St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROD EXT FIXATION 8MM DIA 3 A

Facility

$820.75

Service Code	HCPCS C1713
Hospital Charge Code	64901719
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$861.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$451.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$492.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$410.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$471.93
Rate for Payer: EmblemHealth Commercial	$410.38
Rate for Payer: Fidelis Medicare Advantage	$861.79
Rate for Payer: Group Health Inc Commercial	$410.38
Rate for Payer: Group Health Inc Medicare	$287.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$410.38
Rate for Payer: Hamaspik Choice Inc Medicare	$410.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$533.49

ROD EXT FIXATION 8MM DIA 3 A

Facility

$820.75

Service Code	HCPCS C1713
Hospital Charge Code	64901719
Hospital Revenue Code	278
Min. Negotiated Rate	$410.38
Max. Negotiated Rate	$410.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$410.38
Rate for Payer: Hamaspik Choice Inc Medicare	$410.38

ROD EXT FIXATION 8MM DIA 3 B

Facility

$820.75

Service Code	HCPCS C1713
Hospital Charge Code	64901721
Hospital Revenue Code	278
Min. Negotiated Rate	$410.38
Max. Negotiated Rate	$410.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$410.38
Rate for Payer: Hamaspik Choice Inc Medicare	$410.38

ROD EXT FIXATION 8MM DIA 3 B

Facility

$820.75

Service Code	HCPCS C1713
Hospital Charge Code	64901721
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$861.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$451.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$492.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$410.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$471.93
Rate for Payer: EmblemHealth Commercial	$410.38
Rate for Payer: Fidelis Medicare Advantage	$861.79
Rate for Payer: Group Health Inc Commercial	$410.38
Rate for Payer: Group Health Inc Medicare	$287.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$410.38
Rate for Payer: Hamaspik Choice Inc Medicare	$410.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$533.49

ROD EXT FIXATION 8MM DIA 4 A

Facility

$841.75

Service Code	HCPCS C1713
Hospital Charge Code	64901722
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$883.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$462.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$505.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$420.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$484.01
Rate for Payer: EmblemHealth Commercial	$420.88
Rate for Payer: Fidelis Medicare Advantage	$883.84
Rate for Payer: Group Health Inc Commercial	$420.88
Rate for Payer: Group Health Inc Medicare	$294.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.88
Rate for Payer: Hamaspik Choice Inc Medicare	$420.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$547.14

ROD EXT FIXATION 8MM DIA 4 A

Facility

$841.75

Service Code	HCPCS C1713
Hospital Charge Code	64901722
Hospital Revenue Code	278
Min. Negotiated Rate	$420.88
Max. Negotiated Rate	$420.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$420.88
Rate for Payer: Hamaspik Choice Inc Medicare	$420.88

ROD EXT FIXATION 8MM DIA 4 B

Facility

$815.50

Service Code	HCPCS C1713
Hospital Charge Code	64901863
Hospital Revenue Code	278
Min. Negotiated Rate	$407.75
Max. Negotiated Rate	$407.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$407.75
Rate for Payer: Hamaspik Choice Inc Medicare	$407.75

ROD EXT FIXATION 8MM DIA 4 B

Facility

$815.50

Service Code	HCPCS C1713
Hospital Charge Code	64901863
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$856.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$448.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$489.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$407.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$468.91
Rate for Payer: EmblemHealth Commercial	$407.75
Rate for Payer: Fidelis Medicare Advantage	$856.28
Rate for Payer: Group Health Inc Commercial	$407.75
Rate for Payer: Group Health Inc Medicare	$285.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$407.75
Rate for Payer: Hamaspik Choice Inc Medicare	$407.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$530.08

ROD EXT FIXATION 8MM DIA 5

Facility

$887.25

Service Code	HCPCS C1713
Hospital Charge Code	64901762
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$931.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$487.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$532.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$443.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$510.17
Rate for Payer: EmblemHealth Commercial	$443.62
Rate for Payer: Fidelis Medicare Advantage	$931.61
Rate for Payer: Group Health Inc Commercial	$443.62
Rate for Payer: Group Health Inc Medicare	$310.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$443.62
Rate for Payer: Hamaspik Choice Inc Medicare	$443.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$576.71

ROD EXT FIXATION 8MM DIA 5

Facility

$887.25

Service Code	HCPCS C1713
Hospital Charge Code	64901762
Hospital Revenue Code	278
Min. Negotiated Rate	$443.62
Max. Negotiated Rate	$443.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$443.62
Rate for Payer: Hamaspik Choice Inc Medicare	$443.62

ROD FIBER 810 MM

Facility

$308.00

Service Code	HCPCS C1713
Hospital Charge Code	40201507
Hospital Revenue Code	278
Min. Negotiated Rate	$154.00
Max. Negotiated Rate	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.00
Rate for Payer: Hamaspik Choice Inc Medicare	$154.00

ROD FIBER 810 MM

Facility

$308.00

Service Code	HCPCS C1713
Hospital Charge Code	40201507
Hospital Revenue Code	278
Min. Negotiated Rate	$107.80
Max. Negotiated Rate	$323.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$169.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$184.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$154.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$177.10
Rate for Payer: EmblemHealth Commercial	$154.00
Rate for Payer: Fidelis Medicare Advantage	$323.40
Rate for Payer: Group Health Inc Commercial	$154.00
Rate for Payer: Group Health Inc Medicare	$107.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$154.00
Rate for Payer: Hamaspik Choice Inc Medicare	$154.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$200.20

