St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INFLUENZA VAC TISS-CULT SUBUNT 0.5 ML IM SUSY

Facility

$25.46

Service Code	HCPCS 90661
Hospital Charge Code	7046165503
Hospital Revenue Code	250
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$12.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.73

INFLUENZA VAC TISS-CULT SUBUNT 0.5 ML IM SUSY

Facility

$25.46

Service Code	HCPCS 90661
Hospital Charge Code	7046165504
Hospital Revenue Code	250
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$49.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.94
Rate for Payer: Aetna Government	$19.94
Rate for Payer: Brighton Health Commercial	$19.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.31
Rate for Payer: EmblemHealth Commercial	$12.73
Rate for Payer: Group Health Inc Commercial	$12.73
Rate for Payer: Group Health Inc Medicare	$8.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.73
Rate for Payer: Hamaspik Choice Inc Medicare	$12.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$49.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.55

INFLUENZA VAC TISS-CULT SUBUNT 0.5 ML IM SUSY

Facility

$25.46

Service Code	HCPCS 90661
Hospital Charge Code	7046165503
Hospital Revenue Code	250
Min. Negotiated Rate	$8.91
Max. Negotiated Rate	$49.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.94
Rate for Payer: Aetna Government	$19.94
Rate for Payer: Brighton Health Commercial	$19.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$20.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.31
Rate for Payer: EmblemHealth Commercial	$12.73
Rate for Payer: Group Health Inc Commercial	$12.73
Rate for Payer: Group Health Inc Medicare	$8.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.73
Rate for Payer: Hamaspik Choice Inc Medicare	$12.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$49.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.55

INFLUENZA VAC TISS-CULT SUBUNT 0.5 ML IM SUSY

Facility

$25.46

Service Code	HCPCS 90661
Hospital Charge Code	7046165504
Hospital Revenue Code	250
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$12.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.73

INFUVITE ADULT IV INJ

Facility

$1.61

Service Code	NDC 5464356491
Hospital Charge Code	5464356491
Hospital Revenue Code	258
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

INFUVITE ADULT IV INJ

Facility

$1.61

Service Code	NDC 5464356491
Hospital Charge Code	5464356491
Hospital Revenue Code	258
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80

INFUVITE PEDIATRIC IV SOLN

Facility

$5.02

Service Code	NDC 5464356461
Hospital Charge Code	5464356461
Hospital Revenue Code	258
Min. Negotiated Rate	$2.51
Max. Negotiated Rate	$2.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51

INFUVITE PEDIATRIC IV SOLN

Facility

$5.02

Service Code	NDC 5464356461
Hospital Charge Code	5464356461
Hospital Revenue Code	258
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Brighton Health Commercial	$3.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.41
Rate for Payer: EmblemHealth Commercial	$2.51
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.26

INGUINAL, FEMORAL AND UMBILICAL HERNIA REPAIR

Facility

$2,631.36

Service Code	EAPG 03033
Min. Negotiated Rate	$2,631.36
Max. Negotiated Rate	$2,631.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2,631.36

Inguinal, femoral & umbilical hernia procedures

Facility

$48,782.79

Service Code	APR-DRG 2282
Min. Negotiated Rate	$10,012.00
Max. Negotiated Rate	$48,782.79
Rate for Payer: Affinity Essential Plan 1&2	$48,782.79
Rate for Payer: Affinity Essential Plan 3&4	$48,782.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,681.24
Rate for Payer: Amida Care Medicaid	$21,681.24
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,782.79
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,681.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,681.24
Rate for Payer: Fidelis Qualified Health Plan	$26,017.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,681.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,681.24
Rate for Payer: Healthfirst Commercial	$17,511.00
Rate for Payer: Healthfirst Essential Plan	$48,782.79
Rate for Payer: Healthfirst QHP	$10,012.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,681.24
Rate for Payer: SOMOS Essential	$48,782.79
Rate for Payer: United Healthcare Essential Plan 1&2	$48,782.79
Rate for Payer: United Healthcare Essential Plan 3&4	$48,782.79
Rate for Payer: United Healthcare Medicaid	$21,681.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,681.24

