St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROBENECID 500 MG PO TABS [6561]

Facility

$0.98

Service Code	NDC 00591534701
Hospital Charge Code	00591534701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

PROBENECID 500 MG TAB

Facility

$1.00

Hospital Charge Code	41644019
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

PROBENECID 500 MG TAB

Facility

$1.00

Hospital Charge Code	41654019
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

PROBE NIM BALL TIP

Facility

$400.15

Hospital Charge Code	64906181
Hospital Revenue Code	270
Min. Negotiated Rate	$140.05
Max. Negotiated Rate	$320.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.08
Rate for Payer: Aetna Government	$200.08
Rate for Payer: Brighton Health Commercial	$300.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.10
Rate for Payer: Group Health Inc Commercial	$200.08
Rate for Payer: Group Health Inc Medicare	$140.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.08
Rate for Payer: Hamaspik Choice Inc Medicare	$200.08

PROBE NIM XPAK

Facility

$557.10

Hospital Charge Code	64906180
Hospital Revenue Code	270
Min. Negotiated Rate	$194.98
Max. Negotiated Rate	$445.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$306.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$278.55
Rate for Payer: Aetna Government	$278.55
Rate for Payer: Brighton Health Commercial	$417.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$445.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$378.83
Rate for Payer: Group Health Inc Commercial	$278.55
Rate for Payer: Group Health Inc Medicare	$194.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$278.55
Rate for Payer: Hamaspik Choice Inc Medicare	$278.55

PROBE RF RT ANG CABLE 3.5MM

Facility

$237.50

Hospital Charge Code	64904911
Hospital Revenue Code	270
Min. Negotiated Rate	$83.12
Max. Negotiated Rate	$190.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$118.75
Rate for Payer: Aetna Government	$118.75
Rate for Payer: Brighton Health Commercial	$178.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$190.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.50
Rate for Payer: Group Health Inc Commercial	$118.75
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.75
Rate for Payer: Hamaspik Choice Inc Medicare	$118.75

PROBES RF2 90-S

Facility

$312.50

Hospital Charge Code	64904982
Hospital Revenue Code	270
Min. Negotiated Rate	$109.38
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$171.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$156.25
Rate for Payer: Aetna Government	$156.25
Rate for Payer: Brighton Health Commercial	$234.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$250.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$212.50
Rate for Payer: Group Health Inc Commercial	$156.25
Rate for Payer: Group Health Inc Medicare	$109.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$156.25
Rate for Payer: Hamaspik Choice Inc Medicare	$156.25

PROBE ST REVOLVE 10G

Facility

$673.82

Hospital Charge Code	41301573
Hospital Revenue Code	270
Min. Negotiated Rate	$235.84
Max. Negotiated Rate	$539.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$370.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$336.91
Rate for Payer: Aetna Government	$336.91
Rate for Payer: Brighton Health Commercial	$505.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$539.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$458.20
Rate for Payer: Group Health Inc Commercial	$336.91
Rate for Payer: Group Health Inc Medicare	$235.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$336.91
Rate for Payer: Hamaspik Choice Inc Medicare	$336.91

PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS

Professional

Both

$6,789.62

Service Code	HCPCS 33814
Min. Negotiated Rate	$5,092.22
Max. Negotiated Rate	$5,092.22
Rate for Payer: Cash Price	$1,808.41
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,092.22
Rate for Payer: SOMOS Essential	$5,092.22

PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS

Professional

Both

$5,529.27

Service Code	HCPCS 33813
Min. Negotiated Rate	$4,146.95
Max. Negotiated Rate	$4,146.95
Rate for Payer: Cash Price	$1,473.08
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,146.95
Rate for Payer: SOMOS Essential	$4,146.95

PR OBLTRJ CAROTID ARYSM ARTVEN CAROTID FISTULA DSJ

Professional

Both

$15,797.11

Service Code	HCPCS 61613
Min. Negotiated Rate	$11,847.83
Max. Negotiated Rate	$11,847.83
Rate for Payer: Cash Price	$4,150.82
Rate for Payer: SOMOS CHP/HARP/Medicaid	$11,847.83
Rate for Payer: SOMOS Essential	$11,847.83

