St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROPOFOL 200 MG/20ML IV EMUL [131627]

Facility

$0.14

Service Code	HCPCS J2704
Hospital Charge Code	63323026994
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 200 MG/20ML IV EMUL [131627]

Facility

$0.36

Service Code	HCPCS J2704
Hospital Charge Code	63323026922
Hospital Revenue Code	278
Min. Negotiated Rate	$0.13
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	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 200 MG/20ML IV EMUL [131627]

Facility

$0.14

Service Code	HCPCS J2704
Hospital Charge Code	63323026994
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 200 MG/20ML IV EMUL [131627]

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 200MG INJECTION

Facility

$0.14

Service Code	HCPCS J3490
Hospital Charge Code	41657028
Hospital Revenue Code	636
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
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 200MG INJECTION

Facility

$0.14

Service Code	HCPCS J3490
Hospital Charge Code	41657028
Hospital Revenue Code	636
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 200MG INJECTION

Facility

$0.14

Hospital Charge Code	41647028
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
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 500 MG/50ML IV EMUL [131628]

Facility

$0.36

Service Code	HCPCS J2704
Hospital Charge Code	63323026950
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 500 MG/50ML IV EMUL [131628]

Facility

$0.36

Service Code	HCPCS J2704
Hospital Charge Code	63323026950
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 INFUSION 10 MG/ML (WRAPPED) [40840026]

Facility

$0.36

Service Code	NDC 63323026965
Hospital Charge Code	63323026965
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
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 INFUSION 10 MG/ML (WRAPPED) [40840026]

Facility

$0.14

Service Code	HCPCS J2704
Hospital Charge Code	63323026959
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.13
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	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.12
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.13
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.13
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

PROPOFOL INFUSION 10 MG/ML (WRAPPED) [40840026]

Facility

$0.14

Service Code	NDC 63323026969
Hospital Charge Code	63323026969
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
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

PROPOXYPHENE

Facility

$49.93

Service Code	HCPCS 80367
Hospital Charge Code	40609010
Hospital Revenue Code	300
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.95
Rate for Payer: Group Health Inc Commercial	$24.96
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.96
Rate for Payer: Hamaspik Choice Inc Medicare	$24.96
Rate for Payer: United Healthcare Commercial	$21.99

PROPOXYPHENE CONFIRMATION, UR

Facility

$49.93

Service Code	HCPCS 80367
Hospital Charge Code	40609843
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$37.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.95
Rate for Payer: Group Health Inc Commercial	$24.96
Rate for Payer: Group Health Inc Medicare	$17.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.96
Rate for Payer: Hamaspik Choice Inc Medicare	$24.96
Rate for Payer: United Healthcare Commercial	$21.99

PR OPPONENSPLASTY HYPOTHENAR MUSC TR

Professional

Both

$3,747.17

Service Code	HCPCS 26494
Min. Negotiated Rate	$2,810.38
Max. Negotiated Rate	$2,810.38
Rate for Payer: Cash Price	$1,009.06
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,810.38
Rate for Payer: SOMOS Essential	$2,810.38

PR OPPONENSPLASTY OTHER METHODS

Professional

Both

$4,035.19

Service Code	HCPCS 26496
Min. Negotiated Rate	$3,026.39
Max. Negotiated Rate	$3,026.39
Rate for Payer: Cash Price	$1,085.93
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,026.39
Rate for Payer: SOMOS Essential	$3,026.39

PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN

Professional

Both

$3,732.61

Service Code	HCPCS 26490
Min. Negotiated Rate	$2,799.46
Max. Negotiated Rate	$2,799.46
Rate for Payer: Cash Price	$1,004.54
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2,799.46
Rate for Payer: SOMOS Essential	$2,799.46

PR OPPONENSPLASTY TDN TR W/GRF EA TDN

Professional

Both

$4,127.24

Service Code	HCPCS 26492
Min. Negotiated Rate	$3,095.43
Max. Negotiated Rate	$3,095.43
Rate for Payer: Cash Price	$1,111.04
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3,095.43
Rate for Payer: SOMOS Essential	$3,095.43

PROPRANOLOL 10 MG TAB

Facility

$0.08

Hospital Charge Code	41654022
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

PROPRANOLOL 10 MG TAB

Facility

$0.08

Hospital Charge Code	41644022
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

PROPRANOLOL 1 MG/ML INJ

Facility

$3.81

Service Code	HCPCS J1800
Hospital Charge Code	41653230
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.62
Rate for Payer: Aetna Government	$6.62
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: Group Health Inc Commercial	$1.90
Rate for Payer: Group Health Inc Medicare	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.48

PROPRANOLOL 1 MG/ML INJ

Facility

$3.81

Service Code	HCPCS J1800
Hospital Charge Code	41653230
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90

PROPRANOLOL 1 MG/ML INJ

Facility

$3.81

Service Code	HCPCS J1800
Hospital Charge Code	41643230
Hospital Revenue Code	636
Min. Negotiated Rate	$1.90
Max. Negotiated Rate	$1.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90

PROPRANOLOL 1 MG/ML INJ

Facility

$3.81

Service Code	HCPCS J1800
Hospital Charge Code	41643230
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$6.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.62
Rate for Payer: Aetna Government	$6.62
Rate for Payer: Brighton Health Commercial	$2.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.19
Rate for Payer: Group Health Inc Commercial	$1.90
Rate for Payer: Group Health Inc Medicare	$1.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.90
Rate for Payer: Hamaspik Choice Inc Medicare	$1.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.48

Know your out-of-pocket cost for care.

All Charges