St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROMETHAZINE SUPPOSITORY 25 MG

Facility

$5.98

Service Code	HCPCS J8498
Hospital Charge Code	41644362
Hospital Revenue Code	636
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$3.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.99
Rate for Payer: Aetna Government	$2.99
Rate for Payer: Brighton Health Commercial	$3.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Group Health Inc Commercial	$2.99
Rate for Payer: Group Health Inc Medicare	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.99
Rate for Payer: Hamaspik Choice Inc Medicare	$2.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.89

PROMETHAZINE SUPPOSITORY 25 MG

Facility

$5.98

Service Code	HCPCS J8498
Hospital Charge Code	41644362
Hospital Revenue Code	636
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.99
Rate for Payer: Hamaspik Choice Inc Medicare	$2.99

PROMETHAZINE SUPPOSITORY 25 MG

Facility

$5.98

Service Code	HCPCS J8498
Hospital Charge Code	41654362
Hospital Revenue Code	636
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$3.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.99
Rate for Payer: Aetna Government	$2.99
Rate for Payer: Brighton Health Commercial	$3.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.44
Rate for Payer: Group Health Inc Commercial	$2.99
Rate for Payer: Group Health Inc Medicare	$2.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.99
Rate for Payer: Hamaspik Choice Inc Medicare	$2.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.89

PROMETHAZINE SUPPOSITORY 25 MG

Facility

$5.98

Service Code	HCPCS J8498
Hospital Charge Code	41654362
Hospital Revenue Code	636
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$2.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.99
Rate for Payer: Hamaspik Choice Inc Medicare	$2.99

PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX

Professional

Both

$3,521.11

Service Code	HCPCS 49255
Min. Negotiated Rate	$2,640.83
Max. Negotiated Rate	$2,640.83
Rate for Payer: Cash Price	$946.35
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,640.83
Rate for Payer: SOMOS Essential	$2,640.83

PR ONC CHEMO RX CYTOTOXICITY ASSAY CSC MIN 14 DRUGS

Professional

Both

$118.55

Service Code	HCPCS 0564T
Min. Negotiated Rate	$88.91
Max. Negotiated Rate	$88.91
Rate for Payer: SOMOS CHP/HARP/Medicaid	$88.91
Rate for Payer: SOMOS Essential	$88.91

PRONE POSITIONING ARM CRADLE

Facility

$13.97

Hospital Charge Code	64905365
Hospital Revenue Code	270
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$11.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.98
Rate for Payer: Aetna Government	$6.98
Rate for Payer: Brighton Health Commercial	$10.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.50
Rate for Payer: Group Health Inc Commercial	$6.98
Rate for Payer: Group Health Inc Medicare	$4.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.98
Rate for Payer: Hamaspik Choice Inc Medicare	$6.98

PRONG C-PAP 2.5 NEOTECH

Facility

$33.36

Hospital Charge Code	64903358
Hospital Revenue Code	270
Min. Negotiated Rate	$11.68
Max. Negotiated Rate	$26.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.68
Rate for Payer: Aetna Government	$16.68
Rate for Payer: Brighton Health Commercial	$25.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.68
Rate for Payer: Group Health Inc Commercial	$16.68
Rate for Payer: Group Health Inc Medicare	$11.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.68
Rate for Payer: Hamaspik Choice Inc Medicare	$16.68

PRONG C-PAP SZ 3.0 NEOTECH

Facility

$21.89

Hospital Charge Code	64903360
Hospital Revenue Code	270
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$17.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.94
Rate for Payer: Aetna Government	$10.94
Rate for Payer: Brighton Health Commercial	$16.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.89
Rate for Payer: Group Health Inc Commercial	$10.94
Rate for Payer: Group Health Inc Medicare	$7.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.94
Rate for Payer: Hamaspik Choice Inc Medicare	$10.94

PRONG C-PAP SZ 3.5 NEOTECH

Facility

$21.89

Hospital Charge Code	64903363
Hospital Revenue Code	270
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$17.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.94
Rate for Payer: Aetna Government	$10.94
Rate for Payer: Brighton Health Commercial	$16.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.89
Rate for Payer: Group Health Inc Commercial	$10.94
Rate for Payer: Group Health Inc Medicare	$7.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.94
Rate for Payer: Hamaspik Choice Inc Medicare	$10.94