ROD GUIDE 3.0MM SMOOTH TIP 950M

Facility

$347.50

Hospital Charge Code	40200199
Hospital Revenue Code	270
Min. Negotiated Rate	$121.62
Max. Negotiated Rate	$278.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$191.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.75
Rate for Payer: Aetna Government	$173.75
Rate for Payer: Brighton Health Commercial	$260.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$278.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$236.30
Rate for Payer: Group Health Inc Commercial	$173.75
Rate for Payer: Group Health Inc Medicare	$121.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$173.75
Rate for Payer: Hamaspik Choice Inc Medicare	$173.75

ROD, HEX, MANTIS 100MM

Facility

$3,235.25

Service Code	HCPCS C1713
Hospital Charge Code	64904437
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

ROD, HEX, MANTIS 100MM

Facility

$3,235.25

Service Code	HCPCS C1713
Hospital Charge Code	64904437
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 HOFFMN3 CON 11X650MM

Facility

$1,594.00

Service Code	HCPCS C1713
Hospital Charge Code	64905642
Hospital Revenue Code	278
Min. Negotiated Rate	$797.00
Max. Negotiated Rate	$797.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$797.00
Rate for Payer: Hamaspik Choice Inc Medicare	$797.00

ROD HOFFMN3 CON 11X650MM

Facility

$1,594.00

Service Code	HCPCS C1713
Hospital Charge Code	64905642
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,673.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$876.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$956.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$797.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$916.55
Rate for Payer: EmblemHealth Commercial	$797.00
Rate for Payer: Fidelis Medicare Advantage	$1,673.70
Rate for Payer: Group Health Inc Commercial	$797.00
Rate for Payer: Group Health Inc Medicare	$557.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$797.00
Rate for Payer: Hamaspik Choice Inc Medicare	$797.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,036.10

ROD INTRAMED CRVD ALUM 134MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	40200778
Hospital Revenue Code	278
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$207.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$108.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$118.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$113.85
Rate for Payer: EmblemHealth Commercial	$99.00
Rate for Payer: Fidelis Medicare Advantage	$207.90
Rate for Payer: Group Health Inc Commercial	$99.00
Rate for Payer: Group Health Inc Medicare	$69.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$128.70

ROD INTRAMED CRVD ALUM 134MM

Facility

$198.00

Service Code	HCPCS C1713
Hospital Charge Code	40200778
Hospital Revenue Code	278
Min. Negotiated Rate	$99.00
Max. Negotiated Rate	$99.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.00
Rate for Payer: Hamaspik Choice Inc Medicare	$99.00

ROD MOSS MIAMI SI 5.5X30 TI

Facility

$1,110.00

Service Code	HCPCS C1776
Hospital Charge Code	40205095
Hospital Revenue Code	278
Min. Negotiated Rate	$555.00
Max. Negotiated Rate	$555.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$555.00
Rate for Payer: Hamaspik Choice Inc Medicare	$555.00

ROD MOSS MIAMI SI 5.5X30 TI

Facility

$1,110.00

Service Code	HCPCS C1776
Hospital Charge Code	40205095
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,165.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$610.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$666.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$555.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$638.25
Rate for Payer: EmblemHealth Commercial	$555.00
Rate for Payer: Fidelis Medicare Advantage	$1,165.50
Rate for Payer: Group Health Inc Commercial	$555.00
Rate for Payer: Group Health Inc Medicare	$388.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$555.00
Rate for Payer: Hamaspik Choice Inc Medicare	$555.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$721.50

ROD OC TI 100DEG (07.01712.001)

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	64906474
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$287.50
Rate for Payer: EmblemHealth Commercial	$250.00
Rate for Payer: Fidelis Medicare Advantage	$525.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$325.00

ROD OC TI 100DEG (07.01712.001)

Facility

$500.00

Service Code	HCPCS C1713
Hospital Charge Code	64906474
Hospital Revenue Code	278
Min. Negotiated Rate	$250.00
Max. Negotiated Rate	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

ROD ORTHO 5 X 60MM

Facility

$76.38

Service Code	HCPCS C1713
Hospital Charge Code	64905730
Hospital Revenue Code	278
Min. Negotiated Rate	$26.73
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$45.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.92
Rate for Payer: EmblemHealth Commercial	$38.19
Rate for Payer: Fidelis Medicare Advantage	$80.20
Rate for Payer: Group Health Inc Commercial	$38.19
Rate for Payer: Group Health Inc Medicare	$26.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.19
Rate for Payer: Hamaspik Choice Inc Medicare	$38.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.65

ROD ORTHO 5 X 60MM

Facility

$76.38

Service Code	HCPCS C1713
Hospital Charge Code	64905730
Hospital Revenue Code	278
Min. Negotiated Rate	$38.19
Max. Negotiated Rate	$38.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.19
Rate for Payer: Hamaspik Choice Inc Medicare	$38.19

Know your out-of-pocket cost for care.

All Charges