Inguinal, femoral & umbilical hernia procedures

Facility

$60,395.81

Service Code	APR-DRG 2283
Min. Negotiated Rate	$15,762.00
Max. Negotiated Rate	$60,395.81
Rate for Payer: Affinity Essential Plan 1&2	$60,395.81
Rate for Payer: Affinity Essential Plan 3&4	$60,395.81
Rate for Payer: Affinity Medicaid/CHP/HARP	$26,842.58
Rate for Payer: Amida Care Medicaid	$26,842.58
Rate for Payer: EmblemHealth Essential Plan 1&2	$60,395.81
Rate for Payer: EmblemHealth Essential Plan 3&4	$26,842.58
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26,842.58
Rate for Payer: Fidelis Qualified Health Plan	$32,211.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$26,842.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$26,842.58
Rate for Payer: Healthfirst Commercial	$29,163.00
Rate for Payer: Healthfirst Essential Plan	$60,395.81
Rate for Payer: Healthfirst QHP	$15,762.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$26,842.58
Rate for Payer: SOMOS Essential	$60,395.81
Rate for Payer: United Healthcare Essential Plan 1&2	$60,395.81
Rate for Payer: United Healthcare Essential Plan 3&4	$60,395.81
Rate for Payer: United Healthcare Medicaid	$26,842.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26,842.58

Inguinal, femoral & umbilical hernia procedures

Facility

$44,278.65

Service Code	APR-DRG 2281
Min. Negotiated Rate	$7,650.00
Max. Negotiated Rate	$44,278.65
Rate for Payer: Affinity Essential Plan 1&2	$44,278.65
Rate for Payer: Affinity Essential Plan 3&4	$44,278.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,679.40
Rate for Payer: Amida Care Medicaid	$19,679.40
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,278.65
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,679.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,679.40
Rate for Payer: Fidelis Qualified Health Plan	$23,615.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,679.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,679.40
Rate for Payer: Healthfirst Commercial	$13,071.00
Rate for Payer: Healthfirst Essential Plan	$44,278.65
Rate for Payer: Healthfirst QHP	$7,650.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,679.40
Rate for Payer: SOMOS Essential	$44,278.65
Rate for Payer: United Healthcare Essential Plan 1&2	$44,278.65
Rate for Payer: United Healthcare Essential Plan 3&4	$44,278.65
Rate for Payer: United Healthcare Medicaid	$19,679.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,679.40

Inguinal, femoral & umbilical hernia procedures

Facility

$110,382.88

Service Code	APR-DRG 2284
Min. Negotiated Rate	$35,101.00
Max. Negotiated Rate	$110,382.88
Rate for Payer: Affinity Essential Plan 1&2	$110,382.88
Rate for Payer: Affinity Essential Plan 3&4	$110,382.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$49,059.06
Rate for Payer: Amida Care Medicaid	$49,059.06
Rate for Payer: EmblemHealth Essential Plan 1&2	$110,382.88
Rate for Payer: EmblemHealth Essential Plan 3&4	$49,059.06
Rate for Payer: Fidelis CHP/HARP/Medicaid	$49,059.06
Rate for Payer: Fidelis Qualified Health Plan	$58,870.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$49,059.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$49,059.06
Rate for Payer: Healthfirst Commercial	$69,294.00
Rate for Payer: Healthfirst Essential Plan	$110,382.88
Rate for Payer: Healthfirst QHP	$35,101.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$49,059.06
Rate for Payer: SOMOS Essential	$110,382.88
Rate for Payer: United Healthcare Essential Plan 1&2	$110,382.88
Rate for Payer: United Healthcare Essential Plan 3&4	$110,382.88
Rate for Payer: United Healthcare Medicaid	$49,059.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$49,059.06

INJECTION(S) FOR RADIOLOGICAL IMAGING

Facility

$585.52

Service Code	EAPG 00278
Min. Negotiated Rate	$585.52
Max. Negotiated Rate	$585.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$585.52