PROBNP

Facility

$98.15

Service Code	HCPCS 83880
Hospital Charge Code	40609750
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.26

PROBNP

Facility

$98.15

Service Code	HCPCS 83880
Hospital Charge Code	40609750
Hospital Revenue Code	301
Min. Negotiated Rate	$27.48
Max. Negotiated Rate	$73.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.26
Rate for Payer: Aetna Government	$39.26
Rate for Payer: Affinity Essential Plan 1&2	$27.48
Rate for Payer: Affinity Essential Plan 3&4	$27.48
Rate for Payer: Affinity Medicaid/CHP/HARP	$27.48
Rate for Payer: Brighton Health Commercial	$73.61
Rate for Payer: Cash Price	$39.26
Rate for Payer: Cash Price	$39.26
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$39.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$53.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$45.66
Rate for Payer: Elderplan Medicare Advantage	$39.26
Rate for Payer: EmblemHealth Commercial	$39.26
Rate for Payer: Fidelis Essential Plan Aliesa	$33.37
Rate for Payer: Fidelis Essential Plan QHP	$34.94
Rate for Payer: Fidelis Medicare Advantage	$39.26
Rate for Payer: Fidelis Qualified Health Plan	$34.94
Rate for Payer: Group Health Inc Commercial	$39.26
Rate for Payer: Group Health Inc Medicare	$39.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$49.08
Rate for Payer: Hamaspik Choice Inc Medicare	$39.26
Rate for Payer: Healthfirst Medicare Advantage	$39.26
Rate for Payer: Healthfirst QHP	$39.26
Rate for Payer: Humana Medicare	$40.05
Rate for Payer: Senior Whole Health Medicare Advantage	$39.26
Rate for Payer: United Healthcare Commercial	$42.99
Rate for Payer: United Healthcare Medicare Advantage	$39.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$39.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$31.41
Rate for Payer: Wellcare Medicare	$35.33

PROBREATH CELON ELITE (WB990310)

Facility

$169.84

Hospital Charge Code	64906470
Hospital Revenue Code	270
Min. Negotiated Rate	$59.44
Max. Negotiated Rate	$135.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$93.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$84.92
Rate for Payer: Aetna Government	$84.92
Rate for Payer: Brighton Health Commercial	$127.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$115.49
Rate for Payer: Group Health Inc Commercial	$84.92
Rate for Payer: Group Health Inc Medicare	$59.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.92
Rate for Payer: Hamaspik Choice Inc Medicare	$84.92

PR OBSTRUCTIVE MATERIAL REMOVAL FROM GI TUBE

Professional

Both

$207.69

Service Code	HCPCS 49460
Min. Negotiated Rate	$155.77
Max. Negotiated Rate	$155.77
Rate for Payer: Cash Price	$57.33
Rate for Payer: SOMOS CHP/HARP/Medicaid	$155.77
Rate for Payer: SOMOS Essential	$155.77

PR OBTAINING SCREEN PAP SMEAR

Professional

Both

$73.36

Service Code	HCPCS Q0091
Min. Negotiated Rate	$55.02
Max. Negotiated Rate	$55.02
Rate for Payer: Cash Price	$20.05
Rate for Payer: SOMOS CHP/HARP/Medicaid	$55.02
Rate for Payer: SOMOS Essential	$55.02

