St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROCHLORPERAZINE 10 MG/2 ML INJ

Facility

$10.00

Service Code	HCPCS J0780
Hospital Charge Code	41640187
Hospital Revenue Code	636
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$5.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

PROCHLORPERAZINE 10 MG/2 ML INJ

Facility

$10.00

Service Code	HCPCS J0780
Hospital Charge Code	41640187
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$6.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.74
Rate for Payer: Aetna Government	$4.74
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.75
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4.18
Rate for Payer: SOMOS Essential	$4.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.50

PROCHLORPERAZINE 25 MG RE SUPP [11138]

Facility

$12.58

Service Code	NDC 00574722612
Hospital Charge Code	00574722612
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$10.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.29
Rate for Payer: Aetna Government	$6.29
Rate for Payer: Brighton Health Commercial	$9.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.56
Rate for Payer: Group Health Inc Commercial	$6.29
Rate for Payer: Group Health Inc Medicare	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.29
Rate for Payer: Hamaspik Choice Inc Medicare	$6.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.18

PROCHLORPERAZINE 25 MG RE SUPP [11138]

Facility

$12.26

Service Code	NDC 00713013512
Hospital Charge Code	00713013512
Hospital Revenue Code	250
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$9.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.13
Rate for Payer: Aetna Government	$6.13
Rate for Payer: Brighton Health Commercial	$9.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.34
Rate for Payer: Group Health Inc Commercial	$6.13
Rate for Payer: Group Health Inc Medicare	$4.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.13
Rate for Payer: Hamaspik Choice Inc Medicare	$6.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.97

PROCHLORPERAZINE 25 MG RE SUPP [11138]

Facility

$12.26

Service Code	NDC 00713013506
Hospital Charge Code	00713013506
Hospital Revenue Code	250
Min. Negotiated Rate	$4.29
Max. Negotiated Rate	$9.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.13
Rate for Payer: Aetna Government	$6.13
Rate for Payer: Brighton Health Commercial	$9.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.34
Rate for Payer: Group Health Inc Commercial	$6.13
Rate for Payer: Group Health Inc Medicare	$4.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.13
Rate for Payer: Hamaspik Choice Inc Medicare	$6.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.97

PROCHLORPERAZINE 5 MG TAB

Facility

$0.20

Hospital Charge Code	41654048
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10

PROCHLORPERAZINE 5 MG TAB

Facility

$0.20

Hospital Charge Code	41644048
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10

PROCHLORPERAZINE 5 MG TAB

Facility

$0.20

Hospital Charge Code	41644048
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

PROCHLORPERAZINE 5 MG TAB

Facility

$0.20

Hospital Charge Code	41654048
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.13

PROCHLORPERAZINE MALEATE 10 MG PO TABS [6582]

Facility

$0.89

Service Code	HCPCS Q0164
Hospital Charge Code	59746011506
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

PROCHLORPERAZINE MALEATE 5 MG PO TABS [6583]

Facility

$0.59

Service Code	HCPCS Q0164
Hospital Charge Code	59746011306
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

PROCHLORPERAZINE SUPPOSITORY 25 MG

Facility

$5.60

Service Code	HCPCS J8498
Hospital Charge Code	41650335
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$3.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.80
Rate for Payer: Aetna Government	$2.80
Rate for Payer: Brighton Health Commercial	$3.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.22
Rate for Payer: Group Health Inc Commercial	$2.80
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.64

PROCHLORPERAZINE SUPPOSITORY 25 MG

Facility

$5.60

Service Code	HCPCS J8498
Hospital Charge Code	41650335
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80

PROCHLORPERAZINE SUPPOSITORY 25 MG

Facility

$5.60

Service Code	HCPCS J8498
Hospital Charge Code	41640335
Hospital Revenue Code	636
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$3.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.80
Rate for Payer: Aetna Government	$2.80
Rate for Payer: Brighton Health Commercial	$3.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.22
Rate for Payer: Group Health Inc Commercial	$2.80
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.64

PROCHLORPERAZINE SUPPOSITORY 25 MG

Facility

$5.60

Service Code	HCPCS J8498
Hospital Charge Code	41640335
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80

