St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROD CARBON 250

Facility

$211.40

Service Code	HCPCS C1713
Hospital Charge Code	40200769
Hospital Revenue Code	278
Min. Negotiated Rate	$73.99
Max. Negotiated Rate	$221.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$126.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$105.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$121.56
Rate for Payer: EmblemHealth Commercial	$105.70
Rate for Payer: Fidelis Medicare Advantage	$221.97
Rate for Payer: Group Health Inc Commercial	$105.70
Rate for Payer: Group Health Inc Medicare	$73.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$105.70
Rate for Payer: Hamaspik Choice Inc Medicare	$105.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$137.41

ROD CARBON 300

Facility

$1,045.83

Service Code	HCPCS C1713
Hospital Charge Code	40200770
Hospital Revenue Code	278
Min. Negotiated Rate	$522.91
Max. Negotiated Rate	$522.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$522.91
Rate for Payer: Hamaspik Choice Inc Medicare	$522.91

ROD CARBON 300

Facility

$1,045.83

Service Code	HCPCS C1713
Hospital Charge Code	40200770
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,098.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$575.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$627.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$522.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$601.35
Rate for Payer: EmblemHealth Commercial	$522.91
Rate for Payer: Fidelis Medicare Advantage	$1,098.12
Rate for Payer: Group Health Inc Commercial	$522.91
Rate for Payer: Group Health Inc Medicare	$366.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$522.91
Rate for Payer: Hamaspik Choice Inc Medicare	$522.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$679.79

ROD CARBON 8X200MM

Facility

$1,242.90

Service Code	HCPCS C1713
Hospital Charge Code	40200771
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,305.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$683.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$745.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$621.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$714.67
Rate for Payer: EmblemHealth Commercial	$621.45
Rate for Payer: Fidelis Medicare Advantage	$1,305.05
Rate for Payer: Group Health Inc Commercial	$621.45
Rate for Payer: Group Health Inc Medicare	$435.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$621.45
Rate for Payer: Hamaspik Choice Inc Medicare	$621.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$807.88

ROD CARBON 8X200MM

Facility

$1,242.90

Service Code	HCPCS C1713
Hospital Charge Code	40200771
Hospital Revenue Code	278
Min. Negotiated Rate	$621.45
Max. Negotiated Rate	$621.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$621.45
Rate for Payer: Hamaspik Choice Inc Medicare	$621.45

ROD CARBON 8X450MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	40200772
Hospital Revenue Code	278
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$299.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$156.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$171.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$142.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$163.88
Rate for Payer: EmblemHealth Commercial	$142.50
Rate for Payer: Fidelis Medicare Advantage	$299.25
Rate for Payer: Group Health Inc Commercial	$142.50
Rate for Payer: Group Health Inc Medicare	$99.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$185.25

ROD CARBON 8X450MM

Facility

$285.00

Service Code	HCPCS C1713
Hospital Charge Code	40200772
Hospital Revenue Code	278
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$142.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$142.50
Rate for Payer: Hamaspik Choice Inc Medicare	$142.50

ROD CARBON CONN 5 X 100MM

Facility

$190.40

Service Code	HCPCS C1713
Hospital Charge Code	64906559
Hospital Revenue Code	278
Min. Negotiated Rate	$95.20
Max. Negotiated Rate	$95.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.20
Rate for Payer: Hamaspik Choice Inc Medicare	$95.20

ROD CARBON CONN 5 X 100MM

Facility

$190.40

Service Code	HCPCS C1713
Hospital Charge Code	64906559
Hospital Revenue Code	278
Min. Negotiated Rate	$66.64
Max. Negotiated Rate	$199.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$114.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.48
Rate for Payer: EmblemHealth Commercial	$95.20
Rate for Payer: Fidelis Medicare Advantage	$199.92
Rate for Payer: Group Health Inc Commercial	$95.20
Rate for Payer: Group Health Inc Medicare	$66.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.20
Rate for Payer: Hamaspik Choice Inc Medicare	$95.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.76

ROD CARBON CONN 5 X 250MM

Facility

$144.20

Service Code	HCPCS C1713
Hospital Charge Code	64906587
Hospital Revenue Code	278
Min. Negotiated Rate	$50.47
Max. Negotiated Rate	$151.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$79.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$86.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$82.92
Rate for Payer: EmblemHealth Commercial	$72.10
Rate for Payer: Fidelis Medicare Advantage	$151.41
Rate for Payer: Group Health Inc Commercial	$72.10
Rate for Payer: Group Health Inc Medicare	$50.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.10
Rate for Payer: Hamaspik Choice Inc Medicare	$72.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$93.73

ROD CARBON CONN 5 X 250MM

Facility

$144.20

Service Code	HCPCS C1713
Hospital Charge Code	64906587
Hospital Revenue Code	278
Min. Negotiated Rate	$72.10
Max. Negotiated Rate	$72.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$72.10
Rate for Payer: Hamaspik Choice Inc Medicare	$72.10

ROD CARBON CONN HOFFMAN 15MM

Facility

$212.00

Service Code	HCPCS C1713
Hospital Charge Code	40200773
Hospital Revenue Code	278
Min. Negotiated Rate	$106.00
Max. Negotiated Rate	$106.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.00
Rate for Payer: Hamaspik Choice Inc Medicare	$106.00