PROCAINAMIDE 100 MG/ML INJ

Facility

$25.11

Service Code	HCPCS J2690
Hospital Charge Code	41654420
Hospital Revenue Code	636
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$198.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$146.32
Rate for Payer: Aetna Government	$146.32
Rate for Payer: Affinity Essential Plan 1&2	$102.42
Rate for Payer: Affinity Essential Plan 3&4	$102.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$102.42
Rate for Payer: Brighton Health Commercial	$15.07
Rate for Payer: Cash Price	$146.32
Rate for Payer: Cash Price	$146.32
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$146.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.44
Rate for Payer: Elderplan Medicare Advantage	$146.32
Rate for Payer: EmblemHealth Commercial	$146.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.32
Rate for Payer: Fidelis Essential Plan Aliesa	$146.32
Rate for Payer: Fidelis Essential Plan QHP	$153.63
Rate for Payer: Fidelis Medicare Advantage	$146.32
Rate for Payer: Fidelis Qualified Health Plan	$153.63
Rate for Payer: Group Health Inc Commercial	$146.32
Rate for Payer: Group Health Inc Medicare	$146.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.56
Rate for Payer: Hamaspik Choice Inc Medicare	$12.56
Rate for Payer: Healthfirst Medicare Advantage	$124.37
Rate for Payer: Healthfirst QHP	$146.32
Rate for Payer: Humana Medicare	$149.24
Rate for Payer: Senior Whole Health Medicare Advantage	$146.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$198.43
Rate for Payer: SOMOS Essential	$198.43
Rate for Payer: United Healthcare Medicare Advantage	$146.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$117.05
Rate for Payer: Wellcare Medicare	$139.00

PROCAINAMIDE 100 MG/ML INJ

Facility

$25.11

Service Code	HCPCS J2690
Hospital Charge Code	41654420
Hospital Revenue Code	636
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$12.56
Rate for Payer: Cash Price	$146.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.56
Rate for Payer: Hamaspik Choice Inc Medicare	$12.56

PROCAINAMIDE 100 MG/ML INJ

Facility

$25.11

Service Code	HCPCS J2690
Hospital Charge Code	41644420
Hospital Revenue Code	636
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$198.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$146.32
Rate for Payer: Aetna Government	$146.32
Rate for Payer: Affinity Essential Plan 1&2	$102.42
Rate for Payer: Affinity Essential Plan 3&4	$102.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$102.42
Rate for Payer: Brighton Health Commercial	$15.07
Rate for Payer: Cash Price	$146.32
Rate for Payer: Cash Price	$146.32
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$146.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.44
Rate for Payer: Elderplan Medicare Advantage	$146.32
Rate for Payer: EmblemHealth Commercial	$146.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.32
Rate for Payer: Fidelis Essential Plan Aliesa	$146.32
Rate for Payer: Fidelis Essential Plan QHP	$153.63
Rate for Payer: Fidelis Medicare Advantage	$146.32
Rate for Payer: Fidelis Qualified Health Plan	$153.63
Rate for Payer: Group Health Inc Commercial	$146.32
Rate for Payer: Group Health Inc Medicare	$146.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.56
Rate for Payer: Hamaspik Choice Inc Medicare	$12.56
Rate for Payer: Healthfirst Medicare Advantage	$124.37
Rate for Payer: Healthfirst QHP	$146.32
Rate for Payer: Humana Medicare	$149.24
Rate for Payer: Senior Whole Health Medicare Advantage	$146.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$198.43
Rate for Payer: SOMOS Essential	$198.43
Rate for Payer: United Healthcare Medicare Advantage	$146.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.32
Rate for Payer: Wellcare CHP/FHP/Medicaid	$117.05
Rate for Payer: Wellcare Medicare	$139.00

PROCAINAMIDE 100 MG/ML INJ

Facility

$25.11

Service Code	HCPCS J2690
Hospital Charge Code	41644420
Hospital Revenue Code	636
Min. Negotiated Rate	$12.56
Max. Negotiated Rate	$12.56
Rate for Payer: Cash Price	$146.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.56
Rate for Payer: Hamaspik Choice Inc Medicare	$12.56

PROCAINAMIDE 1G/2ML INJ

Facility

$87.94

Service Code	HCPCS J2690
Hospital Charge Code	41654248
Hospital Revenue Code	636
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Cash Price	$146.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.97
Rate for Payer: Hamaspik Choice Inc Medicare	$43.97

