St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROD 70MM

Facility

$3,235.25

Service Code	HCPCS C1713
Hospital Charge Code	64904041
Hospital Revenue Code	278
Min. Negotiated Rate	$1,617.62
Max. Negotiated Rate	$1,617.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,617.62
Rate for Payer: Hamaspik Choice Inc Medicare	$1,617.62

ROD 7MM X 200MM

Facility

$2,124.00

Service Code	HCPCS C1713
Hospital Charge Code	40201310
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,230.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,168.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,274.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,062.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,221.30
Rate for Payer: EmblemHealth Commercial	$1,062.00
Rate for Payer: Fidelis Medicare Advantage	$2,230.20
Rate for Payer: Group Health Inc Commercial	$1,062.00
Rate for Payer: Group Health Inc Medicare	$743.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,062.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,062.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,380.60

ROD 7MM X 200MM

Facility

$2,124.00

Service Code	HCPCS C1713
Hospital Charge Code	40201310
Hospital Revenue Code	278
Min. Negotiated Rate	$1,062.00
Max. Negotiated Rate	$1,062.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,062.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,062.00

ROD 7 MM X 210

Facility

$2,260.00

Service Code	HCPCS C1713
Hospital Charge Code	40201311
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,373.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,243.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,356.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,130.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,299.50
Rate for Payer: EmblemHealth Commercial	$1,130.00
Rate for Payer: Fidelis Medicare Advantage	$2,373.00
Rate for Payer: Group Health Inc Commercial	$1,130.00
Rate for Payer: Group Health Inc Medicare	$791.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,130.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,469.00

ROD 7 MM X 210

Facility

$2,260.00

Service Code	HCPCS C1713
Hospital Charge Code	40201311
Hospital Revenue Code	278
Min. Negotiated Rate	$1,130.00
Max. Negotiated Rate	$1,130.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,130.00

ROD 7 MM X 220

Facility

$2,170.00

Service Code	HCPCS C1713
Hospital Charge Code	40201312
Hospital Revenue Code	278
Min. Negotiated Rate	$1,085.00
Max. Negotiated Rate	$1,085.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,085.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,085.00

ROD 7 MM X 220

Facility

$2,170.00

Service Code	HCPCS C1713
Hospital Charge Code	40201312
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,278.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,193.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,302.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,085.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,247.75
Rate for Payer: EmblemHealth Commercial	$1,085.00
Rate for Payer: Fidelis Medicare Advantage	$2,278.50
Rate for Payer: Group Health Inc Commercial	$1,085.00
Rate for Payer: Group Health Inc Medicare	$759.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,085.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,085.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,410.50

ROD 80MM

Facility

$462.62

Service Code	HCPCS C1713
Hospital Charge Code	40200767
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$485.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$254.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$277.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$231.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$266.01
Rate for Payer: EmblemHealth Commercial	$231.31
Rate for Payer: Fidelis Medicare Advantage	$485.75
Rate for Payer: Group Health Inc Commercial	$231.31
Rate for Payer: Group Health Inc Medicare	$161.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.31
Rate for Payer: Hamaspik Choice Inc Medicare	$231.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$300.70

ROD 80MM

Facility

$462.62

Service Code	HCPCS C1713
Hospital Charge Code	40200767
Hospital Revenue Code	278
Min. Negotiated Rate	$231.31
Max. Negotiated Rate	$231.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$231.31
Rate for Payer: Hamaspik Choice Inc Medicare	$231.31

ROD 8X 400MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	40205061
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 8X 400MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	40205061
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 ADJUSTABLE OCCIPITAL T

Facility

$3,375.00

Hospital Charge Code	64904829
Hospital Revenue Code	270
Min. Negotiated Rate	$1,181.25
Max. Negotiated Rate	$2,700.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,856.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,687.50
Rate for Payer: Aetna Government	$1,687.50
Rate for Payer: Brighton Health Commercial	$2,531.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,700.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,295.00
Rate for Payer: Group Health Inc Commercial	$1,687.50
Rate for Payer: Group Health Inc Medicare	$1,181.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,687.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,687.50

ROD ARM15T 35MM CONV PRE

Facility

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903919
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$958.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$501.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$547.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$456.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$524.69
Rate for Payer: EmblemHealth Commercial	$456.25
Rate for Payer: Fidelis Medicare Advantage	$958.12
Rate for Payer: Group Health Inc Commercial	$456.25
Rate for Payer: Group Health Inc Medicare	$319.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$593.12

