St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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 DRILL C/D MICRO 1.5X5MM

Facility

$114.00

Service Code	HCPCS C1713
Hospital Charge Code	40205411
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 DRILL C/D MICRO 1.5X5MM

Facility

$114.00

Service Code	HCPCS C1713
Hospital Charge Code	40205411
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 DRILL CRDR M SRW 1.5MMX4MM

Facility

$114.00

Service Code	HCPCS C1713
Hospital Charge Code	40206091
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 DRILL CRDR M SRW 1.5MMX4MM

Facility

$114.00

Service Code	HCPCS C1713
Hospital Charge Code	40206091
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 DRILL TWIST 1.1MM DIA X50MM

Facility

$264.00

Hospital Charge Code	40205412
Hospital Revenue Code	270
Min. Negotiated Rate	$92.40
Max. Negotiated Rate	$211.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$145.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$132.00
Rate for Payer: Aetna Government	$132.00
Rate for Payer: Brighton Health Commercial	$198.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$211.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.52
Rate for Payer: Group Health Inc Commercial	$132.00
Rate for Payer: Group Health Inc Medicare	$92.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$132.00
Rate for Payer: Hamaspik Choice Inc Medicare	$132.00

KLS EMERGENCY SCREW 2.0MM

Facility

$128.00

Service Code	HCPCS C1776
Hospital Charge Code	40208111
Hospital Revenue Code	278
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$76.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$64.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$73.60
Rate for Payer: EmblemHealth Commercial	$64.00
Rate for Payer: Fidelis Medicare Advantage	$134.40
Rate for Payer: Group Health Inc Commercial	$64.00
Rate for Payer: Group Health Inc Medicare	$44.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.00
Rate for Payer: Hamaspik Choice Inc Medicare	$64.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$83.20

KLS EMERGENCY SCREW 2.0MM

Facility

$128.00

Service Code	HCPCS C1776
Hospital Charge Code	40208111
Hospital Revenue Code	278
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$64.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$64.00
Rate for Payer: Hamaspik Choice Inc Medicare	$64.00

KLS EMERGENCY SCREW 2.5X9MM

Facility

$800.00

Service Code	HCPCS C1713
Hospital Charge Code	40200781
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$840.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$440.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$480.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$460.00
Rate for Payer: EmblemHealth Commercial	$400.00
Rate for Payer: Fidelis Medicare Advantage	$840.00
Rate for Payer: Group Health Inc Commercial	$400.00
Rate for Payer: Group Health Inc Medicare	$280.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$520.00

KLS EMERGENCY SCREW 2.5X9MM

Facility

$800.00

Service Code	HCPCS C1713
Hospital Charge Code	40200781
Hospital Revenue Code	278
Min. Negotiated Rate	$400.00
Max. Negotiated Rate	$400.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$400.00
Rate for Payer: Hamaspik Choice Inc Medicare	$400.00

KLS EMERGENCY SCRW 2.3

Facility

$124.00

Service Code	HCPCS C1776
Hospital Charge Code	40208077
Hospital Revenue Code	278
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$74.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.30
Rate for Payer: EmblemHealth Commercial	$62.00
Rate for Payer: Fidelis Medicare Advantage	$130.20
Rate for Payer: Group Health Inc Commercial	$62.00
Rate for Payer: Group Health Inc Medicare	$43.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.00
Rate for Payer: Hamaspik Choice Inc Medicare	$62.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$80.60

KLS EMERGENCY SCRW 2.3

Facility

$124.00

Service Code	HCPCS C1776
Hospital Charge Code	40208077
Hospital Revenue Code	278
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$62.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.00
Rate for Payer: Hamaspik Choice Inc Medicare	$62.00

KLS EMERGENCY SCRW 2.3X

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40205614
Hospital Revenue Code	278
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$65.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00

