St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

KLS PLATE 2.0MM 12HOLE

Facility

$280.00

Service Code	HCPCS C1713
Hospital Charge Code	40200036
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$294.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$168.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.00
Rate for Payer: EmblemHealth Commercial	$140.00
Rate for Payer: Fidelis Medicare Advantage	$294.00
Rate for Payer: Group Health Inc Commercial	$140.00
Rate for Payer: Group Health Inc Medicare	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.00

KLS PLATE 2.0MM 4HOLE

Facility

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	40209410
Hospital Revenue Code	278
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$75.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00

KLS PLATE 2.0MM 4HOLE

Facility

$150.00

Service Code	HCPCS C1713
Hospital Charge Code	40209410
Hospital Revenue Code	278
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$157.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$75.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$86.25
Rate for Payer: EmblemHealth Commercial	$75.00
Rate for Payer: Fidelis Medicare Advantage	$157.50
Rate for Payer: Group Health Inc Commercial	$75.00
Rate for Payer: Group Health Inc Medicare	$52.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$75.00
Rate for Payer: Hamaspik Choice Inc Medicare	$75.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.50

KLS PLATE 2.0MM 5 HOLE

Facility

$280.00

Hospital Charge Code	40209726
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$294.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$140.00
Rate for Payer: Aetna Government	$140.00
Rate for Payer: Brighton Health Commercial	$168.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.00
Rate for Payer: EmblemHealth Commercial	$140.00
Rate for Payer: Fidelis Medicare Advantage	$294.00
Rate for Payer: Group Health Inc Commercial	$140.00
Rate for Payer: Group Health Inc Medicare	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.00

KLS PLATE 2.0MM 5 HOLE

Facility

$280.00

Hospital Charge Code	40209726
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

KLS PLATE 6 HOLE

Facility

$482.00

Service Code	HCPCS C1713
Hospital Charge Code	40205549
Hospital Revenue Code	278
Min. Negotiated Rate	$241.00
Max. Negotiated Rate	$241.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$241.00
Rate for Payer: Hamaspik Choice Inc Medicare	$241.00

KLS PLATE 6 HOLE

Facility

$482.00

Service Code	HCPCS C1713
Hospital Charge Code	40205549
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$506.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$265.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$289.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$241.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$277.15
Rate for Payer: EmblemHealth Commercial	$241.00
Rate for Payer: Fidelis Medicare Advantage	$506.10
Rate for Payer: Group Health Inc Commercial	$241.00
Rate for Payer: Group Health Inc Medicare	$168.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$241.00
Rate for Payer: Hamaspik Choice Inc Medicare	$241.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$313.30

KLS PLATE 8HOLE

Facility

$280.00

Service Code	HCPCS C1713
Hospital Charge Code	40200037
Hospital Revenue Code	278
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$294.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$168.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.00
Rate for Payer: EmblemHealth Commercial	$140.00
Rate for Payer: Fidelis Medicare Advantage	$294.00
Rate for Payer: Group Health Inc Commercial	$140.00
Rate for Payer: Group Health Inc Medicare	$98.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.00
Rate for Payer: Hamaspik Choice Inc Medicare	$140.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.00

KLS PLATE 8HOLE

Facility

$280.00

Service Code	HCPCS C1713
Hospital Charge Code	40200037
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

KLS PLATE FRACTURE 4 HOLE

Facility

$360.00

Service Code	HCPCS C1713
Hospital Charge Code	40200368
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 PLATE FRACTURE 4 HOLE

Facility

$360.00

Service Code	HCPCS C1713
Hospital Charge Code	40200368
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 PLATE FRACTURE 5 HOLE

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	40200369
Hospital Revenue Code	278
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$325.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$170.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$186.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$155.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$178.25
Rate for Payer: EmblemHealth Commercial	$155.00
Rate for Payer: Fidelis Medicare Advantage	$325.50
Rate for Payer: Group Health Inc Commercial	$155.00
Rate for Payer: Group Health Inc Medicare	$108.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$201.50

KLS PLATE FRACTURE 5 HOLE

Facility

$310.00

Service Code	HCPCS C1713
Hospital Charge Code	40200369
Hospital Revenue Code	278
Min. Negotiated Rate	$155.00
Max. Negotiated Rate	$155.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$155.00
Rate for Payer: Hamaspik Choice Inc Medicare	$155.00