ROD ARM15T 35MM CONV PRE

Facility

$912.50

Service Code	HCPCS C1713
Hospital Charge Code	64903919
Hospital Revenue Code	278
Min. Negotiated Rate	$456.25
Max. Negotiated Rate	$456.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$456.25
Rate for Payer: Hamaspik Choice Inc Medicare	$456.25

ROD BENT X118

Facility

$1,763.75

Service Code	HCPCS C1713
Hospital Charge Code	64907124
Hospital Revenue Code	278
Min. Negotiated Rate	$881.88
Max. Negotiated Rate	$881.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$881.88
Rate for Payer: Hamaspik Choice Inc Medicare	$881.88

ROD BENT X118

Facility

$1,763.75

Service Code	HCPCS C1713
Hospital Charge Code	64907124
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,851.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$970.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,058.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$881.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,014.16
Rate for Payer: EmblemHealth Commercial	$881.88
Rate for Payer: Fidelis Medicare Advantage	$1,851.94
Rate for Payer: Group Health Inc Commercial	$881.88
Rate for Payer: Group Health Inc Medicare	$617.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$881.88
Rate for Payer: Hamaspik Choice Inc Medicare	$881.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,146.44

ROD CARBON 11 X 150 MM

Facility

$416.00

Service Code	HCPCS C1713
Hospital Charge Code	40201501
Hospital Revenue Code	278
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$208.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$208.00
Rate for Payer: Hamaspik Choice Inc Medicare	$208.00

ROD CARBON 11 X 150 MM

Facility

$416.00

Service Code	HCPCS C1713
Hospital Charge Code	40201501
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$436.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$228.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$249.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$239.20
Rate for Payer: EmblemHealth Commercial	$208.00
Rate for Payer: Fidelis Medicare Advantage	$436.80
Rate for Payer: Group Health Inc Commercial	$208.00
Rate for Payer: Group Health Inc Medicare	$145.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$208.00
Rate for Payer: Hamaspik Choice Inc Medicare	$208.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$270.40

ROD CARBON 11 X 200 MM

Facility

$832.00

Service Code	HCPCS C1713
Hospital Charge Code	40201502
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$873.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$457.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$499.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$416.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$478.40
Rate for Payer: EmblemHealth Commercial	$416.00
Rate for Payer: Fidelis Medicare Advantage	$873.60
Rate for Payer: Group Health Inc Commercial	$416.00
Rate for Payer: Group Health Inc Medicare	$291.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$416.00
Rate for Payer: Hamaspik Choice Inc Medicare	$416.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$540.80

ROD CARBON 11 X 200 MM

Facility

$832.00

Service Code	HCPCS C1713
Hospital Charge Code	40201502
Hospital Revenue Code	278
Min. Negotiated Rate	$416.00
Max. Negotiated Rate	$416.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$416.00
Rate for Payer: Hamaspik Choice Inc Medicare	$416.00

ROD CARBON 11 X 350 MM

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40201503
Hospital Revenue Code	278
Min. Negotiated Rate	$225.00
Max. Negotiated Rate	$225.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00

ROD CARBON 11 X 350 MM

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40201503
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$472.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$270.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$258.75
Rate for Payer: EmblemHealth Commercial	$225.00
Rate for Payer: Fidelis Medicare Advantage	$472.50
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$292.50

ROD CARBON 200MM

Facility

$99.40

Service Code	HCPCS C1713
Hospital Charge Code	40200768
Hospital Revenue Code	278
Min. Negotiated Rate	$49.70
Max. Negotiated Rate	$49.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.70
Rate for Payer: Hamaspik Choice Inc Medicare	$49.70

ROD CARBON 200MM

Facility

$99.40

Service Code	HCPCS C1713
Hospital Charge Code	40200768
Hospital Revenue Code	278
Min. Negotiated Rate	$34.79
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$59.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$57.16
Rate for Payer: EmblemHealth Commercial	$49.70
Rate for Payer: Fidelis Medicare Advantage	$104.37
Rate for Payer: Group Health Inc Commercial	$49.70
Rate for Payer: Group Health Inc Medicare	$34.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.70
Rate for Payer: Hamaspik Choice Inc Medicare	$49.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$64.61

ROD CARBON 250

Facility

$211.40

Service Code	HCPCS C1713
Hospital Charge Code	40200769
Hospital Revenue Code	278
Min. Negotiated Rate	$105.70
Max. Negotiated Rate	$105.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.70
Rate for Payer: Hamaspik Choice Inc Medicare	$105.70

Know your out-of-pocket cost for care.

All Charges