St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

PERPHENAZINE 16 MG PO TABS

Facility

$3.90

Service Code	NDC 5253617001
Hospital Charge Code	5253617001
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.95

PERPHENAZINE 2 MG PO TABS

Facility

$1.19

Service Code	NDC 0904659961
Hospital Charge Code	0904659961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59

PERPHENAZINE 2 MG PO TABS

Facility

$1.19

Service Code	NDC 0904659961
Hospital Charge Code	0904659961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.59
Rate for Payer: Aetna Government	$0.59
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: EmblemHealth Commercial	$0.59
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

PERPHENAZINE 4 MG PO TABS

Facility

$1.79

Service Code	NDC 0904660061
Hospital Charge Code	0904660061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.90
Rate for Payer: Aetna Government	$0.90
Rate for Payer: Brighton Health Commercial	$1.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.22
Rate for Payer: EmblemHealth Commercial	$0.90
Rate for Payer: Group Health Inc Commercial	$0.90
Rate for Payer: Group Health Inc Medicare	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90
Rate for Payer: Hamaspik Choice Inc Medicare	$0.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.16

PERPHENAZINE 4 MG PO TABS

Facility

$1.79

Service Code	NDC 0904660061
Hospital Charge Code	0904660061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$0.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.90

PERPHENAZINE 8 MG PO TABS

Facility

$1.93

Service Code	NDC 0603506221
Hospital Charge Code	0603506221
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: EmblemHealth Commercial	$0.97
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

PERPHENAZINE 8 MG PO TABS

Facility

$1.93

Service Code	NDC 0603506221
Hospital Charge Code	0603506221
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97

PERPHENAZINE 8 MG PO TABS

Facility

$2.16

Service Code	NDC 0904660161
Hospital Charge Code	0904660161
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$1.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08

PERPHENAZINE 8 MG PO TABS

Facility

$2.16

Service Code	NDC 0904660161
Hospital Charge Code	0904660161
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.08
Rate for Payer: Aetna Government	$1.08
Rate for Payer: Brighton Health Commercial	$1.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.47
Rate for Payer: EmblemHealth Commercial	$1.08
Rate for Payer: Group Health Inc Commercial	$1.08
Rate for Payer: Group Health Inc Medicare	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.08
Rate for Payer: Hamaspik Choice Inc Medicare	$1.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.40

PERSONALITY AND IMPULSE CONTROL DIAGNOSES

Facility

$211.05

Service Code	EAPG 00822
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$211.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$211.05

PERTUZ-TRASTUZ-HYALURON-ZZXF 60-60-2000 MG-MG-U/ML SC SOLN

Facility

$1.00

Service Code	HCPCS J9316
Hospital Charge Code	5024226001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$63.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.10
Rate for Payer: Aetna Government	$62.10
Rate for Payer: Affinity Essential Plan 1&2	$43.47
Rate for Payer: Affinity Essential Plan 3&4	$43.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.47
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$62.10
Rate for Payer: EmblemHealth Commercial	$62.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55.89
Rate for Payer: Fidelis Essential Plan Aliesa	$52.78
Rate for Payer: Fidelis Essential Plan QHP	$55.27
Rate for Payer: Fidelis Medicare Advantage	$62.10
Rate for Payer: Fidelis Qualified Health Plan	$55.27
Rate for Payer: Group Health Inc Commercial	$62.10
Rate for Payer: Group Health Inc Medicare	$62.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.10
Rate for Payer: Hamaspik Choice Inc Medicare	$62.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.10
Rate for Payer: Healthfirst Medicare Advantage	$52.78
Rate for Payer: Healthfirst QHP	$62.10
Rate for Payer: Humana Medicare	$63.34
Rate for Payer: Senior Whole Health Medicare Advantage	$62.10
Rate for Payer: United Healthcare Medicare Advantage	$62.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.99
Rate for Payer: Wellcare Medicare	$58.99

PERTUZ-TRASTUZ-HYALURON-ZZXF 60-60-2000 MG-MG-U/ML SC SOLN

Facility

$1.00

Service Code	HCPCS J9316
Hospital Charge Code	5024226001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

PERTUZ-TRASTUZ-HYALURON-ZZXF 80-40-2000 MG-MG-U/ML SC SOLN

Facility

$1.00

Service Code	HCPCS J9316
Hospital Charge Code	5024224501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50

PERTUZ-TRASTUZ-HYALURON-ZZXF 80-40-2000 MG-MG-U/ML SC SOLN

Facility

$1.00

Service Code	HCPCS J9316
Hospital Charge Code	5024224501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$63.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$62.10
Rate for Payer: Aetna Government	$62.10
Rate for Payer: Affinity Essential Plan 1&2	$43.47
Rate for Payer: Affinity Essential Plan 3&4	$43.47
Rate for Payer: Affinity Medicaid/CHP/HARP	$43.47
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$62.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Elderplan Medicare Advantage	$62.10
Rate for Payer: EmblemHealth Commercial	$62.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$55.89
Rate for Payer: Fidelis Essential Plan Aliesa	$52.78
Rate for Payer: Fidelis Essential Plan QHP	$55.27
Rate for Payer: Fidelis Medicare Advantage	$62.10
Rate for Payer: Fidelis Qualified Health Plan	$55.27
Rate for Payer: Group Health Inc Commercial	$62.10
Rate for Payer: Group Health Inc Medicare	$62.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.10
Rate for Payer: Hamaspik Choice Inc Medicare	$62.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$62.10
Rate for Payer: Healthfirst Medicare Advantage	$52.78
Rate for Payer: Healthfirst QHP	$62.10
Rate for Payer: Humana Medicare	$63.34
Rate for Payer: Senior Whole Health Medicare Advantage	$62.10
Rate for Payer: United Healthcare Medicare Advantage	$62.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65
Rate for Payer: Wellcare CHP/FHP/Medicaid	$58.99
Rate for Payer: Wellcare Medicare	$58.99

