI SAFE CONNECT ROD 8X450MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201372
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI SAFE CONNECT ROD 8X450MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201372
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI SAFE CONNECT ROD 8X500MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201373
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI SAFE CONNECT ROD 8X500MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201373
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI SAFE CONNECT ROD 8X650MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201374
Hospital Revenue Code	278
Min. Negotiated Rate	$114.10
Max. Negotiated Rate	$342.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$179.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$195.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$163.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.45
Rate for Payer: EmblemHealth Commercial	$163.00
Rate for Payer: Fidelis Medicare Advantage	$342.30
Rate for Payer: Group Health Inc Commercial	$163.00
Rate for Payer: Group Health Inc Medicare	$114.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$211.90

MRI SAFE CONNECT ROD 8X650MM

Facility

$326.00

Service Code	HCPCS C1713
Hospital Charge Code	40201374
Hospital Revenue Code	278
Min. Negotiated Rate	$163.00
Max. Negotiated Rate	$163.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$163.00
Rate for Payer: Hamaspik Choice Inc Medicare	$163.00

MRI SAFE CONNECT ROD 8 X 65MM

Facility

$274.40

Service Code	HCPCS C1713
Hospital Charge Code	40201375
Hospital Revenue Code	278
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$137.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.20
Rate for Payer: Hamaspik Choice Inc Medicare	$137.20

MRI SAFE CONNECT ROD 8 X 65MM

Facility

$274.40

Service Code	HCPCS C1713
Hospital Charge Code	40201375
Hospital Revenue Code	278
Min. Negotiated Rate	$96.04
Max. Negotiated Rate	$288.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$150.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$164.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$137.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$157.78
Rate for Payer: EmblemHealth Commercial	$137.20
Rate for Payer: Fidelis Medicare Advantage	$288.12
Rate for Payer: Group Health Inc Commercial	$137.20
Rate for Payer: Group Health Inc Medicare	$96.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.20
Rate for Payer: Hamaspik Choice Inc Medicare	$137.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$178.36

MR KIDNEY(S) C+

Facility

$1,156.53

Service Code	HCPCS 74182 TC
Hospital Charge Code	41407384
Hospital Revenue Code	610
Min. Negotiated Rate	$311.31
Max. Negotiated Rate	$874.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$636.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$444.73
Rate for Payer: Aetna Government	$444.73
Rate for Payer: Affinity Essential Plan 1&2	$311.31
Rate for Payer: Affinity Essential Plan 3&4	$311.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$311.31
Rate for Payer: Brighton Health Commercial	$867.40
Rate for Payer: Cash Price	$444.73
Rate for Payer: Cash Price	$444.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$444.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$874.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$740.04
Rate for Payer: Elderplan Medicare Advantage	$444.73
Rate for Payer: EmblemHealth Commercial	$311.31
Rate for Payer: Fidelis Essential Plan Aliesa	$378.02
Rate for Payer: Fidelis Essential Plan QHP	$395.81
Rate for Payer: Fidelis Medicare Advantage	$444.73
Rate for Payer: Fidelis Qualified Health Plan	$395.81
Rate for Payer: Group Health Inc Commercial	$400.26
Rate for Payer: Group Health Inc Medicare	$400.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.26
Rate for Payer: Hamaspik Choice Inc Medicare	$444.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$400.26
Rate for Payer: Healthfirst Medicare Advantage	$444.73
Rate for Payer: Healthfirst QHP	$444.73
Rate for Payer: Humana Medicare	$453.62
Rate for Payer: Senior Whole Health Medicare Advantage	$444.73
Rate for Payer: United Healthcare Commercial	$349.58
Rate for Payer: United Healthcare Medicare Advantage	$444.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$444.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$355.78
Rate for Payer: Wellcare Medicare	$422.49

MR KIDNEY(S) C+

Facility

$1,156.53

Service Code	HCPCS 74182 TC
Hospital Charge Code	41407384
Hospital Revenue Code	610
Rate for Payer: Cash Price	$444.73

Know your out-of-pocket cost for care.

All Charges