INSERTION OF PENILE PROSTHESIS

Facility

$9,199.92

Service Code	EAPG 00182
Min. Negotiated Rate	$6,679.07
Max. Negotiated Rate	$9,199.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6,679.07
Rate for Payer: Healthfirst Commercial	$9,199.92

INSERTION OR REMOVAL OF DRUG DELIVERY DEVICE

Facility

$407.32

Service Code	EAPG 00307
Min. Negotiated Rate	$407.32
Max. Negotiated Rate	$407.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$407.32

INSULIN ASPART 100 UNIT/ML IJ SOLN

Facility

$8.68

Service Code	HCPCS J1817
Hospital Charge Code	0169750111
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$6.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.90
Rate for Payer: EmblemHealth Commercial	$4.34
Rate for Payer: Group Health Inc Commercial	$4.34
Rate for Payer: Group Health Inc Medicare	$3.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.34
Rate for Payer: Hamaspik Choice Inc Medicare	$4.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.64

INSULIN ASPART 100 UNIT/ML IJ SOLN

Facility

$8.68

Service Code	HCPCS J1817
Hospital Charge Code	0169750111
Hospital Revenue Code	250
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$4.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.34

INSULIN GLARGINE 100 UNIT/ML SC SOLN

Facility

$7.71

Service Code	HCPCS J1815
Hospital Charge Code	0088222033
Hospital Revenue Code	250
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$3.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.86

INSULIN GLARGINE 100 UNIT/ML SC SOLN

Facility

$7.71

Service Code	HCPCS J1815
Hospital Charge Code	0088222033
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$6.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: EmblemHealth Commercial	$3.86
Rate for Payer: Group Health Inc Commercial	$3.86
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.86
Rate for Payer: Hamaspik Choice Inc Medicare	$3.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.01

INSULIN GLULISINE 100 UNIT/ML IJ SOLN

Facility

$10.22

Service Code	NDC 0088250033
Hospital Charge Code	0088250033
Hospital Revenue Code	250
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$5.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.11

INSULIN GLULISINE 100 UNIT/ML IJ SOLN

Facility

$10.22

Service Code	NDC 0088250033
Hospital Charge Code	0088250033
Hospital Revenue Code	250
Min. Negotiated Rate	$3.58
Max. Negotiated Rate	$8.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.11
Rate for Payer: Aetna Government	$5.11
Rate for Payer: Brighton Health Commercial	$7.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.95
Rate for Payer: EmblemHealth Commercial	$5.11
Rate for Payer: Group Health Inc Commercial	$5.11
Rate for Payer: Group Health Inc Medicare	$3.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.11
Rate for Payer: Hamaspik Choice Inc Medicare	$5.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.64

INSULIN LISPRO 100 UNIT/ML IJ SOLN

Facility

$3.00

Service Code	HCPCS J1815
Hospital Charge Code	0002773701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: EmblemHealth Commercial	$1.50
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

INSULIN LISPRO 100 UNIT/ML IJ SOLN

Facility

$7.97

Service Code	HCPCS J1815
Hospital Charge Code	0002751001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$6.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$5.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.42
Rate for Payer: EmblemHealth Commercial	$3.98
Rate for Payer: Group Health Inc Commercial	$3.98
Rate for Payer: Group Health Inc Medicare	$2.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98
Rate for Payer: Hamaspik Choice Inc Medicare	$3.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.18

INSULIN LISPRO 100 UNIT/ML IJ SOLN

Facility

$7.97

Service Code	HCPCS J1815
Hospital Charge Code	0002753301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.95
Max. Negotiated Rate	$6.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$5.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.42
Rate for Payer: EmblemHealth Commercial	$3.98
Rate for Payer: Group Health Inc Commercial	$3.98
Rate for Payer: Group Health Inc Medicare	$2.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.98
Rate for Payer: Hamaspik Choice Inc Medicare	$3.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.18

Know your out-of-pocket cost for care.

All Charges