PERTUZUMAB 420 MG/14ML IV SOLN

Facility

$559.44

Service Code	HCPCS J9306
Hospital Charge Code	5024214501
Hospital Revenue Code	258
Min. Negotiated Rate	$10.32
Max. Negotiated Rate	$1,032.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$307.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.02
Rate for Payer: Aetna Government	$17.02
Rate for Payer: Affinity Essential Plan 1&2	$23.22
Rate for Payer: Affinity Essential Plan 3&4	$23.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.32
Rate for Payer: Amida Care Medicaid	$10.32
Rate for Payer: Brighton Health Commercial	$419.58
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$17.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$447.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$380.42
Rate for Payer: Elderplan Medicare Advantage	$17.02
Rate for Payer: EmblemHealth Commercial	$17.02
Rate for Payer: EmblemHealth Essential Plan 1&2	$23.22
Rate for Payer: EmblemHealth Essential Plan 3&4	$10.32
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.32
Rate for Payer: Fidelis Essential Plan Aliesa	$23.22
Rate for Payer: Fidelis Essential Plan QHP	$23.22
Rate for Payer: Fidelis Medicare Advantage	$17.02
Rate for Payer: Fidelis Qualified Health Plan	$10.84
Rate for Payer: Group Health Inc Commercial	$17.02
Rate for Payer: Group Health Inc Medicare	$17.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.32
Rate for Payer: Hamaspik Choice Inc Medicare	$17.02
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,032.00
Rate for Payer: Healthfirst Essential Plan	$23.22
Rate for Payer: Healthfirst Medicare Advantage	$14.47
Rate for Payer: Healthfirst QHP	$16.82
Rate for Payer: Humana Medicare	$17.36
Rate for Payer: Senior Whole Health Medicare Advantage	$17.02
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.32
Rate for Payer: SOMOS Essential	$23.22
Rate for Payer: United Healthcare Essential Plan 1&2	$23.22
Rate for Payer: United Healthcare Essential Plan 3&4	$11.35
Rate for Payer: United Healthcare Medicaid	$10.32
Rate for Payer: United Healthcare Medicare Advantage	$17.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$363.64
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.32
Rate for Payer: Wellcare Medicare	$16.17

PERTUZUMAB 420 MG/14ML IV SOLN

Facility

$559.44

Service Code	HCPCS J9306
Hospital Charge Code	5024214501
Hospital Revenue Code	258
Min. Negotiated Rate	$279.72
Max. Negotiated Rate	$279.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$279.72

PET SCANS

Facility

$2,645.23

Service Code	EAPG 00290
Min. Negotiated Rate	$1,920.87
Max. Negotiated Rate	$2,645.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,920.87
Rate for Payer: Healthfirst Commercial	$2,645.23

PHARMACOTHERAPY BY EXTENDED INFUSION

Facility

$1,244.88

Service Code	EAPG 00110
Min. Negotiated Rate	$902.58
Max. Negotiated Rate	$1,244.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$902.58
Rate for Payer: Healthfirst Commercial	$1,244.88

PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION

Facility

$466.25

Service Code	EAPG 00111
Min. Negotiated Rate	$337.89
Max. Negotiated Rate	$466.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$337.89
Rate for Payer: Healthfirst Commercial	$466.25

PHENAZOPYRIDINE HCL 100 MG PO TABS

Facility

$2.70

Service Code	NDC 5129361101
Hospital Charge Code	5129361101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.35
Rate for Payer: Aetna Government	$1.35
Rate for Payer: Brighton Health Commercial	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: EmblemHealth Commercial	$1.35
Rate for Payer: Group Health Inc Commercial	$1.35
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35
Rate for Payer: Hamaspik Choice Inc Medicare	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.75

PHENAZOPYRIDINE HCL 100 MG PO TABS

Facility

$2.70

Service Code	NDC 6516268110
Hospital Charge Code	6516268110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.35
Rate for Payer: Aetna Government	$1.35
Rate for Payer: Brighton Health Commercial	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: EmblemHealth Commercial	$1.35
Rate for Payer: Group Health Inc Commercial	$1.35
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35
Rate for Payer: Hamaspik Choice Inc Medicare	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.75

PHENAZOPYRIDINE HCL 100 MG PO TABS

Facility

$2.70

Service Code	NDC 6516268110
Hospital Charge Code	6516268110
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35

PHENAZOPYRIDINE HCL 100 MG PO TABS

Facility

$2.70

Service Code	NDC 4219280101
Hospital Charge Code	4219280101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35

PHENAZOPYRIDINE HCL 100 MG PO TABS

Facility

$2.70

Service Code	NDC 5129380101
Hospital Charge Code	5129380101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.35
Rate for Payer: Aetna Government	$1.35
Rate for Payer: Brighton Health Commercial	$2.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.84
Rate for Payer: EmblemHealth Commercial	$1.35
Rate for Payer: Group Health Inc Commercial	$1.35
Rate for Payer: Group Health Inc Medicare	$0.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35
Rate for Payer: Hamaspik Choice Inc Medicare	$1.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.75

PHENAZOPYRIDINE HCL 100 MG PO TABS

Facility

$2.70

Service Code	NDC 5129380101
Hospital Charge Code	5129380101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$1.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.35

Know your out-of-pocket cost for care.

All Charges