KLS PLATE FRACTURE 6 HOLE LONG

Facility

$490.00

Service Code	HCPCS C1713
Hospital Charge Code	40200370
Hospital Revenue Code	278
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$245.00
Rate for Payer: Hamaspik Choice Inc Medicare	$245.00

KLS PLATE FRACTURE 6 HOLE LONG

Facility

$490.00

Service Code	HCPCS C1713
Hospital Charge Code	40200370
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$514.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$269.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$294.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$245.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$281.75
Rate for Payer: EmblemHealth Commercial	$245.00
Rate for Payer: Fidelis Medicare Advantage	$514.50
Rate for Payer: Group Health Inc Commercial	$245.00
Rate for Payer: Group Health Inc Medicare	$171.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$245.00
Rate for Payer: Hamaspik Choice Inc Medicare	$245.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$318.50

KLS PLATE LKNG ST 20H

Facility

$2,172.00

Service Code	HCPCS C1713
Hospital Charge Code	40206102
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,280.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,194.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,303.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,086.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,248.90
Rate for Payer: EmblemHealth Commercial	$1,086.00
Rate for Payer: Fidelis Medicare Advantage	$2,280.60
Rate for Payer: Group Health Inc Commercial	$1,086.00
Rate for Payer: Group Health Inc Medicare	$760.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,086.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,086.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,411.80

KLS PLATE LKNG ST 20H

Facility

$2,172.00

Service Code	HCPCS C1713
Hospital Charge Code	40206102
Hospital Revenue Code	278
Min. Negotiated Rate	$1,086.00
Max. Negotiated Rate	$1,086.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,086.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,086.00

KLS PLATE L-SHAPE 2.0MM 7 HOLE

Facility

$330.00

Service Code	HCPCS C1713
Hospital Charge Code	40205692
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 PLATE L-SHAPE 2.0MM 7 HOLE

Facility

$330.00

Service Code	HCPCS C1713
Hospital Charge Code	40205692
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 PLATE MANDIBLE

Facility

$178.00

Service Code	HCPCS C1713
Hospital Charge Code	40209428
Hospital Revenue Code	278
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$89.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.00
Rate for Payer: Hamaspik Choice Inc Medicare	$89.00

KLS PLATE MANDIBLE

Facility

$178.00

Service Code	HCPCS C1713
Hospital Charge Code	40209428
Hospital Revenue Code	278
Min. Negotiated Rate	$62.30
Max. Negotiated Rate	$186.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$97.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$106.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$89.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$102.35
Rate for Payer: EmblemHealth Commercial	$89.00
Rate for Payer: Fidelis Medicare Advantage	$186.90
Rate for Payer: Group Health Inc Commercial	$89.00
Rate for Payer: Group Health Inc Medicare	$62.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$89.00
Rate for Payer: Hamaspik Choice Inc Medicare	$89.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$115.70

KLS PLATE MANDIBLE 2.7MM 4 HOLES

Facility

$384.00

Service Code	HCPCS C1713
Hospital Charge Code	40200372
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 PLATE MANDIBLE 2.7MM 4 HOLES

Facility

$384.00

Service Code	HCPCS C1713
Hospital Charge Code	40200372
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

KLS PLATE MICRO 16 H ST

Facility

$364.00

Service Code	HCPCS C1713
Hospital Charge Code	40205409
Hospital Revenue Code	278
Min. Negotiated Rate	$182.00
Max. Negotiated Rate	$182.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$182.00

KLS PLATE MICRO 16 H ST

Facility

$364.00

Service Code	HCPCS C1713
Hospital Charge Code	40205409
Hospital Revenue Code	278
Min. Negotiated Rate	$127.40
Max. Negotiated Rate	$382.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$200.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$218.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$182.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$209.30
Rate for Payer: EmblemHealth Commercial	$182.00
Rate for Payer: Fidelis Medicare Advantage	$382.20
Rate for Payer: Group Health Inc Commercial	$182.00
Rate for Payer: Group Health Inc Medicare	$127.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$182.00
Rate for Payer: Hamaspik Choice Inc Medicare	$182.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$236.60

Know your out-of-pocket cost for care.

All Charges