St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PUTTY, 15CC

Facility

$8,608.00

Service Code	HCPCS C1713
Hospital Charge Code	40005117
Hospital Revenue Code	278
Min. Negotiated Rate	$4,304.00
Max. Negotiated Rate	$4,304.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,304.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,304.00

PUTTY, 15CC

Facility

$6,099.80

Service Code	HCPCS C1713
Hospital Charge Code	64905393
Hospital Revenue Code	278
Min. Negotiated Rate	$3,049.90
Max. Negotiated Rate	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicare	$3,049.90

PUTTY, 15CC

Facility

$6,099.80

Service Code	HCPCS C1713
Hospital Charge Code	64905393
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$6,404.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,354.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,659.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,049.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,507.38
Rate for Payer: EmblemHealth Commercial	$3,049.90
Rate for Payer: Fidelis Medicare Advantage	$6,404.79
Rate for Payer: Group Health Inc Commercial	$3,049.90
Rate for Payer: Group Health Inc Medicare	$2,134.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,049.90
Rate for Payer: Hamaspik Choice Inc Medicare	$3,049.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,964.87

PUTTY, 15CC

Facility

$8,608.00

Service Code	HCPCS C1713
Hospital Charge Code	40005117
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$9,038.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,734.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$5,164.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,304.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,949.60
Rate for Payer: EmblemHealth Commercial	$4,304.00
Rate for Payer: Fidelis Medicare Advantage	$9,038.40
Rate for Payer: Group Health Inc Commercial	$4,304.00
Rate for Payer: Group Health Inc Medicare	$3,012.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,304.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4,304.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,595.20

PUTTY, 5.0CC

Facility

$2,702.45

Service Code	HCPCS C1713
Hospital Charge Code	64905390
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,837.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,486.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,621.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,351.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,553.91
Rate for Payer: EmblemHealth Commercial	$1,351.22
Rate for Payer: Fidelis Medicare Advantage	$2,837.57
Rate for Payer: Group Health Inc Commercial	$1,351.22
Rate for Payer: Group Health Inc Medicare	$945.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1,351.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,756.59

PUTTY, 5.0CC

Facility

$2,702.45

Service Code	HCPCS C1713
Hospital Charge Code	64905390
Hospital Revenue Code	278
Min. Negotiated Rate	$1,351.22
Max. Negotiated Rate	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,351.22
Rate for Payer: Hamaspik Choice Inc Medicare	$1,351.22

PUTTY, 5.0CC

Facility

$3,790.00

Service Code	HCPCS C1713
Hospital Charge Code	40005115
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$3,979.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,084.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$2,274.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,895.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,179.25
Rate for Payer: EmblemHealth Commercial	$1,895.00
Rate for Payer: Fidelis Medicare Advantage	$3,979.50
Rate for Payer: Group Health Inc Commercial	$1,895.00
Rate for Payer: Group Health Inc Medicare	$1,326.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,895.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,895.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,463.50

PUTTY, 5.0CC

Facility

$3,790.00

Service Code	HCPCS C1713
Hospital Charge Code	40005115
Hospital Revenue Code	278
Min. Negotiated Rate	$1,895.00
Max. Negotiated Rate	$1,895.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,895.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,895.00

PUTTY, .5CC

Facility

$675.60

Service Code	HCPCS C1713
Hospital Charge Code	64905395
Hospital Revenue Code	278
Min. Negotiated Rate	$337.80
Max. Negotiated Rate	$337.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$337.80
Rate for Payer: Hamaspik Choice Inc Medicare	$337.80

PUTTY, .5CC

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	40005118
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$924.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$484.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$528.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$440.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$506.00
Rate for Payer: EmblemHealth Commercial	$440.00
Rate for Payer: Fidelis Medicare Advantage	$924.00
Rate for Payer: Group Health Inc Commercial	$440.00
Rate for Payer: Group Health Inc Medicare	$308.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$440.00
Rate for Payer: Hamaspik Choice Inc Medicare	$440.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$572.00

PUTTY, .5CC

Facility

$675.60

Service Code	HCPCS C1713
Hospital Charge Code	64905395
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$709.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$371.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$405.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$337.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$388.47
Rate for Payer: EmblemHealth Commercial	$337.80
Rate for Payer: Fidelis Medicare Advantage	$709.38
Rate for Payer: Group Health Inc Commercial	$337.80
Rate for Payer: Group Health Inc Medicare	$236.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$337.80
Rate for Payer: Hamaspik Choice Inc Medicare	$337.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$439.14

PUTTY, .5CC

Facility

$880.00

Service Code	HCPCS C1713
Hospital Charge Code	40005118
Hospital Revenue Code	278
Min. Negotiated Rate	$440.00
Max. Negotiated Rate	$440.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$440.00
Rate for Payer: Hamaspik Choice Inc Medicare	$440.00

PUTTY GRAFTON 2.5CC JAR

Facility

$1,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64902003
Hospital Revenue Code	278
Min. Negotiated Rate	$550.00
Max. Negotiated Rate	$550.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00

