St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROD PRECUT 45MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64906855
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,050.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$550.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$600.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$575.00
Rate for Payer: EmblemHealth Commercial	$500.00
Rate for Payer: Fidelis Medicare Advantage	$1,050.00
Rate for Payer: Group Health Inc Commercial	$500.00
Rate for Payer: Group Health Inc Medicare	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$650.00

ROD PRECUT 45MM

Facility

$1,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64906855
Hospital Revenue Code	278
Min. Negotiated Rate	$500.00
Max. Negotiated Rate	$500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$500.00

ROD RAD 80MM

Facility

$1,591.10

Service Code	HCPCS C1713
Hospital Charge Code	64905113
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 RAD 80MM

Facility

$1,591.10

Service Code	HCPCS C1713
Hospital Charge Code	64905113
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 RAD 90MM

Facility

$1,591.10

Service Code	HCPCS C1713
Hospital Charge Code	64905115
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 RAD 90MM

Facility

$1,591.10

Service Code	HCPCS C1713
Hospital Charge Code	64905115
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 RAD SPINAL 30MM

Facility

$3,235.33

Service Code	HCPCS C1776
Hospital Charge Code	64905227
Hospital Revenue Code	278
Min. Negotiated Rate	$1,617.66
Max. Negotiated Rate	$1,617.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,617.66
Rate for Payer: Hamaspik Choice Inc Medicare	$1,617.66

ROD RAD SPINAL 30MM

Facility

$3,235.33

Service Code	HCPCS C1776
Hospital Charge Code	64905227
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,397.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,779.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,941.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,617.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,860.31
Rate for Payer: EmblemHealth Commercial	$1,617.66
Rate for Payer: Fidelis Medicare Advantage	$3,397.10
Rate for Payer: Group Health Inc Commercial	$1,617.66
Rate for Payer: Group Health Inc Medicare	$1,132.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,617.66
Rate for Payer: Hamaspik Choice Inc Medicare	$1,617.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,102.96

ROD RAD XIA3 6MM X 40MM

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64902284
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$511.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$268.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$292.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$243.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.31
Rate for Payer: EmblemHealth Commercial	$243.75
Rate for Payer: Fidelis Medicare Advantage	$511.88
Rate for Payer: Group Health Inc Commercial	$243.75
Rate for Payer: Group Health Inc Medicare	$170.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$316.88

ROD RAD XIA3 6MM X 40MM

Facility

$487.50

Service Code	HCPCS C1713
Hospital Charge Code	64902284
Hospital Revenue Code	278
Min. Negotiated Rate	$243.75
Max. Negotiated Rate	$243.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$243.75
Rate for Payer: Hamaspik Choice Inc Medicare	$243.75

ROD REAM 3.0MM STR TIP 950 M ST

Facility

$266.00

Service Code	HCPCS C1713
Hospital Charge Code	40201508
Hospital Revenue Code	278
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$279.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$146.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$159.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$133.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$152.95
Rate for Payer: EmblemHealth Commercial	$133.00
Rate for Payer: Fidelis Medicare Advantage	$279.30
Rate for Payer: Group Health Inc Commercial	$133.00
Rate for Payer: Group Health Inc Medicare	$93.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.00
Rate for Payer: Hamaspik Choice Inc Medicare	$133.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$172.90

ROD REAM 3.0MM STR TIP 950 M ST

Facility

$266.00

Service Code	HCPCS C1713
Hospital Charge Code	40201508
Hospital Revenue Code	278
Min. Negotiated Rate	$133.00
Max. Negotiated Rate	$133.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$133.00
Rate for Payer: Hamaspik Choice Inc Medicare	$133.00

ROD REAMING BALL TIP 2.5X950MM

Facility

$382.50

Service Code	HCPCS C1713
Hospital Charge Code	40201509
Hospital Revenue Code	278
Min. Negotiated Rate	$133.88
Max. Negotiated Rate	$401.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$210.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$229.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$191.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$219.94
Rate for Payer: EmblemHealth Commercial	$191.25
Rate for Payer: Fidelis Medicare Advantage	$401.62
Rate for Payer: Group Health Inc Commercial	$191.25
Rate for Payer: Group Health Inc Medicare	$133.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.25
Rate for Payer: Hamaspik Choice Inc Medicare	$191.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$248.62

