St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KLS LCKNG TEMPLATE ST 20H

Facility

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40206103
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$64.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.10
Rate for Payer: EmblemHealth Commercial	$54.00
Rate for Payer: Fidelis Medicare Advantage	$113.40
Rate for Payer: Group Health Inc Commercial	$54.00
Rate for Payer: Group Health Inc Medicare	$37.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.20

KLS LOCKING CROSS DRIVE SCREW 2.7

Facility

$258.00

Service Code	HCPCS C1713
Hospital Charge Code	40205626
Hospital Revenue Code	278
Min. Negotiated Rate	$129.00
Max. Negotiated Rate	$129.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00
Rate for Payer: Hamaspik Choice Inc Medicare	$129.00

KLS LOCKING CROSS DRIVE SCREW 2.7

Facility

$258.00

Service Code	HCPCS C1713
Hospital Charge Code	40205626
Hospital Revenue Code	278
Min. Negotiated Rate	$90.30
Max. Negotiated Rate	$270.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$141.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$154.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$148.35
Rate for Payer: EmblemHealth Commercial	$129.00
Rate for Payer: Fidelis Medicare Advantage	$270.90
Rate for Payer: Group Health Inc Commercial	$129.00
Rate for Payer: Group Health Inc Medicare	$90.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.00
Rate for Payer: Hamaspik Choice Inc Medicare	$129.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$167.70

KLS MANDIBULAR SCREWS 2.0MM

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	40202358
Hospital Revenue Code	278
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$62.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.80
Rate for Payer: EmblemHealth Commercial	$52.00
Rate for Payer: Fidelis Medicare Advantage	$109.20
Rate for Payer: Group Health Inc Commercial	$52.00
Rate for Payer: Group Health Inc Medicare	$36.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$67.60

KLS MANDIBULAR SCREWS 2.0MM

Facility

$104.00

Service Code	HCPCS C1713
Hospital Charge Code	40202358
Hospital Revenue Code	278
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$52.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.00
Rate for Payer: Hamaspik Choice Inc Medicare	$52.00

KLS MANDIBULAR SCRW 2.0X5MM

Facility

$114.00

Service Code	HCPCS C1776
Hospital Charge Code	40205101
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 MANDIBULAR SCRW 2.0X5MM

Facility

$114.00

Service Code	HCPCS C1776
Hospital Charge Code	40205101
Hospital Revenue Code	278
Min. Negotiated Rate	$39.90
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
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 MAXDRIVE EMERGENCY SCREW 2.5X

Facility

$134.00

Service Code	HCPCS C1713
Hospital Charge Code	40205787
Hospital Revenue Code	278
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$140.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$80.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$67.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.05
Rate for Payer: EmblemHealth Commercial	$67.00
Rate for Payer: Fidelis Medicare Advantage	$140.70
Rate for Payer: Group Health Inc Commercial	$67.00
Rate for Payer: Group Health Inc Medicare	$46.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.00
Rate for Payer: Hamaspik Choice Inc Medicare	$67.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$87.10

KLS MAXDRIVE EMERGENCY SCREW 2.5X

Facility

$134.00

Service Code	HCPCS C1713
Hospital Charge Code	40205787
Hospital Revenue Code	278
Min. Negotiated Rate	$67.00
Max. Negotiated Rate	$67.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.00
Rate for Payer: Hamaspik Choice Inc Medicare	$67.00

KLS MAXDRIVE MINI SCRW 2.0MMX7MM

Facility

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40205430
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$64.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.10
Rate for Payer: EmblemHealth Commercial	$54.00
Rate for Payer: Fidelis Medicare Advantage	$113.40
Rate for Payer: Group Health Inc Commercial	$54.00
Rate for Payer: Group Health Inc Medicare	$37.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.20

KLS MAXDRIVE MINI SCRW 2.0MMX7MM

Facility

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40205430
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

KLS MAXDRIVE MINI SCRW 2.0X5MM

Facility

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40205429
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

KLS MAXDRIVE MINI SCRW 2.0X5MM

Facility

$108.00

Service Code	HCPCS C1713
Hospital Charge Code	40205429
Hospital Revenue Code	278
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$59.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$64.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$54.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.10
Rate for Payer: EmblemHealth Commercial	$54.00
Rate for Payer: Fidelis Medicare Advantage	$113.40
Rate for Payer: Group Health Inc Commercial	$54.00
Rate for Payer: Group Health Inc Medicare	$37.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$54.00
Rate for Payer: Hamaspik Choice Inc Medicare	$54.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$70.20