PUTTY GRAFTON 2.5CC JAR

Facility

$1,100.00

Service Code	HCPCS C1713
Hospital Charge Code	64902003
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$1,155.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$605.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$660.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$550.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$632.50
Rate for Payer: EmblemHealth Commercial	$550.00
Rate for Payer: Fidelis Medicare Advantage	$1,155.00
Rate for Payer: Group Health Inc Commercial	$550.00
Rate for Payer: Group Health Inc Medicare	$385.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$550.00
Rate for Payer: Hamaspik Choice Inc Medicare	$550.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$715.00

PUTTY OSTEOSELECT 10 SYRINGE

Facility

$2,465.00

Service Code	HCPCS C1713
Hospital Charge Code	64903801
Hospital Revenue Code	278
Min. Negotiated Rate	$1,232.50
Max. Negotiated Rate	$1,232.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,232.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,232.50

PUTTY OSTEOSELECT 10 SYRINGE

Facility

$2,465.00

Service Code	HCPCS C1713
Hospital Charge Code	64903801
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,588.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,355.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,479.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,232.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,417.38
Rate for Payer: EmblemHealth Commercial	$1,232.50
Rate for Payer: Fidelis Medicare Advantage	$2,588.25
Rate for Payer: Group Health Inc Commercial	$1,232.50
Rate for Payer: Group Health Inc Medicare	$862.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,232.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1,232.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,602.25

PWRD ECH FLEX 60MM 34CM SHAF

Facility

$995.25

Hospital Charge Code	64905187
Hospital Revenue Code	270
Min. Negotiated Rate	$348.34
Max. Negotiated Rate	$796.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$547.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$497.62
Rate for Payer: Aetna Government	$497.62
Rate for Payer: Brighton Health Commercial	$746.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$796.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$676.77
Rate for Payer: Group Health Inc Commercial	$497.62
Rate for Payer: Group Health Inc Medicare	$348.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$497.62
Rate for Payer: Hamaspik Choice Inc Medicare	$497.62

PYELOLITHOTOMY

Facility

$3,400.30

Service Code	HCPCS 50130
Hospital Charge Code	40123030
Hospital Revenue Code	360
Min. Negotiated Rate	$1,190.10
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,870.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,255.94
Rate for Payer: Aetna Government	$1,255.94
Rate for Payer: Brighton Health Commercial	$2,550.22
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$1,700.15
Rate for Payer: Group Health Inc Medicare	$1,190.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,700.15
Rate for Payer: Hamaspik Choice Inc Medicare	$1,700.15
Rate for Payer: United Healthcare Commercial	$1,496.00

PYRAZINAMIDE 500 MG PO TABS [6738]

Facility

$6.16

Service Code	NDC 70954048430
Hospital Charge Code	70954048430
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$4.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$4.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.19
Rate for Payer: Group Health Inc Commercial	$3.08
Rate for Payer: Group Health Inc Medicare	$2.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.08
Rate for Payer: Hamaspik Choice Inc Medicare	$3.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.00

PYRAZINAMIDE 500 MG PO TABS [6738]

Facility

$6.16

Service Code	NDC 61748001201
Hospital Charge Code	61748001201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.15
Max. Negotiated Rate	$4.92
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.08
Rate for Payer: Aetna Government	$3.08
Rate for Payer: Brighton Health Commercial	$4.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.92
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.19
Rate for Payer: Group Health Inc Commercial	$3.08
Rate for Payer: Group Health Inc Medicare	$2.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.08
Rate for Payer: Hamaspik Choice Inc Medicare	$3.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.00

PYRAZINAMIDE 500 MG PO TABS [6738]

Facility

$6.28

Service Code	NDC 70954048420
Hospital Charge Code	70954048420
Hospital Revenue Code	250
Min. Negotiated Rate	$2.20
Max. Negotiated Rate	$5.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.14
Rate for Payer: Aetna Government	$3.14
Rate for Payer: Brighton Health Commercial	$4.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.27
Rate for Payer: Group Health Inc Commercial	$3.14
Rate for Payer: Group Health Inc Medicare	$2.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.14
Rate for Payer: Hamaspik Choice Inc Medicare	$3.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.08

PYRAZINAMIDE 500 MG TAB

Facility

$2.00

Hospital Charge Code	41640234
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

PYRAZINAMIDE 500 MG TAB

Facility

$2.00

Hospital Charge Code	41650234
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

PYRIDOSTIGMINE 5 MG/ML INJ

Facility

$45.30

Hospital Charge Code	41644327
Hospital Revenue Code	250
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$36.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.65
Rate for Payer: Aetna Government	$22.65
Rate for Payer: Brighton Health Commercial	$33.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.80
Rate for Payer: Group Health Inc Commercial	$22.65
Rate for Payer: Group Health Inc Medicare	$15.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.65
Rate for Payer: Hamaspik Choice Inc Medicare	$22.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.44

PYRIDOSTIGMINE 5 MG/ML INJ

Facility

$45.30

Hospital Charge Code	41654327
Hospital Revenue Code	250
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$36.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.65
Rate for Payer: Aetna Government	$22.65
Rate for Payer: Brighton Health Commercial	$33.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.80
Rate for Payer: Group Health Inc Commercial	$22.65
Rate for Payer: Group Health Inc Medicare	$15.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.65
Rate for Payer: Hamaspik Choice Inc Medicare	$22.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.44

Know your out-of-pocket cost for care.

All Charges