PRONG C-PAP SZ 4 NEOTECH

Facility

$28.57

Hospital Charge Code	64903365
Hospital Revenue Code	270
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$22.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.28
Rate for Payer: Aetna Government	$14.28
Rate for Payer: Brighton Health Commercial	$21.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.43
Rate for Payer: Group Health Inc Commercial	$14.28
Rate for Payer: Group Health Inc Medicare	$10.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.28
Rate for Payer: Hamaspik Choice Inc Medicare	$14.28

PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES

Professional

Both

$103.74

Service Code	HCPCS 99422
Min. Negotiated Rate	$77.80
Max. Negotiated Rate	$77.80
Rate for Payer: Cash Price	$28.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$77.80
Rate for Payer: SOMOS Essential	$77.80

PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES

Professional

Both

$164.05

Service Code	HCPCS 99423
Min. Negotiated Rate	$123.04
Max. Negotiated Rate	$123.04
Rate for Payer: Cash Price	$45.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$123.04
Rate for Payer: SOMOS Essential	$123.04

PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES

Professional

Both

$52.61

Service Code	HCPCS 99421
Min. Negotiated Rate	$39.46
Max. Negotiated Rate	$39.46
Rate for Payer: Cash Price	$14.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$39.46
Rate for Payer: SOMOS Essential	$39.46

PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI

Professional

Both

$2,455.57

Service Code	HCPCS 58940
Min. Negotiated Rate	$1,841.68
Max. Negotiated Rate	$1,841.68
Rate for Payer: Cash Price	$660.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,841.68
Rate for Payer: SOMOS Essential	$1,841.68

PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY

Professional

Both

$5,110.00

Service Code	HCPCS 58943
Min. Negotiated Rate	$3,832.50
Max. Negotiated Rate	$3,832.50
Rate for Payer: Cash Price	$1,414.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,832.50
Rate for Payer: SOMOS Essential	$3,832.50

PRO PADZ RADIOLUCENT

Facility

$90.36

Hospital Charge Code	66520316
Hospital Revenue Code	270
Min. Negotiated Rate	$31.63
Max. Negotiated Rate	$72.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$49.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$45.18
Rate for Payer: Aetna Government	$45.18
Rate for Payer: Brighton Health Commercial	$67.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$72.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$61.44
Rate for Payer: Group Health Inc Commercial	$45.18
Rate for Payer: Group Health Inc Medicare	$31.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.18
Rate for Payer: Hamaspik Choice Inc Medicare	$45.18

PROPAFENONE 150 MG TAB

Facility

$1.00

Hospital Charge Code	41643023
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

PROPAFENONE 150 MG TAB

Facility

$1.00

Hospital Charge Code	41653023
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

PROPAFENONE HCL 150 MG PO TABS [11146]

Facility

$1.64

Service Code	NDC 53489055101
Hospital Charge Code	53489055101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$1.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.11
Rate for Payer: Group Health Inc Commercial	$0.82
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.06

PROPANTHELINE 15 MG TAB

Facility

$1.00

Hospital Charge Code	41641159
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

PROPANTHELINE 15 MG TAB

Facility

$1.00

Hospital Charge Code	41651159
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

PROPARACAINE 0.5% OPHTHLAMIC SOLUTION

Facility

$4.00

Hospital Charge Code	41640548
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

PROPARACAINE 0.5% OPHTHLAMIC SOLUTION

Facility

$4.00

Hospital Charge Code	41650548
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

PROPARACAINE HCL 0.5 % OP SOLN [6644]

Facility

$2.81

Service Code	NDC 24208073006
Hospital Charge Code	24208073006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.98
Max. Negotiated Rate	$2.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.40
Rate for Payer: Aetna Government	$1.40
Rate for Payer: Brighton Health Commercial	$2.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.91
Rate for Payer: Group Health Inc Commercial	$1.40
Rate for Payer: Group Health Inc Medicare	$0.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.40
Rate for Payer: Hamaspik Choice Inc Medicare	$1.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.82

Know your out-of-pocket cost for care.

All Charges