ROD CARBON CONN HOFFMAN 15MM

Facility

$212.00

Service Code	HCPCS C1713
Hospital Charge Code	40200773
Hospital Revenue Code	278
Min. Negotiated Rate	$74.20
Max. Negotiated Rate	$222.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$116.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$127.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$106.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$121.90
Rate for Payer: EmblemHealth Commercial	$106.00
Rate for Payer: Fidelis Medicare Advantage	$222.60
Rate for Payer: Group Health Inc Commercial	$106.00
Rate for Payer: Group Health Inc Medicare	$74.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$106.00
Rate for Payer: Hamaspik Choice Inc Medicare	$106.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$137.80

ROD CARBON FIBER

Facility

$929.25

Service Code	HCPCS C1713
Hospital Charge Code	40201504
Hospital Revenue Code	278
Min. Negotiated Rate	$464.62
Max. Negotiated Rate	$464.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$464.62
Rate for Payer: Hamaspik Choice Inc Medicare	$464.62

ROD CARBON FIBER

Facility

$929.25

Service Code	HCPCS C1713
Hospital Charge Code	40201504
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$975.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$511.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$557.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$464.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$534.32
Rate for Payer: EmblemHealth Commercial	$464.62
Rate for Payer: Fidelis Medicare Advantage	$975.71
Rate for Payer: Group Health Inc Commercial	$464.62
Rate for Payer: Group Health Inc Medicare	$325.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$464.62
Rate for Payer: Hamaspik Choice Inc Medicare	$464.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$604.01

ROD CARBON FIBER 11.0MMX400MM

Facility

$948.00

Service Code	HCPCS C1713
Hospital Charge Code	40201505
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$995.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$521.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$568.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$474.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$545.10
Rate for Payer: EmblemHealth Commercial	$474.00
Rate for Payer: Fidelis Medicare Advantage	$995.40
Rate for Payer: Group Health Inc Commercial	$474.00
Rate for Payer: Group Health Inc Medicare	$331.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$474.00
Rate for Payer: Hamaspik Choice Inc Medicare	$474.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$616.20

ROD CARBON FIBER 11.0MMX400MM

Facility

$948.00

Service Code	HCPCS C1713
Hospital Charge Code	40201505
Hospital Revenue Code	278
Min. Negotiated Rate	$474.00
Max. Negotiated Rate	$474.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$474.00
Rate for Payer: Hamaspik Choice Inc Medicare	$474.00

ROD CARBON FIBER 300MM 11.0MM

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40201506
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 FIBER 300MM 11.0MM

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40201506
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 CIRCULAR SEMI

Facility

$209.00

Service Code	HCPCS C1713
Hospital Charge Code	40200774
Hospital Revenue Code	278
Min. Negotiated Rate	$104.50
Max. Negotiated Rate	$104.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.50
Rate for Payer: Hamaspik Choice Inc Medicare	$104.50

ROD CIRCULAR SEMI

Facility

$209.00

Service Code	HCPCS C1713
Hospital Charge Code	40200774
Hospital Revenue Code	278
Min. Negotiated Rate	$73.15
Max. Negotiated Rate	$219.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$125.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$104.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$120.17
Rate for Payer: EmblemHealth Commercial	$104.50
Rate for Payer: Fidelis Medicare Advantage	$219.45
Rate for Payer: Group Health Inc Commercial	$104.50
Rate for Payer: Group Health Inc Medicare	$73.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.50
Rate for Payer: Hamaspik Choice Inc Medicare	$104.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$135.85

ROD COCRT 4.75X40MM

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64905867
Hospital Revenue Code	278
Min. Negotiated Rate	$562.50
Max. Negotiated Rate	$562.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50

ROD COCRT 4.75X40MM

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64905867
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,181.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$618.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$562.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$646.88
Rate for Payer: EmblemHealth Commercial	$562.50
Rate for Payer: Fidelis Medicare Advantage	$1,181.25
Rate for Payer: Group Health Inc Commercial	$562.50
Rate for Payer: Group Health Inc Medicare	$393.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$562.50
Rate for Payer: Hamaspik Choice Inc Medicare	$562.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$731.25

ROD CONN CARBON 400MM

Facility

$247.00

Service Code	HCPCS C1713
Hospital Charge Code	40200777
Hospital Revenue Code	278
Min. Negotiated Rate	$123.50
Max. Negotiated Rate	$123.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.50
Rate for Payer: Hamaspik Choice Inc Medicare	$123.50

ROD CONN CARBON 400MM

Facility

$247.00

Service Code	HCPCS C1713
Hospital Charge Code	40200777
Hospital Revenue Code	278
Min. Negotiated Rate	$86.45
Max. Negotiated Rate	$259.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$135.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$148.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$123.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.03
Rate for Payer: EmblemHealth Commercial	$123.50
Rate for Payer: Fidelis Medicare Advantage	$259.35
Rate for Payer: Group Health Inc Commercial	$123.50
Rate for Payer: Group Health Inc Medicare	$86.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$123.50
Rate for Payer: Hamaspik Choice Inc Medicare	$123.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$160.55

Know your out-of-pocket cost for care.

All Charges