PROCIMAL HUMERAL NAIL LONG,LEFT

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Charge Code	40201292
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,635.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,904.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,077.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,731.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,990.65
Rate for Payer: EmblemHealth Commercial	$1,731.00
Rate for Payer: Fidelis Medicare Advantage	$3,635.10
Rate for Payer: Group Health Inc Commercial	$1,731.00
Rate for Payer: Group Health Inc Medicare	$1,211.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,731.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,731.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,250.30

PROCIMAL HUMERAL NAIL LONG,LEFT

Facility

$3,462.00

Service Code	HCPCS C1713
Hospital Charge Code	40201292
Hospital Revenue Code	278
Min. Negotiated Rate	$1,731.00
Max. Negotiated Rate	$1,731.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,731.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,731.00

PR OCT MIDDLE EAR WITH I&R UNILATERAL

Professional

Both

$47.67

Service Code	HCPCS 0485T 26
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$35.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.75
Rate for Payer: SOMOS Essential	$35.75

PR OCT MIDDLE EAR WITH I&R UNILATERAL

Professional

Both

$47.67

Service Code	HCPCS 0485T
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$35.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.75
Rate for Payer: SOMOS Essential	$35.75

PR OCT MIDDLE EAR WITH I&R UNILATERAL

Professional

Both

$47.67

Service Code	HCPCS 0485T TC
Min. Negotiated Rate	$35.75
Max. Negotiated Rate	$35.75
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35.75
Rate for Payer: SOMOS Essential	$35.75

PR OCT OF BREAST SURG CAVITY REAL TIME INTRAOP

Professional

Both

$158.10

Service Code	HCPCS 0353T
Min. Negotiated Rate	$118.58
Max. Negotiated Rate	$118.58
Rate for Payer: SOMOS CHP/HARP/Medicaid	$118.58
Rate for Payer: SOMOS Essential	$118.58

PROCTOSCOPE SET

Facility

$25.52

Hospital Charge Code	40204850
Hospital Revenue Code	270
Min. Negotiated Rate	$8.93
Max. Negotiated Rate	$20.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.76
Rate for Payer: Aetna Government	$12.76
Rate for Payer: Brighton Health Commercial	$19.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.35
Rate for Payer: Group Health Inc Commercial	$12.76
Rate for Payer: Group Health Inc Medicare	$8.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.76
Rate for Payer: Hamaspik Choice Inc Medicare	$12.76

PROCTOSIGMOIDOSCOPY - DIAGNOSTIC

Facility

$2,313.60

Service Code	HCPCS 45300
Hospital Charge Code	41118916
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,056.92

PROCTOSIGMOIDOSCOPY - DIAGNOSTIC

Facility

$2,313.60

Service Code	HCPCS 45300
Hospital Charge Code	41118916
Hospital Revenue Code	360
Min. Negotiated Rate	$739.84
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$780.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,056.92
Rate for Payer: Aetna Government	$1,056.92
Rate for Payer: Affinity Essential Plan 1&2	$739.84
Rate for Payer: Affinity Essential Plan 3&4	$739.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$739.84
Rate for Payer: Brighton Health Commercial	$1,735.20
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Cash Price	$1,056.92
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,056.92
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	$1,056.92
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$898.38
Rate for Payer: Fidelis Essential Plan QHP	$940.66
Rate for Payer: Fidelis Medicare Advantage	$1,056.92
Rate for Payer: Fidelis Qualified Health Plan	$940.66
Rate for Payer: Group Health Inc Commercial	$1,056.92
Rate for Payer: Group Health Inc Medicare	$1,056.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,156.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1,056.92
Rate for Payer: Healthfirst Medicare Advantage	$898.38
Rate for Payer: Healthfirst QHP	$1,056.92
Rate for Payer: Humana Medicare	$1,078.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,056.92
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$1,056.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,056.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$845.54
Rate for Payer: Wellcare Medicare	$1,004.07

PROCTOSIGMOIDOSCOPY DX

Facility

$2,313.60

Service Code	HCPCS 45300
Hospital Charge Code	30105536
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,056.92

Know your out-of-pocket cost for care.

All Charges