St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROD TO ROD COUPLING 5/5MM

Facility

$522.00

Service Code	HCPCS C1713
Hospital Charge Code	40202369
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$548.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$287.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$313.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$261.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$300.15
Rate for Payer: EmblemHealth Commercial	$261.00
Rate for Payer: Fidelis Medicare Advantage	$548.10
Rate for Payer: Group Health Inc Commercial	$261.00
Rate for Payer: Group Health Inc Medicare	$182.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$261.00
Rate for Payer: Hamaspik Choice Inc Medicare	$261.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$339.30

ROD TO ROD COUPLING 5/8MM

Facility

$762.00

Service Code	HCPCS C1713
Hospital Charge Code	40201423
Hospital Revenue Code	278
Min. Negotiated Rate	$381.00
Max. Negotiated Rate	$381.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$381.00
Rate for Payer: Hamaspik Choice Inc Medicare	$381.00

ROD TO ROD COUPLING 5/8MM

Facility

$762.00

Service Code	HCPCS C1713
Hospital Charge Code	40201423
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$800.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$419.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$457.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$381.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$438.15
Rate for Payer: EmblemHealth Commercial	$381.00
Rate for Payer: Fidelis Medicare Advantage	$800.10
Rate for Payer: Group Health Inc Commercial	$381.00
Rate for Payer: Group Health Inc Medicare	$266.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$381.00
Rate for Payer: Hamaspik Choice Inc Medicare	$381.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$495.30

ROD TO ROD COUPLING 8/8MM

Facility

$1,057.00

Service Code	HCPCS C1713
Hospital Charge Code	40201424
Hospital Revenue Code	278
Min. Negotiated Rate	$528.50
Max. Negotiated Rate	$528.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.50
Rate for Payer: Hamaspik Choice Inc Medicare	$528.50

ROD TO ROD COUPLING 8/8MM

Facility

$1,057.00

Service Code	HCPCS C1713
Hospital Charge Code	40201424
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,109.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$581.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$634.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$528.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$607.78
Rate for Payer: EmblemHealth Commercial	$528.50
Rate for Payer: Fidelis Medicare Advantage	$1,109.85
Rate for Payer: Group Health Inc Commercial	$528.50
Rate for Payer: Group Health Inc Medicare	$369.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$528.50
Rate for Payer: Hamaspik Choice Inc Medicare	$528.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$687.05

ROD TO TUBE COUPLING

Facility

$892.00

Service Code	HCPCS C1713
Hospital Charge Code	40200795
Hospital Revenue Code	278
Min. Negotiated Rate	$446.00
Max. Negotiated Rate	$446.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$446.00
Rate for Payer: Hamaspik Choice Inc Medicare	$446.00

ROD TO TUBE COUPLING

Facility

$464.80

Service Code	HCPCS C1713
Hospital Charge Code	40201425
Hospital Revenue Code	278
Min. Negotiated Rate	$232.40
Max. Negotiated Rate	$232.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.40
Rate for Payer: Hamaspik Choice Inc Medicare	$232.40

ROD TO TUBE COUPLING

Facility

$464.80

Service Code	HCPCS C1713
Hospital Charge Code	40201425
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$488.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$255.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$278.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$232.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$267.26
Rate for Payer: EmblemHealth Commercial	$232.40
Rate for Payer: Fidelis Medicare Advantage	$488.04
Rate for Payer: Group Health Inc Commercial	$232.40
Rate for Payer: Group Health Inc Medicare	$162.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$232.40
Rate for Payer: Hamaspik Choice Inc Medicare	$232.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$302.12

ROD TO TUBE COUPLING

Facility

$892.00

Service Code	HCPCS C1713
Hospital Charge Code	40200795
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$936.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$490.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$535.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$446.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$512.90
Rate for Payer: EmblemHealth Commercial	$446.00
Rate for Payer: Fidelis Medicare Advantage	$936.60
Rate for Payer: Group Health Inc Commercial	$446.00
Rate for Payer: Group Health Inc Medicare	$312.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$446.00
Rate for Payer: Hamaspik Choice Inc Medicare	$446.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$579.80

ROD T STRAIGHT HEX 110MM

Facility

$3,235.33

Service Code	HCPCS C1713
Hospital Charge Code	64904899
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,397.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,779.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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 T STRAIGHT HEX 110MM

Facility

$3,235.33

Service Code	HCPCS C1713
Hospital Charge Code	64904899
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 VUEPOINT 2 3.5X120MM

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64903813
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 VUEPOINT 2 3.5X120MM

Facility

$1,125.00

Service Code	HCPCS C1713
Hospital Charge Code	64903813
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 YUKON 120MM

Facility

$1,666.00

Service Code	HCPCS C1713
Hospital Charge Code	64906787
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,749.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$916.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$999.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$833.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$957.95
Rate for Payer: EmblemHealth Commercial	$833.00
Rate for Payer: Fidelis Medicare Advantage	$1,749.30
Rate for Payer: Group Health Inc Commercial	$833.00
Rate for Payer: Group Health Inc Medicare	$583.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$833.00
Rate for Payer: Hamaspik Choice Inc Medicare	$833.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,082.90

