St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HFN RH 125 DEG 13MM X 280MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005982
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 280MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005982
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 300MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005983
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 300MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005983
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 320MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005984
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 320MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005984
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 340MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005985
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 340MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005985
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 360MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005986
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 360MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005986
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 380M

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005987
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 380M

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005987
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 400MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005988
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 400MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005988
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 420MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005989
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 420MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005989
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 440MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005990
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 440MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005990
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 13MM X 460MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005991
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 13MM X 460MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005991
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 9MM X 260MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005959
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 9MM X 260MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005959
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 9MM X 280MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005960
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

HFN RH 125 DEG 9MM X 280MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005960
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,657.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,048.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,505.20
Rate for Payer: EmblemHealth Commercial	$3,048.00
Rate for Payer: Fidelis Medicare Advantage	$6,400.80
Rate for Payer: Group Health Inc Commercial	$3,048.00
Rate for Payer: Group Health Inc Medicare	$2,133.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,962.40

HFN RH 125 DEG 9MM X 300MM

Facility

$6,096.00

Service Code	HCPCS C1713
Hospital Charge Code	40005961
Hospital Revenue Code	278
Min. Negotiated Rate	$3,048.00
Max. Negotiated Rate	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,048.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,048.00

Know your out-of-pocket cost for care.

All Charges