St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PROSTHETIC PMP PN 21CMX12MM

Facility

$9,239.00

Hospital Charge Code	64906257
Hospital Revenue Code	270
Min. Negotiated Rate	$3,233.65
Max. Negotiated Rate	$7,391.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,081.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4,619.50
Rate for Payer: Aetna Government	$4,619.50
Rate for Payer: Brighton Health Commercial	$6,929.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7,391.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6,282.52
Rate for Payer: Group Health Inc Commercial	$4,619.50
Rate for Payer: Group Health Inc Medicare	$3,233.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,619.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4,619.50

PR OSTPL FEMUR CMBN LNGTH&SHRT W/FEMORAL SGM TRNSFR

Professional

Both

$5,919.83

Service Code	HCPCS 27468
Min. Negotiated Rate	$4,439.87
Max. Negotiated Rate	$4,439.87
Rate for Payer: Cash Price	$1,594.29
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4,439.87
Rate for Payer: SOMOS Essential	$4,439.87

PR OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX

Professional

Both

$1,597.30

Service Code	HCPCS 63295
Min. Negotiated Rate	$1,197.98
Max. Negotiated Rate	$1,197.98
Rate for Payer: Cash Price	$413.90
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1,197.98
Rate for Payer: SOMOS Essential	$1,197.98

PROTAMINE 10 MG/ML INJ

Facility

$2.57

Service Code	HCPCS J2720
Hospital Charge Code	41643543
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28

PROTAMINE 10 MG/ML INJ

Facility

$2.57

Service Code	HCPCS J2720
Hospital Charge Code	41653543
Hospital Revenue Code	636
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28

PROTAMINE 10 MG/ML INJ

Facility

$2.57

Service Code	HCPCS J2720
Hospital Charge Code	41643543
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$2.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.39
Rate for Payer: Aetna Government	$1.39
Rate for Payer: Brighton Health Commercial	$1.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.48
Rate for Payer: Group Health Inc Commercial	$1.28
Rate for Payer: Group Health Inc Medicare	$0.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.25
Rate for Payer: SOMOS Essential	$2.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.67

PROTAMINE 10 MG/ML INJ

Facility

$2.57

Service Code	HCPCS J2720
Hospital Charge Code	41653543
Hospital Revenue Code	636
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$2.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.39
Rate for Payer: Aetna Government	$1.39
Rate for Payer: Brighton Health Commercial	$1.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.48
Rate for Payer: Group Health Inc Commercial	$1.28
Rate for Payer: Group Health Inc Medicare	$0.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.25
Rate for Payer: SOMOS Essential	$2.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.67

PROTAMINE SULFATE 10 MG/ML IV SOLN [6677]

Facility

$3.72

Service Code	HCPCS J2720
Hospital Charge Code	63323022905
Hospital Revenue Code	278
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$3.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.39
Rate for Payer: Aetna Government	$1.39
Rate for Payer: Brighton Health Commercial	$2.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.14
Rate for Payer: EmblemHealth Commercial	$1.86
Rate for Payer: Fidelis Medicare Advantage	$3.90
Rate for Payer: Group Health Inc Commercial	$1.86
Rate for Payer: Group Health Inc Medicare	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.41

PROTAMINE SULFATE 10 MG/ML IV SOLN [6677]

Facility

$2.23

Service Code	HCPCS J2720
Hospital Charge Code	63323022930
Hospital Revenue Code	278
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$2.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.39
Rate for Payer: Aetna Government	$1.39
Rate for Payer: Brighton Health Commercial	$1.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.28
Rate for Payer: EmblemHealth Commercial	$1.11
Rate for Payer: Fidelis Medicare Advantage	$2.34
Rate for Payer: Group Health Inc Commercial	$1.11
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.45

PROTAMINE SULFATE 10 MG/ML IV SOLN [6677]

Facility

$2.23

Service Code	HCPCS J2720
Hospital Charge Code	63323022930
Hospital Revenue Code	278
Min. Negotiated Rate	$1.11
Max. Negotiated Rate	$1.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11

PROTAMINE SULFATE 10 MG/ML IV SOLN [6677]

Facility

$3.72

Service Code	HCPCS J2720
Hospital Charge Code	63323022905
Hospital Revenue Code	278
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86

