St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROD 350MM

Facility

$246.40

Service Code	HCPCS C1713
Hospital Charge Code	40200766
Hospital Revenue Code	278
Min. Negotiated Rate	$86.24
Max. Negotiated Rate	$258.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$135.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$147.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$123.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$141.68
Rate for Payer: EmblemHealth Commercial	$123.20
Rate for Payer: Fidelis Medicare Advantage	$258.72
Rate for Payer: Group Health Inc Commercial	$123.20
Rate for Payer: Group Health Inc Medicare	$86.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.20
Rate for Payer: Hamaspik Choice Inc Medicare	$123.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$160.16

ROD 350MM

Facility

$246.40

Service Code	HCPCS C1713
Hospital Charge Code	40200766
Hospital Revenue Code	278
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$123.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.20
Rate for Payer: Hamaspik Choice Inc Medicare	$123.20

ROD 3.5 X 60

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64904118
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

ROD 3.5 X 60

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64904118
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$787.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$431.25
Rate for Payer: EmblemHealth Commercial	$375.00
Rate for Payer: Fidelis Medicare Advantage	$787.50
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$487.50

ROD 40MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64904870
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

ROD 40MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64904870
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$787.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$431.25
Rate for Payer: EmblemHealth Commercial	$375.00
Rate for Payer: Fidelis Medicare Advantage	$787.50
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$487.50

ROD 45 MM

Facility

$1,591.10

Service Code	HCPCS C1713
Hospital Charge Code	64903937
Hospital Revenue Code	278
Min. Negotiated Rate	$795.55
Max. Negotiated Rate	$795.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$795.55
Rate for Payer: Hamaspik Choice Inc Medicare	$795.55

ROD 45 MM

Facility

$1,591.10

Service Code	HCPCS C1713
Hospital Charge Code	64903937
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,670.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$875.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$954.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$795.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$914.88
Rate for Payer: EmblemHealth Commercial	$795.55
Rate for Payer: Fidelis Medicare Advantage	$1,670.66
Rate for Payer: Group Health Inc Commercial	$795.55
Rate for Payer: Group Health Inc Medicare	$556.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$795.55
Rate for Payer: Hamaspik Choice Inc Medicare	$795.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,034.22

ROD 45MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905473
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

ROD 45MM

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	40005332
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

ROD 45MM

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	40005332
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$630.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$330.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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

ROD 45MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905473
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$787.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$431.25
Rate for Payer: EmblemHealth Commercial	$375.00
Rate for Payer: Fidelis Medicare Advantage	$787.50
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$487.50

ROD- 45MM

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	40204584
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

ROD- 45MM

Facility

$600.00

Service Code	HCPCS C1713
Hospital Charge Code	40204584
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$630.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$330.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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

ROD- 45MM

Facility

$600.00

Service Code	HCPCS L8699
Hospital Charge Code	40007503
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

ROD- 45MM

Facility

$600.00

Service Code	HCPCS L8699
Hospital Charge Code	40007503
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	$300.00
Rate for Payer: Aetna Government	$300.00
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

ROD, 50MM SPINE

Facility

$750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905767
Hospital Revenue Code	278
Min. Negotiated Rate	$375.00
Max. Negotiated Rate	$375.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00

ROD, 50MM SPINE

Facility

$750.00

Service Code	HCPCS C1776
Hospital Charge Code	64905767
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$787.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$412.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$450.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$375.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$431.25
Rate for Payer: EmblemHealth Commercial	$375.00
Rate for Payer: Fidelis Medicare Advantage	$787.50
Rate for Payer: Group Health Inc Commercial	$375.00
Rate for Payer: Group Health Inc Medicare	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$487.50

ROD 55MM

Facility

$1,848.75

Service Code	HCPCS C1713
Hospital Charge Code	64907183
Hospital Revenue Code	278
Min. Negotiated Rate	$924.38
Max. Negotiated Rate	$924.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$924.38
Rate for Payer: Hamaspik Choice Inc Medicare	$924.38

ROD 55MM

Facility

$1,848.75

Service Code	HCPCS C1713
Hospital Charge Code	64907183
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,941.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,016.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,109.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$924.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,063.03
Rate for Payer: EmblemHealth Commercial	$924.38
Rate for Payer: Fidelis Medicare Advantage	$1,941.19
Rate for Payer: Group Health Inc Commercial	$924.38
Rate for Payer: Group Health Inc Medicare	$647.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$924.38
Rate for Payer: Hamaspik Choice Inc Medicare	$924.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,201.69

ROD 5 X 200 MM

Facility

$213.50

Service Code	HCPCS C1713
Hospital Charge Code	40201309
Hospital Revenue Code	278
Min. Negotiated Rate	$74.72
Max. Negotiated Rate	$224.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$128.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$106.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.76
Rate for Payer: EmblemHealth Commercial	$106.75
Rate for Payer: Fidelis Medicare Advantage	$224.18
Rate for Payer: Group Health Inc Commercial	$106.75
Rate for Payer: Group Health Inc Medicare	$74.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.75
Rate for Payer: Hamaspik Choice Inc Medicare	$106.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$138.78

ROD 5 X 200 MM

Facility

$213.50

Service Code	HCPCS C1713
Hospital Charge Code	40201309
Hospital Revenue Code	278
Min. Negotiated Rate	$106.75
Max. Negotiated Rate	$106.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.75
Rate for Payer: Hamaspik Choice Inc Medicare	$106.75

ROD 60MM

Facility

$1,591.10

Service Code	HCPCS C1713
Hospital Charge Code	64905289
Hospital Revenue Code	278
Min. Negotiated Rate	$795.55
Max. Negotiated Rate	$795.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$795.55
Rate for Payer: Hamaspik Choice Inc Medicare	$795.55

ROD 60MM

Facility

$1,591.10

Service Code	HCPCS C1713
Hospital Charge Code	64905289
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,670.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$875.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$954.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$795.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$914.88
Rate for Payer: EmblemHealth Commercial	$795.55
Rate for Payer: Fidelis Medicare Advantage	$1,670.66
Rate for Payer: Group Health Inc Commercial	$795.55
Rate for Payer: Group Health Inc Medicare	$556.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$795.55
Rate for Payer: Hamaspik Choice Inc Medicare	$795.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,034.22

ROD 70MM

Facility

$3,235.25

Service Code	HCPCS C1713
Hospital Charge Code	64904041
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,397.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,779.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,941.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,617.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,860.27
Rate for Payer: EmblemHealth Commercial	$1,617.62
Rate for Payer: Fidelis Medicare Advantage	$3,397.01
Rate for Payer: Group Health Inc Commercial	$1,617.62
Rate for Payer: Group Health Inc Medicare	$1,132.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,617.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,617.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,102.91

Know your out-of-pocket cost for care.

All Charges