St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PERMETHRIN 5 % EX CREA [10917]

Facility

$2.06

Service Code	NDC 00472024260
Hospital Charge Code	00472024260
Hospital Revenue Code	250
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.03
Rate for Payer: Aetna Government	$1.03
Rate for Payer: Brighton Health Commercial	$1.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.40
Rate for Payer: Group Health Inc Commercial	$1.03
Rate for Payer: Group Health Inc Medicare	$0.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.03
Rate for Payer: Hamaspik Choice Inc Medicare	$1.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.34

PERMETHRIN 5 % EX CREA [10917]

Facility

$1.97

Service Code	NDC 21922002107
Hospital Charge Code	21922002107
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.98
Rate for Payer: Aetna Government	$0.98
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.34
Rate for Payer: Group Health Inc Commercial	$0.98
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.98
Rate for Payer: Hamaspik Choice Inc Medicare	$0.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.28

PERM NAIL REMOVAL

Facility

$967.73

Service Code	HCPCS 11750
Hospital Charge Code	42500130
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$461.12
Rate for Payer: Aetna Government	$461.12
Rate for Payer: Affinity Essential Plan 1&2	$322.78
Rate for Payer: Affinity Essential Plan 3&4	$322.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$322.78
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Cash Price	$461.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$461.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$461.12
Rate for Payer: Fidelis Essential Plan Aliesa	$391.95
Rate for Payer: Fidelis Essential Plan QHP	$410.40
Rate for Payer: Fidelis Medicare Advantage	$461.12
Rate for Payer: Fidelis Qualified Health Plan	$410.40
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$483.86
Rate for Payer: Hamaspik Choice Inc Medicare	$461.12
Rate for Payer: Healthfirst Medicare Advantage	$391.95
Rate for Payer: Healthfirst QHP	$461.12
Rate for Payer: Humana Medicare	$470.34
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$461.12
Rate for Payer: Senior Whole Health Medicare Advantage	$461.12
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$461.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$461.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$368.90
Rate for Payer: Wellcare Medicare	$438.06

PERM NAIL REMOVAL

Facility

$967.73

Service Code	HCPCS 11750
Hospital Charge Code	42500130
Hospital Revenue Code	510
Rate for Payer: Cash Price	$461.12

PEROSRI DASE BLOCK HK111-5K

Facility

$20.25

Hospital Charge Code	64902614
Hospital Revenue Code	270
Min. Negotiated Rate	$7.09
Max. Negotiated Rate	$16.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.12
Rate for Payer: Aetna Government	$10.12
Rate for Payer: Brighton Health Commercial	$15.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.77
Rate for Payer: Group Health Inc Commercial	$10.12
Rate for Payer: Group Health Inc Medicare	$7.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.12
Rate for Payer: Hamaspik Choice Inc Medicare	$10.12

PERPHENAZINE 16 MG PO TABS [6156]

Facility

$3.90

Service Code	NDC 52536017001
Hospital Charge Code	52536017001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.36
Max. Negotiated Rate	$3.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.95
Rate for Payer: Aetna Government	$1.95
Rate for Payer: Brighton Health Commercial	$2.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: Group Health Inc Commercial	$1.95
Rate for Payer: Group Health Inc Medicare	$1.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95
Rate for Payer: Hamaspik Choice Inc Medicare	$1.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.53

PERPHENAZINE 16 MG TAB

Facility

$5.47

Hospital Charge Code	41650965
Hospital Revenue Code	636
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$2.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.74
Rate for Payer: Hamaspik Choice Inc Medicare	$2.74

PERPHENAZINE 16 MG TAB

Facility

$5.47

Hospital Charge Code	41640965
Hospital Revenue Code	636
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$2.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.74
Rate for Payer: Hamaspik Choice Inc Medicare	$2.74

