St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

SIZER,RE-STER,INSPIRA 520CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64905701
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER,STY 10 RE-STER 390CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906119
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SIZER,STY 10 RE-STER 390CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906119
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER,STY 10 RE-STER 420CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906120
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SIZER,STY 10 RE-STER 420CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906120
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER,STY 10 RE-STER 450CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906121
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SIZER,STY 10 RE-STER 450CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906121
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER STY 10 RE-STER MSZ10390

Facility

$500.00

Hospital Charge Code	40005949
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SIZER STY 10 RE-STER MSZ10420

Facility

$500.00

Hospital Charge Code	40005950
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SIZER STY 10 RE-STER MSZ10450

Facility

$500.00

Hospital Charge Code	40005951
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SIZER,STY 15 RE-STER 397CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906122
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SIZER,STY 15 RE-STER 397CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906122
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER,STY 15 RE-STER 421CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906123
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER,STY 15 RE-STER 421CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906123
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SIZER,STY 15 RE-STER 457CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906124
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SIZER,STY 15 RE-STER 457CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906124
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER STY 15 RE-STER MSZ15397

Facility

$500.00

Hospital Charge Code	40005952
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SIZER STY 15 RE-STER MSZ15421

Facility

$500.00

Hospital Charge Code	40005953
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SIZER STY 15 RE-STER MSZ15457

Facility

$500.00

Hospital Charge Code	40005954
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SIZER STY 410LF MSZLF440

Facility

$500.00

Hospital Charge Code	40005948
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SIZER,STY 410LF RE-STER 440CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906118
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER,STY 410LF RE-STER 440CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906118
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

SIZER STY 410LM MSZM320

Facility

$500.00

Hospital Charge Code	40005947
Hospital Revenue Code	272
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$250.00
Rate for Payer: Aetna Government	$250.00
Rate for Payer: Brighton Health Commercial	$375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$400.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$340.00
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$175.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$250.00
Rate for Payer: Hamaspik Choice Inc Medicare	$250.00

SIZER,STY 410LM RE-STER 320CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906117
Hospital Revenue Code	278
Min. Negotiated Rate	$262.50
Max. Negotiated Rate	$262.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50

SIZER,STY 410LM RE-STER 320CC

Facility

$525.00

Service Code	HCPCS C1789
Hospital Charge Code	64906117
Hospital Revenue Code	278
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$551.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$288.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.32
Rate for Payer: Aetna Government	$402.32
Rate for Payer: Brighton Health Commercial	$315.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$262.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$301.88
Rate for Payer: EmblemHealth Commercial	$262.50
Rate for Payer: Fidelis Medicare Advantage	$551.25
Rate for Payer: Group Health Inc Commercial	$262.50
Rate for Payer: Group Health Inc Medicare	$183.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$262.50
Rate for Payer: Hamaspik Choice Inc Medicare	$262.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$341.25

Know your out-of-pocket cost for care.

All Charges