St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP

Professional

Both

$1,745.07

Service Code	HCPCS 34833
Min. Negotiated Rate	$1,308.80
Max. Negotiated Rate	$1,308.80
Rate for Payer: Cash Price	$461.49
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,308.80
Rate for Payer: SOMOS Essential	$1,308.80

PR OPN ILIAC ART EXPOS PROSTH/ILIAC OCCLS EVASC UNI

Professional

Both

$1,497.27

Service Code	HCPCS 34820
Min. Negotiated Rate	$1,122.95
Max. Negotiated Rate	$1,122.95
Rate for Payer: Cash Price	$395.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,122.95
Rate for Payer: SOMOS Essential	$1,122.95

PR OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH

Professional

Both

$7,844.41

Service Code	HCPCS 34830
Min. Negotiated Rate	$5,883.31
Max. Negotiated Rate	$5,883.31
Rate for Payer: Cash Price	$2,076.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5,883.31
Rate for Payer: SOMOS Essential	$5,883.31

PR OPN RPR ARYSM RPR ARTL TRMA AORTO-BIFEM PROSTH

Professional

Both

$8,431.26

Service Code	HCPCS 34832
Min. Negotiated Rate	$6,323.44
Max. Negotiated Rate	$6,323.44
Rate for Payer: Cash Price	$2,232.40
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,323.44
Rate for Payer: SOMOS Essential	$6,323.44

PR OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH

Professional

Both

$8,569.26

Service Code	HCPCS 34831
Min. Negotiated Rate	$6,426.94
Max. Negotiated Rate	$6,426.94
Rate for Payer: Cash Price	$2,270.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6,426.94
Rate for Payer: SOMOS Essential	$6,426.94

PR OPN SUBCLA CRTD ART TRPOS NCK INC ULAT

Professional

Both

$3,529.23

Service Code	HCPCS 33889
Min. Negotiated Rate	$2,646.92
Max. Negotiated Rate	$2,646.92
Rate for Payer: Cash Price	$933.51
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,646.92
Rate for Payer: SOMOS Essential	$2,646.92

PROPOFOL 1000 MG/100ML IV EMUL [131629]

Facility

$0.14

Service Code	HCPCS J2704
Hospital Charge Code	63323026969
Hospital Revenue Code	278
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Fidelis Medicare Advantage	$0.15
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

PROPOFOL 1000 MG/100ML IV EMUL [131629]

Facility

$0.14

Service Code	HCPCS J2704
Hospital Charge Code	63323026969
Hospital Revenue Code	278
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07

PROPOFOL 1000 MG/100ML IV EMUL [131629]

Facility

$0.36

Service Code	HCPCS J2704
Hospital Charge Code	63323026965
Hospital Revenue Code	278
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

PROPOFOL 1000 MG/100ML IV EMUL [131629]

Facility

$0.36

Service Code	HCPCS J2704
Hospital Charge Code	63323026965
Hospital Revenue Code	278
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Fidelis Medicare Advantage	$0.38
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

PROPOFOL 10 MG/ML INJ 100 ML

Facility

$3.75

Service Code	HCPCS J2704
Hospital Charge Code	41652900
Hospital Revenue Code	636
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88

PROPOFOL 10 MG/ML INJ 100 ML

Facility

$3.75

Service Code	HCPCS J2704
Hospital Charge Code	41652900
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$2.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.16
Rate for Payer: Group Health Inc Commercial	$1.88
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.13
Rate for Payer: SOMOS Essential	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.44

PROPOFOL 10 MG/ML INJ 100 ML

Facility

$3.75

Service Code	HCPCS J3490
Hospital Charge Code	41642900
Hospital Revenue Code	636
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.88
Rate for Payer: Aetna Government	$1.88
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.16
Rate for Payer: Group Health Inc Commercial	$1.88
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.44

PROPOFOL 10 MG/ML INJ 100 ML

Facility

$3.75

Service Code	HCPCS J3490
Hospital Charge Code	41642900
Hospital Revenue Code	636
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$1.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.88
Rate for Payer: Hamaspik Choice Inc Medicare	$1.88

PROPOFOL 10 MG/ML INJ 20 ML

Facility

$3.03

Service Code	HCPCS J2704
Hospital Charge Code	41653258
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.74
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.13
Rate for Payer: SOMOS Essential	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

PROPOFOL 10 MG/ML INJ 20 ML

Facility

$3.03

Service Code	HCPCS J2704
Hospital Charge Code	41653258
Hospital Revenue Code	636
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52

PROPOFOL 10 MG/ML INJ 20 ML

Facility

$3.03

Service Code	HCPCS J2704
Hospital Charge Code	41643258
Hospital Revenue Code	636
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52

PROPOFOL 10 MG/ML INJ 20 ML

Facility

$3.03

Service Code	HCPCS J2704
Hospital Charge Code	41643258
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.74
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.13
Rate for Payer: SOMOS Essential	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

PROPOFOL 10 MG/ML INJ 50 ML

Facility

$11.44

Service Code	HCPCS J2704
Hospital Charge Code	41642626
Hospital Revenue Code	636
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$5.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5.72

PROPOFOL 10 MG/ML INJ 50 ML

Facility

$11.44

Service Code	HCPCS J2704
Hospital Charge Code	41652626
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$7.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$6.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.58
Rate for Payer: Group Health Inc Commercial	$5.72
Rate for Payer: Group Health Inc Medicare	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.13
Rate for Payer: SOMOS Essential	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.44

PROPOFOL 10 MG/ML INJ 50 ML

Facility

$11.44

Service Code	HCPCS J2704
Hospital Charge Code	41642626
Hospital Revenue Code	636
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$7.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$6.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.58
Rate for Payer: Group Health Inc Commercial	$5.72
Rate for Payer: Group Health Inc Medicare	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5.72
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.13
Rate for Payer: SOMOS Essential	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.44

PROPOFOL 10 MG/ML INJ 50 ML

Facility

$11.44

Service Code	HCPCS J2704
Hospital Charge Code	41652626
Hospital Revenue Code	636
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$5.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.72
Rate for Payer: Hamaspik Choice Inc Medicare	$5.72

PROPOFOL 10 MG/ML IV INJECTION (WRAPPED) [408011150]

Facility

$0.36

Service Code	HCPCS J2704
Hospital Charge Code	63323026929
Hospital Revenue Code	278
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

PROPOFOL 10 MG/ML IV INJECTION (WRAPPED) [408011150]

Facility

$0.36

Service Code	HCPCS J2704
Hospital Charge Code	63323026929
Hospital Revenue Code	278
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.21
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Fidelis Medicare Advantage	$0.38
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

PROPOFOL 200 MG/20ML IV EMUL [131627]

Facility

$0.36

Service Code	HCPCS J2704
Hospital Charge Code	63323026922
Hospital Revenue Code	278
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

Know your out-of-pocket cost for care.

All Charges