St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KLS 1.5 7 HOLE L-SHAPE PLATE

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40205679
Hospital Revenue Code	278
Min. Negotiated Rate	$130.90
Max. Negotiated Rate	$392.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$205.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$224.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$187.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$215.05
Rate for Payer: EmblemHealth Commercial	$187.00
Rate for Payer: Fidelis Medicare Advantage	$392.70
Rate for Payer: Group Health Inc Commercial	$187.00
Rate for Payer: Group Health Inc Medicare	$130.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$243.10

KLS 1.5 7 HOLE L-SHAPE PLATE

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40205679
Hospital Revenue Code	278
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$187.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$187.00
Rate for Payer: Hamaspik Choice Inc Medicare	$187.00

KLS 1.5MM 5HOLE L-SHAPE RIGHT

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40205593
Hospital Revenue Code	278
Min. Negotiated Rate	$105.00
Max. Negotiated Rate	$315.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$150.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$172.50
Rate for Payer: EmblemHealth Commercial	$150.00
Rate for Payer: Fidelis Medicare Advantage	$315.00
Rate for Payer: Group Health Inc Commercial	$150.00
Rate for Payer: Group Health Inc Medicare	$105.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$195.00

KLS 1.5MM 5HOLE L-SHAPE RIGHT

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40205593
Hospital Revenue Code	278
Min. Negotiated Rate	$150.00
Max. Negotiated Rate	$150.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$150.00
Rate for Payer: Hamaspik Choice Inc Medicare	$150.00

KLS 2.0MM 5HOLE L-SHAPE LEFT

Facility

$330.00

Service Code	HCPCS C1713
Hospital Charge Code	40205592
Hospital Revenue Code	278
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$165.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00

KLS 2.0MM 5HOLE L-SHAPE LEFT

Facility

$330.00

Service Code	HCPCS C1713
Hospital Charge Code	40205592
Hospital Revenue Code	278
Min. Negotiated Rate	$115.50
Max. Negotiated Rate	$346.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$181.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$198.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$165.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$189.75
Rate for Payer: EmblemHealth Commercial	$165.00
Rate for Payer: Fidelis Medicare Advantage	$346.50
Rate for Payer: Group Health Inc Commercial	$165.00
Rate for Payer: Group Health Inc Medicare	$115.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$165.00
Rate for Payer: Hamaspik Choice Inc Medicare	$165.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$214.50

KLS 2.0MM MAND PLT TRAUMA MODULE

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40202362
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

KLS 2.0MM MAND PLT TRAUMA MODULE

Facility

$450.00

Service Code	HCPCS C1713
Hospital Charge Code	40202362
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

KLS C/DR/MINI SCRW 2.0MM

Facility

$96.00

Service Code	HCPCS C1776
Hospital Charge Code	40208078
Hospital Revenue Code	278
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$57.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.20
Rate for Payer: EmblemHealth Commercial	$48.00
Rate for Payer: Fidelis Medicare Advantage	$100.80
Rate for Payer: Group Health Inc Commercial	$48.00
Rate for Payer: Group Health Inc Medicare	$33.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00
Rate for Payer: Hamaspik Choice Inc Medicare	$48.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.40

KLS C/DR/MINI SCRW 2.0MM

Facility

$96.00

Service Code	HCPCS C1776
Hospital Charge Code	40208078
Hospital Revenue Code	278
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00
Rate for Payer: Hamaspik Choice Inc Medicare	$48.00

KLS C/DRV M SCRW 1.5MM X7MM

Facility

$102.00

Service Code	HCPCS C1776
Hospital Charge Code	40205014
Hospital Revenue Code	278
Min. Negotiated Rate	$35.70
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$61.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$51.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$58.65
Rate for Payer: EmblemHealth Commercial	$51.00
Rate for Payer: Fidelis Medicare Advantage	$107.10
Rate for Payer: Group Health Inc Commercial	$51.00
Rate for Payer: Group Health Inc Medicare	$35.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.30

KLS C/DRV M SCRW 1.5MM X7MM

Facility

$102.00

Service Code	HCPCS C1776
Hospital Charge Code	40205014
Hospital Revenue Code	278
Min. Negotiated Rate	$51.00
Max. Negotiated Rate	$51.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$51.00
Rate for Payer: Hamaspik Choice Inc Medicare	$51.00

KLS CROSS DRI MINI SCRW 2.0MMX9MM

Facility

$96.00

Service Code	HCPCS C1776
Hospital Charge Code	40206094
Hospital Revenue Code	278
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$52.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$57.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.20
Rate for Payer: EmblemHealth Commercial	$48.00
Rate for Payer: Fidelis Medicare Advantage	$100.80
Rate for Payer: Group Health Inc Commercial	$48.00
Rate for Payer: Group Health Inc Medicare	$33.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00
Rate for Payer: Hamaspik Choice Inc Medicare	$48.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$62.40