KLS EMERGENCY SCRW 2.3X

Facility

$130.00

Service Code	HCPCS C1713
Hospital Charge Code	40205614
Hospital Revenue Code	278
Min. Negotiated Rate	$45.50
Max. Negotiated Rate	$136.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$71.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$78.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$74.75
Rate for Payer: EmblemHealth Commercial	$65.00
Rate for Payer: Fidelis Medicare Advantage	$136.50
Rate for Payer: Group Health Inc Commercial	$65.00
Rate for Payer: Group Health Inc Medicare	$45.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$65.00
Rate for Payer: Hamaspik Choice Inc Medicare	$65.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$84.50

KLS FRACTURE PLATE

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40209897
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$462.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$242.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$264.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$253.00
Rate for Payer: EmblemHealth Commercial	$220.00
Rate for Payer: Fidelis Medicare Advantage	$462.00
Rate for Payer: Group Health Inc Commercial	$220.00
Rate for Payer: Group Health Inc Medicare	$154.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$286.00

KLS FRACTURE PLATE

Facility

$440.00

Service Code	HCPCS C1713
Hospital Charge Code	40209897
Hospital Revenue Code	278
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$220.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$220.00
Rate for Payer: Hamaspik Choice Inc Medicare	$220.00

KLS FRACTURE PLATE 16 HOLE

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	40209898
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$735.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$420.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$350.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$402.50
Rate for Payer: EmblemHealth Commercial	$350.00
Rate for Payer: Fidelis Medicare Advantage	$735.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$455.00

KLS FRACTURE PLATE 16 HOLE

Facility

$700.00

Service Code	HCPCS C1713
Hospital Charge Code	40209898
Hospital Revenue Code	278
Min. Negotiated Rate	$350.00
Max. Negotiated Rate	$350.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

KLS FRACTURE PLATE 2.3MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209957
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,575.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$825.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$750.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$862.50
Rate for Payer: EmblemHealth Commercial	$750.00
Rate for Payer: Fidelis Medicare Advantage	$1,575.00
Rate for Payer: Group Health Inc Commercial	$750.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$975.00

KLS FRACTURE PLATE 2.3MM

Facility

$1,500.00

Service Code	HCPCS C1713
Hospital Charge Code	40209957
Hospital Revenue Code	278
Min. Negotiated Rate	$750.00
Max. Negotiated Rate	$750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$750.00
Rate for Payer: Hamaspik Choice Inc Medicare	$750.00

KLS FRACTURE PLT 2MM 4 HOLES

Facility

$360.00

Service Code	HCPCS C1713
Hospital Charge Code	40207059
Hospital Revenue Code	278
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$180.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00

KLS FRACTURE PLT 2MM 4 HOLES

Facility

$360.00

Service Code	HCPCS C1713
Hospital Charge Code	40207059
Hospital Revenue Code	278
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$378.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$198.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$216.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$180.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$207.00
Rate for Payer: EmblemHealth Commercial	$180.00
Rate for Payer: Fidelis Medicare Advantage	$378.00
Rate for Payer: Group Health Inc Commercial	$180.00
Rate for Payer: Group Health Inc Medicare	$126.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$180.00
Rate for Payer: Hamaspik Choice Inc Medicare	$180.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$234.00

KLS LCKNG PLT ST 12 H 3MM THICK

Facility

$1,582.00

Service Code	HCPCS C1713
Hospital Charge Code	40205625
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,661.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$870.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$949.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$791.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$909.65
Rate for Payer: EmblemHealth Commercial	$791.00
Rate for Payer: Fidelis Medicare Advantage	$1,661.10
Rate for Payer: Group Health Inc Commercial	$791.00
Rate for Payer: Group Health Inc Medicare	$553.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$791.00
Rate for Payer: Hamaspik Choice Inc Medicare	$791.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,028.30

KLS LCKNG PLT ST 12 H 3MM THICK

Facility

$1,582.00

Service Code	HCPCS C1713
Hospital Charge Code	40205625
Hospital Revenue Code	278
Min. Negotiated Rate	$791.00
Max. Negotiated Rate	$791.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$791.00
Rate for Payer: Hamaspik Choice Inc Medicare	$791.00

KLS LCKNG TEMPLATE ST 20H

Facility

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40206103
Hospital Revenue Code	278
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$54.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00

Know your out-of-pocket cost for care.

All Charges