PROTECTOR CORNER

Facility

$2.63

Hospital Charge Code	64903500
Hospital Revenue Code	270
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.32
Rate for Payer: Aetna Government	$1.32
Rate for Payer: Brighton Health Commercial	$1.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Group Health Inc Commercial	$1.32
Rate for Payer: Group Health Inc Medicare	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.32
Rate for Payer: Hamaspik Choice Inc Medicare	$1.32

PROTECTOR CROUCH CORNEAL

Facility

$17.90

Hospital Charge Code	64902795
Hospital Revenue Code	270
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$14.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.95
Rate for Payer: Aetna Government	$8.95
Rate for Payer: Brighton Health Commercial	$13.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.17
Rate for Payer: Group Health Inc Commercial	$8.95
Rate for Payer: Group Health Inc Medicare	$6.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.95
Rate for Payer: Hamaspik Choice Inc Medicare	$8.95

PROTECTOR CROUCH CORNEAL

Facility

$134.00

Hospital Charge Code	40201019
Hospital Revenue Code	270
Min. Negotiated Rate	$46.90
Max. Negotiated Rate	$107.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$73.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$67.00
Rate for Payer: Aetna Government	$67.00
Rate for Payer: Brighton Health Commercial	$100.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.12
Rate for Payer: Group Health Inc Commercial	$67.00
Rate for Payer: Group Health Inc Medicare	$46.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$67.00
Rate for Payer: Hamaspik Choice Inc Medicare	$67.00

PROTECTOR EYE NEWBORN

Facility

$4.73

Hospital Charge Code	64902478
Hospital Revenue Code	270
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.22
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36

PROTECTOR EYE PREMIE

Facility

$4.73

Hospital Charge Code	64902476
Hospital Revenue Code	270
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$3.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.22
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36

PROTECTOR, HEEL, HEELMEDIX

Facility

$105.00

Hospital Charge Code	64901647
Hospital Revenue Code	270
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.50
Rate for Payer: Aetna Government	$52.50
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

PROTECTOR,HEEL,OSFM

Facility

$105.00

Hospital Charge Code	64906201
Hospital Revenue Code	270
Min. Negotiated Rate	$36.75
Max. Negotiated Rate	$84.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$57.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$52.50
Rate for Payer: Aetna Government	$52.50
Rate for Payer: Brighton Health Commercial	$78.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$84.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.40
Rate for Payer: Group Health Inc Commercial	$52.50
Rate for Payer: Group Health Inc Medicare	$36.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$52.50
Rate for Payer: Hamaspik Choice Inc Medicare	$52.50

PROTECTOR HEEL PREVALON

Facility

$260.00

Hospital Charge Code	64901124
Hospital Revenue Code	270
Min. Negotiated Rate	$91.00
Max. Negotiated Rate	$208.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$143.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$130.00
Rate for Payer: Aetna Government	$130.00
Rate for Payer: Brighton Health Commercial	$195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$208.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$176.80
Rate for Payer: Group Health Inc Commercial	$130.00
Rate for Payer: Group Health Inc Medicare	$91.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$130.00
Rate for Payer: Hamaspik Choice Inc Medicare	$130.00

PROTECTOR TRANSDUCER DBL LU LK

Facility

$0.11

Hospital Charge Code	64902004
Hospital Revenue Code	270
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06

PROTEIN-A/G RATIO

Facility

$26.85

Service Code	HCPCS 84165
Hospital Charge Code	40602150
Hospital Revenue Code	301
Min. Negotiated Rate	$7.52
Max. Negotiated Rate	$20.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.74
Rate for Payer: Aetna Government	$10.74
Rate for Payer: Affinity Essential Plan 1&2	$7.52
Rate for Payer: Affinity Essential Plan 3&4	$7.52
Rate for Payer: Affinity Medicaid/CHP/HARP	$7.52
Rate for Payer: Brighton Health Commercial	$20.14
Rate for Payer: Cash Price	$10.74
Rate for Payer: Cash Price	$10.74
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$10.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.45
Rate for Payer: Elderplan Medicare Advantage	$10.74
Rate for Payer: EmblemHealth Commercial	$10.74
Rate for Payer: Fidelis Essential Plan Aliesa	$9.13
Rate for Payer: Fidelis Essential Plan QHP	$9.56
Rate for Payer: Fidelis Medicare Advantage	$10.74
Rate for Payer: Fidelis Qualified Health Plan	$9.56
Rate for Payer: Group Health Inc Commercial	$10.74
Rate for Payer: Group Health Inc Medicare	$10.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.42
Rate for Payer: Hamaspik Choice Inc Medicare	$10.74
Rate for Payer: Healthfirst Medicare Advantage	$10.74
Rate for Payer: Healthfirst QHP	$10.74
Rate for Payer: Humana Medicare	$10.95
Rate for Payer: Senior Whole Health Medicare Advantage	$10.74
Rate for Payer: United Healthcare Commercial	$13.61
Rate for Payer: United Healthcare Medicare Advantage	$10.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.74
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.59
Rate for Payer: Wellcare Medicare	$9.67