ROD REAMING BALL TIP 2.5X950MM

Facility

$382.50

Service Code	HCPCS C1713
Hospital Charge Code	40201509
Hospital Revenue Code	278
Min. Negotiated Rate	$191.25
Max. Negotiated Rate	$191.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$191.25
Rate for Payer: Hamaspik Choice Inc Medicare	$191.25

ROD, RELINE MAS, 5.5X45MM LOR

Facility

$1,172.50

Service Code	HCPCS C1713
Hospital Charge Code	64905585
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,231.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$644.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$703.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$586.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$674.19
Rate for Payer: EmblemHealth Commercial	$586.25
Rate for Payer: Fidelis Medicare Advantage	$1,231.12
Rate for Payer: Group Health Inc Commercial	$586.25
Rate for Payer: Group Health Inc Medicare	$410.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$586.25
Rate for Payer: Hamaspik Choice Inc Medicare	$586.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$762.12

ROD, RELINE MAS, 5.5X45MM LOR

Facility

$1,172.50

Service Code	HCPCS C1713
Hospital Charge Code	64905585
Hospital Revenue Code	278
Min. Negotiated Rate	$586.25
Max. Negotiated Rate	$586.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$586.25
Rate for Payer: Hamaspik Choice Inc Medicare	$586.25

ROD REL-O TI 5.5X60MM LOR

Facility

$1,077.50

Service Code	HCPCS C1713
Hospital Charge Code	64904875
Hospital Revenue Code	278
Min. Negotiated Rate	$538.75
Max. Negotiated Rate	$538.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$538.75
Rate for Payer: Hamaspik Choice Inc Medicare	$538.75

ROD REL-O TI 5.5X60MM LOR

Facility

$1,077.50

Service Code	HCPCS C1713
Hospital Charge Code	64904875
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,131.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$592.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$646.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$538.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$619.56
Rate for Payer: EmblemHealth Commercial	$538.75
Rate for Payer: Fidelis Medicare Advantage	$1,131.38
Rate for Payer: Group Health Inc Commercial	$538.75
Rate for Payer: Group Health Inc Medicare	$377.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$538.75
Rate for Payer: Hamaspik Choice Inc Medicare	$538.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$700.38

RODS 25MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905092
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

RODS 25MM

Facility

$750.00

Service Code	HCPCS C1713
Hospital Charge Code	64905092
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

RODS 300MM

Facility

$1,065.00

Service Code	HCPCS C1713
Hospital Charge Code	40200934
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,118.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$585.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$639.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$532.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.38
Rate for Payer: EmblemHealth Commercial	$532.50
Rate for Payer: Fidelis Medicare Advantage	$1,118.25
Rate for Payer: Group Health Inc Commercial	$532.50
Rate for Payer: Group Health Inc Medicare	$372.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.50
Rate for Payer: Hamaspik Choice Inc Medicare	$532.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$692.25

RODS 300MM

Facility

$1,065.00

Service Code	HCPCS C1713
Hospital Charge Code	40200934
Hospital Revenue Code	278
Min. Negotiated Rate	$532.50
Max. Negotiated Rate	$532.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$532.50
Rate for Payer: Hamaspik Choice Inc Medicare	$532.50

RODS-CARBONFIBER 11.0MM

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40201511
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

RODS-CARBONFIBER 11.0MM

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40201511
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 SPINAL 3.5MM DIA 25MML

Facility

$657.90

Service Code	HCPCS C1776
Hospital Charge Code	64903945
Hospital Revenue Code	278
Min. Negotiated Rate	$328.95
Max. Negotiated Rate	$328.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.95
Rate for Payer: Hamaspik Choice Inc Medicare	$328.95

Know your out-of-pocket cost for care.

All Charges