KLS MAXDRIVE SCREW BONE 2.3X11MM

Facility

$128.00

Service Code	HCPCS C1713
Hospital Charge Code	40205380
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 MAXDRIVE SCREW BONE 2.3X11MM

Facility

$128.00

Service Code	HCPCS C1713
Hospital Charge Code	40205380
Hospital Revenue Code	278
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$134.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$70.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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 MAXDRIVE SCRW BONE 2.3

Facility

$161.25

Service Code	HCPCS C1713
Hospital Charge Code	40205443
Hospital Revenue Code	278
Min. Negotiated Rate	$56.44
Max. Negotiated Rate	$169.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$88.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
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 MAXDRIVE SCRW BONE 2.3

Facility

$161.25

Service Code	HCPCS C1713
Hospital Charge Code	40205443
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 M/D M/T ALLOY SCRW 2.0X9MM

Facility

$62.00

Service Code	HCPCS C1713
Hospital Charge Code	40205783
Hospital Revenue Code	278
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$31.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.00
Rate for Payer: Hamaspik Choice Inc Medicare	$31.00

KLS M/D M/T ALLOY SCRW 2.0X9MM

Facility

$62.00

Service Code	HCPCS C1713
Hospital Charge Code	40205783
Hospital Revenue Code	278
Min. Negotiated Rate	$21.70
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$37.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$35.65
Rate for Payer: EmblemHealth Commercial	$31.00
Rate for Payer: Fidelis Medicare Advantage	$65.10
Rate for Payer: Group Health Inc Commercial	$31.00
Rate for Payer: Group Health Inc Medicare	$21.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.00
Rate for Payer: Hamaspik Choice Inc Medicare	$31.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$40.30

KLS M/D M TIT ALLOY SCRW 2.0X9MM

Facility

$98.40

Service Code	HCPCS C1713
Hospital Charge Code	40205616
Hospital Revenue Code	278
Min. Negotiated Rate	$34.44
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$54.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$59.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$49.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.58
Rate for Payer: EmblemHealth Commercial	$49.20
Rate for Payer: Fidelis Medicare Advantage	$103.32
Rate for Payer: Group Health Inc Commercial	$49.20
Rate for Payer: Group Health Inc Medicare	$34.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.20
Rate for Payer: Hamaspik Choice Inc Medicare	$49.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.96

KLS M/D M TIT ALLOY SCRW 2.0X9MM

Facility

$98.40

Service Code	HCPCS C1713
Hospital Charge Code	40205616
Hospital Revenue Code	278
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$49.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.20
Rate for Payer: Hamaspik Choice Inc Medicare	$49.20

KLS MESH 1.5MM 84X53MM

Facility

$1,540.00

Service Code	HCPCS C1781
Hospital Charge Code	40205416
Hospital Revenue Code	278
Min. Negotiated Rate	$770.00
Max. Negotiated Rate	$770.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$770.00
Rate for Payer: Hamaspik Choice Inc Medicare	$770.00

KLS MESH 1.5MM 84X53MM

Facility

$1,540.00

Service Code	HCPCS C1781
Hospital Charge Code	40205416
Hospital Revenue Code	278
Min. Negotiated Rate	$69.35
Max. Negotiated Rate	$1,617.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$847.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.35
Rate for Payer: Aetna Government	$69.35
Rate for Payer: Brighton Health Commercial	$924.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$770.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$885.50
Rate for Payer: EmblemHealth Commercial	$770.00
Rate for Payer: Fidelis Medicare Advantage	$1,617.00
Rate for Payer: Group Health Inc Commercial	$770.00
Rate for Payer: Group Health Inc Medicare	$539.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$770.00
Rate for Payer: Hamaspik Choice Inc Medicare	$770.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,001.00

KLS MICROPLATE 10 HOLE CURVED PLT

Facility

$384.00

Service Code	HCPCS C1713
Hospital Charge Code	40205572
Hospital Revenue Code	278
Min. Negotiated Rate	$192.00
Max. Negotiated Rate	$192.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.00
Rate for Payer: Hamaspik Choice Inc Medicare	$192.00

KLS MICROPLATE 10 HOLE CURVED PLT

Facility

$384.00

Service Code	HCPCS C1713
Hospital Charge Code	40205572
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$403.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$211.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$230.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$192.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$220.80
Rate for Payer: EmblemHealth Commercial	$192.00
Rate for Payer: Fidelis Medicare Advantage	$403.20
Rate for Payer: Group Health Inc Commercial	$192.00
Rate for Payer: Group Health Inc Medicare	$134.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$192.00
Rate for Payer: Hamaspik Choice Inc Medicare	$192.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$249.60

Know your out-of-pocket cost for care.

All Charges