KLS CROSS DRI MINI SCRW 2.0MMX9MM

Facility

$96.00

Service Code	HCPCS C1776
Hospital Charge Code	40206094
Hospital Revenue Code	278
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$48.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.00
Rate for Payer: Hamaspik Choice Inc Medicare	$48.00

KLS CROSS DRIVE BONE SCREW 2.3MM

Facility

$161.25

Service Code	HCPCS C1776
Hospital Charge Code	40205154
Hospital Revenue Code	278
Min. Negotiated Rate	$80.62
Max. Negotiated Rate	$80.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.62
Rate for Payer: Hamaspik Choice Inc Medicare	$80.62

KLS CROSS DRIVE BONE SCREW 2.3MM

Facility

$161.25

Service Code	HCPCS C1776
Hospital Charge Code	40205154
Hospital Revenue Code	278
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$96.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$92.72
Rate for Payer: EmblemHealth Commercial	$80.62
Rate for Payer: Fidelis Medicare Advantage	$169.31
Rate for Payer: Group Health Inc Commercial	$80.62
Rate for Payer: Group Health Inc Medicare	$56.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.62
Rate for Payer: Hamaspik Choice Inc Medicare	$80.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$104.81

KLS CROSS DR MINI SCRW 2.0MMX9MM

Facility

$6,096.00

Service Code	HCPCS C1776
Hospital Charge Code	40206089
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

KLS CROSS DR MINI SCRW 2.0MMX9MM

Facility

$6,096.00

Service Code	HCPCS C1776
Hospital Charge Code	40206089
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$6,400.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
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

KLS D/F C/D M SCRW 1.5MM DIAX4MM

Facility

$114.00

Service Code	HCPCS C1713
Hospital Charge Code	40205413
Hospital Revenue Code	278
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.00
Rate for Payer: Hamaspik Choice Inc Medicare	$57.00

KLS D/F C/D M SCRW 1.5MM DIAX4MM

Facility

$114.00

Service Code	HCPCS C1713
Hospital Charge Code	40205413
Hospital Revenue Code	278
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$68.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.55
Rate for Payer: EmblemHealth Commercial	$57.00
Rate for Payer: Fidelis Medicare Advantage	$119.70
Rate for Payer: Group Health Inc Commercial	$57.00
Rate for Payer: Group Health Inc Medicare	$39.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.00
Rate for Payer: Hamaspik Choice Inc Medicare	$57.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.10

KLS D/F MAX/DRI 1.8 MICRO ER/SCRW

Facility

$116.00

Service Code	HCPCS C1713
Hospital Charge Code	40205731
Hospital Revenue Code	278
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$69.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.70
Rate for Payer: EmblemHealth Commercial	$58.00
Rate for Payer: Fidelis Medicare Advantage	$121.80
Rate for Payer: Group Health Inc Commercial	$58.00
Rate for Payer: Group Health Inc Medicare	$40.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.40

KLS D/F MAX/DRI 1.8 MICRO ER/SCRW

Facility

$116.00

Service Code	HCPCS C1713
Hospital Charge Code	40205731
Hospital Revenue Code	278
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$58.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00

KLS D/F MAXDRIVE 1.5X4MM M/SCRW

Facility

$116.00

Service Code	HCPCS C1713
Hospital Charge Code	40205613
Hospital Revenue Code	278
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$58.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00

KLS D/F MAXDRIVE 1.5X4MM M/SCRW

Facility

$116.00

Service Code	HCPCS C1713
Hospital Charge Code	40205613
Hospital Revenue Code	278
Min. Negotiated Rate	$40.60
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$69.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$66.70
Rate for Payer: EmblemHealth Commercial	$58.00
Rate for Payer: Fidelis Medicare Advantage	$121.80
Rate for Payer: Group Health Inc Commercial	$58.00
Rate for Payer: Group Health Inc Medicare	$40.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.00
Rate for Payer: Hamaspik Choice Inc Medicare	$58.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.40

KLS D/F M/D 1.5 X M/SCRW

Facility

$114.00

Service Code	HCPCS C1713
Hospital Charge Code	40203840
Hospital Revenue Code	278
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$68.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.55
Rate for Payer: EmblemHealth Commercial	$57.00
Rate for Payer: Fidelis Medicare Advantage	$119.70
Rate for Payer: Group Health Inc Commercial	$57.00
Rate for Payer: Group Health Inc Medicare	$39.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.00
Rate for Payer: Hamaspik Choice Inc Medicare	$57.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.10

Know your out-of-pocket cost for care.

All Charges