PROCAINAMIDE 1G/2ML INJ

Facility

$87.94

Service Code	HCPCS J2690
Hospital Charge Code	41644248
Hospital Revenue Code	636
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$198.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$146.32
Rate for Payer: Aetna Government	$146.32
Rate for Payer: Affinity Essential Plan 1&2	$102.42
Rate for Payer: Affinity Essential Plan 3&4	$102.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$102.42
Rate for Payer: Brighton Health Commercial	$52.76
Rate for Payer: Cash Price	$146.32
Rate for Payer: Cash Price	$146.32
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$146.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.57
Rate for Payer: Elderplan Medicare Advantage	$146.32
Rate for Payer: EmblemHealth Commercial	$146.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.32
Rate for Payer: Fidelis Essential Plan Aliesa	$146.32
Rate for Payer: Fidelis Essential Plan QHP	$153.63
Rate for Payer: Fidelis Medicare Advantage	$146.32
Rate for Payer: Fidelis Qualified Health Plan	$153.63
Rate for Payer: Group Health Inc Commercial	$146.32
Rate for Payer: Group Health Inc Medicare	$146.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.97
Rate for Payer: Hamaspik Choice Inc Medicare	$43.97
Rate for Payer: Healthfirst Medicare Advantage	$124.37
Rate for Payer: Healthfirst QHP	$146.32
Rate for Payer: Humana Medicare	$149.24
Rate for Payer: Senior Whole Health Medicare Advantage	$146.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$198.43
Rate for Payer: SOMOS Essential	$198.43
Rate for Payer: United Healthcare Medicare Advantage	$146.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$117.05
Rate for Payer: Wellcare Medicare	$139.00

PROCAINAMIDE 1G/2ML INJ

Facility

$87.94

Service Code	HCPCS J2690
Hospital Charge Code	41654248
Hospital Revenue Code	636
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$198.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$146.32
Rate for Payer: Aetna Government	$146.32
Rate for Payer: Affinity Essential Plan 1&2	$102.42
Rate for Payer: Affinity Essential Plan 3&4	$102.42
Rate for Payer: Affinity Medicaid/CHP/HARP	$102.42
Rate for Payer: Brighton Health Commercial	$52.76
Rate for Payer: Cash Price	$146.32
Rate for Payer: Cash Price	$146.32
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$146.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$50.57
Rate for Payer: Elderplan Medicare Advantage	$146.32
Rate for Payer: EmblemHealth Commercial	$146.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$146.32
Rate for Payer: Fidelis Essential Plan Aliesa	$146.32
Rate for Payer: Fidelis Essential Plan QHP	$153.63
Rate for Payer: Fidelis Medicare Advantage	$146.32
Rate for Payer: Fidelis Qualified Health Plan	$153.63
Rate for Payer: Group Health Inc Commercial	$146.32
Rate for Payer: Group Health Inc Medicare	$146.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.97
Rate for Payer: Hamaspik Choice Inc Medicare	$43.97
Rate for Payer: Healthfirst Medicare Advantage	$124.37
Rate for Payer: Healthfirst QHP	$146.32
Rate for Payer: Humana Medicare	$149.24
Rate for Payer: Senior Whole Health Medicare Advantage	$146.32
Rate for Payer: SOMOS CHP/HARP/Medicaid	$198.43
Rate for Payer: SOMOS Essential	$198.43
Rate for Payer: United Healthcare Medicare Advantage	$146.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.16
Rate for Payer: Wellcare CHP/FHP/Medicaid	$117.05
Rate for Payer: Wellcare Medicare	$139.00

PROCAINAMIDE 1G/2ML INJ

Facility

$87.94

Service Code	HCPCS J2690
Hospital Charge Code	41644248
Hospital Revenue Code	636
Min. Negotiated Rate	$43.97
Max. Negotiated Rate	$43.97
Rate for Payer: Cash Price	$146.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.97
Rate for Payer: Hamaspik Choice Inc Medicare	$43.97

PROCAINAMIDE 250 MG CAP

Facility

$1.00

Hospital Charge Code	41652965
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

Know your out-of-pocket cost for care.

All Charges