PROTEIN-A/G RATIO

Facility

$26.85

Service Code	HCPCS 84165
Hospital Charge Code	40602150
Hospital Revenue Code	301
Rate for Payer: Cash Price	$10.74

PROTEIN-BF

Facility

$9.18

Service Code	HCPCS 84155
Hospital Charge Code	40602681
Hospital Revenue Code	301
Min. Negotiated Rate	$2.57
Max. Negotiated Rate	$6.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.67
Rate for Payer: Aetna Government	$3.67
Rate for Payer: Affinity Essential Plan 1&2	$2.57
Rate for Payer: Affinity Essential Plan 3&4	$2.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.57
Rate for Payer: Brighton Health Commercial	$6.88
Rate for Payer: Cash Price	$3.67
Rate for Payer: Cash Price	$3.67
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.93
Rate for Payer: Elderplan Medicare Advantage	$3.67
Rate for Payer: EmblemHealth Commercial	$3.67
Rate for Payer: Fidelis Essential Plan Aliesa	$3.12
Rate for Payer: Fidelis Essential Plan QHP	$3.27
Rate for Payer: Fidelis Medicare Advantage	$3.67
Rate for Payer: Fidelis Qualified Health Plan	$3.27
Rate for Payer: Group Health Inc Commercial	$3.67
Rate for Payer: Group Health Inc Medicare	$3.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.59
Rate for Payer: Hamaspik Choice Inc Medicare	$3.67
Rate for Payer: Healthfirst Medicare Advantage	$3.67
Rate for Payer: Healthfirst QHP	$3.67
Rate for Payer: Humana Medicare	$3.74
Rate for Payer: Senior Whole Health Medicare Advantage	$3.67
Rate for Payer: United Healthcare Commercial	$4.64
Rate for Payer: United Healthcare Medicare Advantage	$3.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.67
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2.94
Rate for Payer: Wellcare Medicare	$3.30

PROTEIN-BF

Facility

$9.18

Service Code	HCPCS 84155
Hospital Charge Code	40602681
Hospital Revenue Code	301
Rate for Payer: Cash Price	$3.67

PROTEIN C ANTIGEN

Facility

$30.03

Service Code	HCPCS 85302
Hospital Charge Code	30303358
Hospital Revenue Code	305
Min. Negotiated Rate	$8.41
Max. Negotiated Rate	$22.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.01
Rate for Payer: Aetna Government	$12.01
Rate for Payer: Affinity Essential Plan 1&2	$8.41
Rate for Payer: Affinity Essential Plan 3&4	$8.41
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.41
Rate for Payer: Brighton Health Commercial	$22.52
Rate for Payer: Cash Price	$12.01
Rate for Payer: Cash Price	$12.01
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.17
Rate for Payer: Elderplan Medicare Advantage	$12.01
Rate for Payer: EmblemHealth Commercial	$12.01
Rate for Payer: Fidelis Essential Plan Aliesa	$10.21
Rate for Payer: Fidelis Essential Plan QHP	$10.69
Rate for Payer: Fidelis Medicare Advantage	$12.01
Rate for Payer: Fidelis Qualified Health Plan	$10.69
Rate for Payer: Group Health Inc Commercial	$12.01
Rate for Payer: Group Health Inc Medicare	$12.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.02
Rate for Payer: Hamaspik Choice Inc Medicare	$12.01
Rate for Payer: Healthfirst Medicare Advantage	$12.01
Rate for Payer: Healthfirst QHP	$12.01
Rate for Payer: Humana Medicare	$12.25
Rate for Payer: Senior Whole Health Medicare Advantage	$12.01
Rate for Payer: United Healthcare Commercial	$15.23
Rate for Payer: United Healthcare Medicare Advantage	$12.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.61
Rate for Payer: Wellcare Medicare	$10.81

Know your out-of-pocket cost for care.

All Charges