St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KLS MICROPLATE 7H L-SHAPE PLT LFT

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40205716
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 MICROPLATE 7H L-SHAPE PLT LFT

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40205716
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 MICROPLATE L SHAPE LFT LNG

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40205734
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 MICROPLATE L SHAPE LFT LNG

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40205734
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 MICROPLATE L SHAPE RIGHT LONG

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40205949
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 MICROPLATE L SHAPE RIGHT LONG

Facility

$374.00

Service Code	HCPCS C1713
Hospital Charge Code	40205949
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 MICRO PLT 1.5MM T-SHAPE 6HOLE

Facility

$354.00

Service Code	HCPCS C1713
Hospital Charge Code	40205732
Hospital Revenue Code	278
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$371.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$212.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$177.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.55
Rate for Payer: EmblemHealth Commercial	$177.00
Rate for Payer: Fidelis Medicare Advantage	$371.70
Rate for Payer: Group Health Inc Commercial	$177.00
Rate for Payer: Group Health Inc Medicare	$123.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.10

KLS MICRO PLT 1.5MM T-SHAPE 6HOLE

Facility

$354.00

Service Code	HCPCS C1713
Hospital Charge Code	40205732
Hospital Revenue Code	278
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$177.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00

KLS MICRO PLT 1.6MM DOUBLE Y PLT

Facility

$350.00

Service Code	HCPCS C1776
Hospital Charge Code	40205140
Hospital Revenue Code	278
Min. Negotiated Rate	$122.50
Max. Negotiated Rate	$367.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$192.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$210.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$175.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$201.25
Rate for Payer: EmblemHealth Commercial	$175.00
Rate for Payer: Fidelis Medicare Advantage	$367.50
Rate for Payer: Group Health Inc Commercial	$175.00
Rate for Payer: Group Health Inc Medicare	$122.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$227.50

KLS MICRO PLT 1.6MM DOUBLE Y PLT

Facility

$350.00

Service Code	HCPCS C1776
Hospital Charge Code	40205140
Hospital Revenue Code	278
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$175.00
Rate for Payer: Hamaspik Choice Inc Medicare	$175.00

KLS MICRO PLT ST 24HOLE

Facility

$510.00

Service Code	HCPCS C1713
Hospital Charge Code	40205571
Hospital Revenue Code	278
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$255.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$255.00

KLS MICRO PLT ST 24HOLE

Facility

$510.00

Service Code	HCPCS C1713
Hospital Charge Code	40205571
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$535.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$306.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$255.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$293.25
Rate for Payer: EmblemHealth Commercial	$255.00
Rate for Payer: Fidelis Medicare Advantage	$535.50
Rate for Payer: Group Health Inc Commercial	$255.00
Rate for Payer: Group Health Inc Medicare	$178.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.00
Rate for Payer: Hamaspik Choice Inc Medicare	$255.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$331.50

KLS MICRO SCREW 1.5 X4MM

Facility

$97.20

Service Code	HCPCS C1713
Hospital Charge Code	40205761
Hospital Revenue Code	278
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$48.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.60
Rate for Payer: Hamaspik Choice Inc Medicare	$48.60

KLS MICRO SCREW 1.5 X4MM

Facility

$97.20

Service Code	HCPCS C1713
Hospital Charge Code	40205761
Hospital Revenue Code	278
Min. Negotiated Rate	$34.02
Max. Negotiated Rate	$134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$58.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$48.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.89
Rate for Payer: EmblemHealth Commercial	$48.60
Rate for Payer: Fidelis Medicare Advantage	$102.06
Rate for Payer: Group Health Inc Commercial	$48.60
Rate for Payer: Group Health Inc Medicare	$34.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.60
Rate for Payer: Hamaspik Choice Inc Medicare	$48.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.18

KLS MINI PLATE 6HOLE LONG

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	40209430
Hospital Revenue Code	278
Min. Negotiated Rate	$55.30
Max. Negotiated Rate	$165.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$94.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.85
Rate for Payer: EmblemHealth Commercial	$79.00
Rate for Payer: Fidelis Medicare Advantage	$165.90
Rate for Payer: Group Health Inc Commercial	$79.00
Rate for Payer: Group Health Inc Medicare	$55.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.00
Rate for Payer: Hamaspik Choice Inc Medicare	$79.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.70

KLS MINI PLATE 6HOLE LONG

Facility

$158.00

Service Code	HCPCS C1713
Hospital Charge Code	40209430
Hospital Revenue Code	278
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$79.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.00
Rate for Payer: Hamaspik Choice Inc Medicare	$79.00

KLS MINI PLT 4HOLE LONG CP TIA

Facility

$136.00

Service Code	HCPCS C1776
Hospital Charge Code	40209433
Hospital Revenue Code	278
Min. Negotiated Rate	$47.60
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$81.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.20
Rate for Payer: EmblemHealth Commercial	$68.00
Rate for Payer: Fidelis Medicare Advantage	$142.80
Rate for Payer: Group Health Inc Commercial	$68.00
Rate for Payer: Group Health Inc Medicare	$47.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.40

KLS MINI PLT 4HOLE LONG CP TIA

Facility

$136.00

Service Code	HCPCS C1776
Hospital Charge Code	40209433
Hospital Revenue Code	278
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$68.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00

KLS M PLATE L-SHAPE RGHT L CP TIT

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40205015
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 M PLATE L-SHAPE RGHT L CP TIT

Facility

$300.00

Service Code	HCPCS C1713
Hospital Charge Code	40205015
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 PLATE 0.6MM 6 HOLE Y-SHAPED S

Facility

$354.00

Service Code	HCPCS C1713
Hospital Charge Code	40203841
Hospital Revenue Code	278
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$177.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00

KLS PLATE 0.6MM 6 HOLE Y-SHAPED S

Facility

$354.00

Service Code	HCPCS C1713
Hospital Charge Code	40203841
Hospital Revenue Code	278
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$371.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$212.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$177.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$203.55
Rate for Payer: EmblemHealth Commercial	$177.00
Rate for Payer: Fidelis Medicare Advantage	$371.70
Rate for Payer: Group Health Inc Commercial	$177.00
Rate for Payer: Group Health Inc Medicare	$123.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.10

KLS PLATE 2.0MM

Facility

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	40209422
Hospital Revenue Code	278
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$95.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00

KLS PLATE 2.0MM

Facility

$190.00

Service Code	HCPCS C1713
Hospital Charge Code	40209422
Hospital Revenue Code	278
Min. Negotiated Rate	$66.50
Max. Negotiated Rate	$199.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$114.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$95.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$109.25
Rate for Payer: EmblemHealth Commercial	$95.00
Rate for Payer: Fidelis Medicare Advantage	$199.50
Rate for Payer: Group Health Inc Commercial	$95.00
Rate for Payer: Group Health Inc Medicare	$66.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.00
Rate for Payer: Hamaspik Choice Inc Medicare	$95.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.50

KLS PLATE 2.0MM 12HOLE

Facility

$280.00

Service Code	HCPCS C1713
Hospital Charge Code	40200036
Hospital Revenue Code	278
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00

Know your out-of-pocket cost for care.

All Charges