ROD YUKON 120MM

Facility

$1,666.00

Service Code	HCPCS C1713
Hospital Charge Code	64906787
Hospital Revenue Code	278
Min. Negotiated Rate	$833.00
Max. Negotiated Rate	$833.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$833.00
Rate for Payer: Hamaspik Choice Inc Medicare	$833.00

ROD YUKON 3.5

Facility

$1,848.75

Service Code	HCPCS C1713
Hospital Charge Code	64907239
Hospital Revenue Code	278
Min. Negotiated Rate	$924.38
Max. Negotiated Rate	$924.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$924.38
Rate for Payer: Hamaspik Choice Inc Medicare	$924.38

ROD YUKON 3.5

Facility

$1,848.75

Service Code	HCPCS C1713
Hospital Charge Code	64907239
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,941.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,016.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,109.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$924.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,063.03
Rate for Payer: EmblemHealth Commercial	$924.38
Rate for Payer: Fidelis Medicare Advantage	$1,941.19
Rate for Payer: Group Health Inc Commercial	$924.38
Rate for Payer: Group Health Inc Medicare	$647.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$924.38
Rate for Payer: Hamaspik Choice Inc Medicare	$924.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,201.69

ROD YUKON 55MM

Facility

$1,848.75

Service Code	HCPCS C1713
Hospital Charge Code	64907019
Hospital Revenue Code	278
Min. Negotiated Rate	$924.38
Max. Negotiated Rate	$924.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$924.38
Rate for Payer: Hamaspik Choice Inc Medicare	$924.38

ROD YUKON 55MM

Facility

$1,848.75

Service Code	HCPCS C1713
Hospital Charge Code	64907019
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,941.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,016.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,109.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$924.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,063.03
Rate for Payer: EmblemHealth Commercial	$924.38
Rate for Payer: Fidelis Medicare Advantage	$1,941.19
Rate for Payer: Group Health Inc Commercial	$924.38
Rate for Payer: Group Health Inc Medicare	$647.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$924.38
Rate for Payer: Hamaspik Choice Inc Medicare	$924.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,201.69

ROFLUMILAST 250 MCG PO TABS [160302]

Facility

$17.75

Service Code	NDC 00310008828
Hospital Charge Code	00310008828
Hospital Revenue Code	250
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$14.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.88
Rate for Payer: Aetna Government	$8.88
Rate for Payer: Brighton Health Commercial	$13.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.07
Rate for Payer: Group Health Inc Commercial	$8.88
Rate for Payer: Group Health Inc Medicare	$6.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.54

ROFLUMILAST 250 MCG PO TABS [160302]

Facility

$17.75

Service Code	NDC 00310008839
Hospital Charge Code	00310008839
Hospital Revenue Code	250
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$14.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.87
Rate for Payer: Aetna Government	$8.87
Rate for Payer: Brighton Health Commercial	$13.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.07
Rate for Payer: Group Health Inc Commercial	$8.87
Rate for Payer: Group Health Inc Medicare	$6.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.87
Rate for Payer: Hamaspik Choice Inc Medicare	$8.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.54

ROFLUMILAST 250 MCG PO TABS [160302]

Facility

$15.56

Service Code	NDC 72205020124
Hospital Charge Code	72205020124
Hospital Revenue Code	250
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$12.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.78
Rate for Payer: Aetna Government	$7.78
Rate for Payer: Brighton Health Commercial	$11.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.58
Rate for Payer: Group Health Inc Commercial	$7.78
Rate for Payer: Group Health Inc Medicare	$5.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.78
Rate for Payer: Hamaspik Choice Inc Medicare	$7.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.11

ROFLUMILAST 500MCG

Facility

$8.68

Hospital Charge Code	41658183
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$6.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.34
Rate for Payer: Aetna Government	$4.34
Rate for Payer: Brighton Health Commercial	$6.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.90
Rate for Payer: Group Health Inc Commercial	$4.34
Rate for Payer: Group Health Inc Medicare	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.34
Rate for Payer: Hamaspik Choice Inc Medicare	$4.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.64

ROFLUMILAST 500MCG

Facility

$8.68

Hospital Charge Code	41648183
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$6.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.34
Rate for Payer: Aetna Government	$4.34
Rate for Payer: Brighton Health Commercial	$6.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.90
Rate for Payer: Group Health Inc Commercial	$4.34
Rate for Payer: Group Health Inc Medicare	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.34
Rate for Payer: Hamaspik Choice Inc Medicare	$4.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.64

ROFLUMILAST 500 MCG PO TABS [109401]

Facility

$17.75

Service Code	NDC 00310009530
Hospital Charge Code	00310009530
Hospital Revenue Code	250
Min. Negotiated Rate	$6.21
Max. Negotiated Rate	$14.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.88
Rate for Payer: Aetna Government	$8.88
Rate for Payer: Brighton Health Commercial	$13.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.07
Rate for Payer: Group Health Inc Commercial	$8.88
Rate for Payer: Group Health Inc Medicare	$6.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.88
Rate for Payer: Hamaspik Choice Inc Medicare	$8.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.54

Know your out-of-pocket cost for care.

All Charges