St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROD SPINAL 3.5MM DIA 25MML

Facility

$657.90

Service Code	HCPCS C1776
Hospital Charge Code	64903945
Hospital Revenue Code	278
Min. Negotiated Rate	$230.26
Max. Negotiated Rate	$690.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$361.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$394.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$328.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$378.29
Rate for Payer: EmblemHealth Commercial	$328.95
Rate for Payer: Fidelis Medicare Advantage	$690.80
Rate for Payer: Group Health Inc Commercial	$328.95
Rate for Payer: Group Health Inc Medicare	$230.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$328.95
Rate for Payer: Hamaspik Choice Inc Medicare	$328.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$427.64

ROD SPINAL 3.5MM DIA 30MML

Facility

$750.00

Service Code	HCPCS C1776
Hospital Charge Code	64904133
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 SPINAL 3.5MM DIA 30MML

Facility

$750.00

Service Code	HCPCS C1776
Hospital Charge Code	64904133
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 SPINAL 3.5MM DIA 35MML B

Facility

$750.00

Service Code	HCPCS C1776
Hospital Charge Code	64904135
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 SPINAL 3.5MM DIA 35MML B

Facility

$750.00

Service Code	HCPCS C1776
Hospital Charge Code	64904135
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 SPINAL 3.5MM DIA 40MML TIT

Facility

$678.95

Service Code	HCPCS C1776
Hospital Charge Code	64902874
Hospital Revenue Code	278
Min. Negotiated Rate	$339.48
Max. Negotiated Rate	$339.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$339.48
Rate for Payer: Hamaspik Choice Inc Medicare	$339.48

ROD SPINAL 3.5MM DIA 40MML TIT

Facility

$678.95

Service Code	HCPCS C1776
Hospital Charge Code	64902874
Hospital Revenue Code	278
Min. Negotiated Rate	$237.63
Max. Negotiated Rate	$712.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$373.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$407.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$339.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$390.40
Rate for Payer: EmblemHealth Commercial	$339.48
Rate for Payer: Fidelis Medicare Advantage	$712.90
Rate for Payer: Group Health Inc Commercial	$339.48
Rate for Payer: Group Health Inc Medicare	$237.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$339.48
Rate for Payer: Hamaspik Choice Inc Medicare	$339.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$441.32

ROD SPINAL 3.5MM DIA 50MML TIT

Facility

$678.95

Service Code	HCPCS C1776
Hospital Charge Code	64904459
Hospital Revenue Code	278
Min. Negotiated Rate	$237.63
Max. Negotiated Rate	$712.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$373.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$407.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$339.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$390.40
Rate for Payer: EmblemHealth Commercial	$339.48
Rate for Payer: Fidelis Medicare Advantage	$712.90
Rate for Payer: Group Health Inc Commercial	$339.48
Rate for Payer: Group Health Inc Medicare	$237.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$339.48
Rate for Payer: Hamaspik Choice Inc Medicare	$339.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$441.32

ROD SPINAL 3.5MM DIA 50MML TIT

Facility

$678.95

Service Code	HCPCS C1776
Hospital Charge Code	64904459
Hospital Revenue Code	278
Min. Negotiated Rate	$339.48
Max. Negotiated Rate	$339.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$339.48
Rate for Payer: Hamaspik Choice Inc Medicare	$339.48

ROD SPINAL 5.5MM DIA 40MML TIT

Facility

$875.00

Service Code	HCPCS C1776
Hospital Charge Code	64904098
Hospital Revenue Code	278
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$918.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$481.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$525.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.12
Rate for Payer: EmblemHealth Commercial	$437.50
Rate for Payer: Fidelis Medicare Advantage	$918.75
Rate for Payer: Group Health Inc Commercial	$437.50
Rate for Payer: Group Health Inc Medicare	$306.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$568.75

ROD SPINAL 5.5MM DIA 40MML TIT

Facility

$875.00

Service Code	HCPCS C1776
Hospital Charge Code	64904098
Hospital Revenue Code	278
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50

ROD SPINAL 5.5MM DIA 45MML TIT

Facility

$875.00

Service Code	HCPCS C1776
Hospital Charge Code	64904096
Hospital Revenue Code	278
Min. Negotiated Rate	$306.25
Max. Negotiated Rate	$918.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$481.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$525.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$437.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$503.12
Rate for Payer: EmblemHealth Commercial	$437.50
Rate for Payer: Fidelis Medicare Advantage	$918.75
Rate for Payer: Group Health Inc Commercial	$437.50
Rate for Payer: Group Health Inc Medicare	$306.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$568.75