PERPHENAZINE 16 MG TAB

Facility

$5.47

Hospital Charge Code	41640965
Hospital Revenue Code	636
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$3.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.74
Rate for Payer: Aetna Government	$2.74
Rate for Payer: Brighton Health Commercial	$3.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.15
Rate for Payer: Group Health Inc Commercial	$2.74
Rate for Payer: Group Health Inc Medicare	$1.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.74
Rate for Payer: Hamaspik Choice Inc Medicare	$2.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.56

PERPHENAZINE 16 MG TAB

Facility

$5.47

Hospital Charge Code	41650965
Hospital Revenue Code	636
Min. Negotiated Rate	$1.91
Max. Negotiated Rate	$3.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.74
Rate for Payer: Aetna Government	$2.74
Rate for Payer: Brighton Health Commercial	$3.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.15
Rate for Payer: Group Health Inc Commercial	$2.74
Rate for Payer: Group Health Inc Medicare	$1.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.74
Rate for Payer: Hamaspik Choice Inc Medicare	$2.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.56

PERPHENAZINE 2 MG PO TABS [6157]

Facility

$1.19

Service Code	NDC 00904659961
Hospital Charge Code	00904659961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

PERPHENAZINE 2 MG TAB

Facility

$0.69

Hospital Charge Code	41640960
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35

PERPHENAZINE 2 MG TAB

Facility

$0.69

Hospital Charge Code	41650960
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35

PERPHENAZINE 2 MG TAB

Facility

$0.69

Hospital Charge Code	41650960
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.45

PERPHENAZINE 2 MG TAB

Facility

$0.69

Hospital Charge Code	41640960
Hospital Revenue Code	636
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.45

PERPHENAZINE 4 MG PO TABS [6158]

Facility

$1.79

Service Code	NDC 00904660061
Hospital Charge Code	00904660061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Brighton Health Commercial	$1.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.16

PERPHENAZINE 4 MG TAB

Facility

$1.88

Service Code	HCPCS Q0175
Hospital Charge Code	41643573
Hospital Revenue Code	636
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94

PERPHENAZINE 4 MG TAB

Facility

$1.88

Service Code	HCPCS Q0175
Hospital Charge Code	41643573
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$1.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.08
Rate for Payer: Group Health Inc Commercial	$0.94
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.22

PERPHENAZINE 4 MG TAB

Facility

$1.88

Service Code	HCPCS Q0175
Hospital Charge Code	41653573
Hospital Revenue Code	636
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94

PERPHENAZINE 4 MG TAB

Facility

$1.88

Service Code	HCPCS Q0175
Hospital Charge Code	41653573
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$1.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.08
Rate for Payer: Group Health Inc Commercial	$0.94
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.22

PERPHENAZINE 8 MG PO TABS [6159]

Facility

$1.93

Service Code	NDC 00603506221
Hospital Charge Code	00603506221
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

PERPHENAZINE 8 MG PO TABS [6159]

Facility

$2.16

Service Code	NDC 00904660161
Hospital Charge Code	00904660161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$1.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.47
Rate for Payer: Group Health Inc Commercial	$1.08
Rate for Payer: Group Health Inc Medicare	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.40

PERPHENAZINE 8 MG TAB

Facility

$2.28

Service Code	HCPCS Q0175
Hospital Charge Code	41640963
Hospital Revenue Code	636
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$1.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14

PERPHENAZINE 8 MG TAB

Facility

$2.28

Service Code	HCPCS Q0175
Hospital Charge Code	41640963
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$1.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.48

PERPHENAZINE 8 MG TAB

Facility

$2.28

Service Code	HCPCS Q0175
Hospital Charge Code	41650963
Hospital Revenue Code	636
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.52
Rate for Payer: Aetna Government	$0.52
Rate for Payer: Brighton Health Commercial	$1.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: Group Health Inc Commercial	$1.14
Rate for Payer: Group Health Inc Medicare	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.14
Rate for Payer: Hamaspik Choice Inc Medicare	$1.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.48

Know your out-of-pocket cost for care.

All Charges