ROD SPINAL 5.5MM DIA 45MML TIT

Facility

$875.00

Service Code	HCPCS C1776
Hospital Charge Code	64904096
Hospital Revenue Code	278
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$437.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$437.50
Rate for Payer: Hamaspik Choice Inc Medicare	$437.50

ROD SPINAL 5.5MM DIA 45MML TT

Facility

$937.50

Service Code	HCPCS C1776
Hospital Charge Code	64904159
Hospital Revenue Code	278
Min. Negotiated Rate	$468.75
Max. Negotiated Rate	$468.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$468.75
Rate for Payer: Hamaspik Choice Inc Medicare	$468.75

ROD SPINAL 5.5MM DIA 45MML TT

Facility

$937.50

Service Code	HCPCS C1776
Hospital Charge Code	64904159
Hospital Revenue Code	278
Min. Negotiated Rate	$328.12
Max. Negotiated Rate	$984.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$515.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$562.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$468.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$539.06
Rate for Payer: EmblemHealth Commercial	$468.75
Rate for Payer: Fidelis Medicare Advantage	$984.38
Rate for Payer: Group Health Inc Commercial	$468.75
Rate for Payer: Group Health Inc Medicare	$328.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$468.75
Rate for Payer: Hamaspik Choice Inc Medicare	$468.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$609.38

ROD SPINAL 6MM DIA 110MML TT

Facility

$3,235.00

Service Code	HCPCS C1776
Hospital Charge Code	64904935
Hospital Revenue Code	278
Min. Negotiated Rate	$1,617.50
Max. Negotiated Rate	$1,617.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,617.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,617.50

ROD SPINAL 6MM DIA 110MML TT

Facility

$3,235.00

Service Code	HCPCS C1776
Hospital Charge Code	64904935
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$3,396.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,779.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$1,941.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,617.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,860.12
Rate for Payer: EmblemHealth Commercial	$1,617.50
Rate for Payer: Fidelis Medicare Advantage	$3,396.75
Rate for Payer: Group Health Inc Commercial	$1,617.50
Rate for Payer: Group Health Inc Medicare	$1,132.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,617.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,617.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,102.75

ROD SPINAL 6MM DIA 40MML TITN3

Facility

$3,235.33

Service Code	HCPCS C1776
Hospital Charge Code	64904866
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 SPINAL 6MM DIA 40MML TITN3

Facility

$3,235.33

Service Code	HCPCS C1776
Hospital Charge Code	64904866
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 SPINAL 6MM DIA 50MML CP TI

Facility

$1,188.58

Service Code	HCPCS C1776
Hospital Charge Code	64904784
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,248.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$653.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$713.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$594.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$683.43
Rate for Payer: EmblemHealth Commercial	$594.29
Rate for Payer: Fidelis Medicare Advantage	$1,248.01
Rate for Payer: Group Health Inc Commercial	$594.29
Rate for Payer: Group Health Inc Medicare	$416.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$594.29
Rate for Payer: Hamaspik Choice Inc Medicare	$594.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$772.58

ROD SPINAL 6MM DIA 50MML CP TI

Facility

$1,188.58

Service Code	HCPCS C1776
Hospital Charge Code	64904784
Hospital Revenue Code	278
Min. Negotiated Rate	$594.29
Max. Negotiated Rate	$594.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$594.29
Rate for Payer: Hamaspik Choice Inc Medicare	$594.29

ROD SPINAL 6MM DIA 50MML TITAN

Facility

$1,591.10

Service Code	HCPCS C1776
Hospital Charge Code	64904451
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$1,670.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$875.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
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 SPINAL 6MM DIA 50MML TITAN

Facility

$1,591.10

Service Code	HCPCS C1776
Hospital Charge Code	64904451
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 SPINAL 6MM DIA 50MML TITN

Facility

$3,235.33

Service Code	HCPCS C1776
Hospital Charge Code	64904800
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 SPINAL 6MM DIA 50MML TITN

Facility

$3,235.33

Service Code	HCPCS C1776
Hospital Charge Code	64904800
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

Know your out-of-pocket cost for care.

All Charges