St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INSULIN INF PUMP ASPART SBH DRUG

Facility

$7.73

Service Code	HCPCS J1817
Hospital Charge Code	41658195
Hospital Revenue Code	636
Min. Negotiated Rate	$2.71
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$4.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.44
Rate for Payer: Group Health Inc Commercial	$3.87
Rate for Payer: Group Health Inc Medicare	$2.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.87
Rate for Payer: Hamaspik Choice Inc Medicare	$3.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.02

INSULIN INF PUMP FLULISINE SBH

Facility

$6.25

Service Code	HCPCS J1817
Hospital Charge Code	41658197
Hospital Revenue Code	636
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.59
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

INSULIN INF PUMP FLULISINE SBH

Facility

$6.25

Service Code	HCPCS J1817
Hospital Charge Code	41658197
Hospital Revenue Code	636
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12

INSULIN INF PUMP GLULISINE SBH

Facility

$6.25

Service Code	HCPCS J1817
Hospital Charge Code	41648197
Hospital Revenue Code	636
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$3.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.59
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

INSULIN INF PUMP GLULISINE SBH

Facility

$6.25

Service Code	HCPCS J1817
Hospital Charge Code	41648197
Hospital Revenue Code	636
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12

INSULIN INF PUMP HUMULIN SBH DRUG

Facility

$1.23

Service Code	HCPCS J1817
Hospital Charge Code	41658199
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

INSULIN INF PUMP HUMULIN SBH DRUG

Facility

$1.23

Service Code	HCPCS J1817
Hospital Charge Code	41658199
Hospital Revenue Code	636
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62

INSULIN INF PUMP HUMULIN SBH DRUG

Facility

$1.23

Service Code	HCPCS J1817
Hospital Charge Code	41648199
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

INSULIN INF PUMP HUMULIN SBH DRUG

Facility

$1.23

Service Code	HCPCS J1817
Hospital Charge Code	41648199
Hospital Revenue Code	636
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62

INSULIN INF PUMP LISPRO SBH DRUG

Facility

$4.61

Service Code	HCPCS J1817
Hospital Charge Code	41658201
Hospital Revenue Code	636
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31

INSULIN INF PUMP LISPRO SBH DRUG

Facility

$4.61

Service Code	HCPCS J1817
Hospital Charge Code	41648201
Hospital Revenue Code	636
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$2.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

INSULIN INF PUMP LISPRO SBH DRUG

Facility

$4.61

Service Code	HCPCS J1817
Hospital Charge Code	41648201
Hospital Revenue Code	636
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31

INSULIN INF PUMP LISPRO SBH DRUG

Facility

$4.61

Service Code	HCPCS J1817
Hospital Charge Code	41658201
Hospital Revenue Code	636
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$2.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.65
Rate for Payer: Group Health Inc Commercial	$2.31
Rate for Payer: Group Health Inc Medicare	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.31
Rate for Payer: Hamaspik Choice Inc Medicare	$2.31
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.00

INSULIN INF PUMP NOVOLIN SBH DRUG

Facility

$2.36

Service Code	HCPCS J1817
Hospital Charge Code	41648203
Hospital Revenue Code	636
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.18
Rate for Payer: Group Health Inc Medicare	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.53

INSULIN INF PUMP NOVOLIN SBH DRUG

Facility

$2.36

Service Code	HCPCS J1817
Hospital Charge Code	41648203
Hospital Revenue Code	636
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1.18

INSULIN INF PUMP NOVOLIN SBH DURG

Facility

$2.36

Service Code	HCPCS J1817
Hospital Charge Code	41658203
Hospital Revenue Code	636
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1.18

INSULIN INF PUMP NOVOLIN SBH DURG

Facility

$2.36

Service Code	HCPCS J1817
Hospital Charge Code	41658203
Hospital Revenue Code	636
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$11.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.14
Rate for Payer: Aetna Government	$11.14
Rate for Payer: Brighton Health Commercial	$1.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.18
Rate for Payer: Group Health Inc Medicare	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1.18
Rate for Payer: SOMOS CHP/HARP/Medicaid	$8.01
Rate for Payer: SOMOS Essential	$8.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.53

INSULIN LISPRO 100 UNIT/ML IJ SOLN [183768]

Facility

$7.97

Service Code	HCPCS J1815
Hospital Charge Code	00002751001
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: 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 [183768]

Facility

$3.00

Service Code	HCPCS J1815
Hospital Charge Code	00002773701
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: 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 [183768]

Facility

$7.97

Service Code	HCPCS J1815
Hospital Charge Code	00002753301
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: 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 INJ 3ML-5U

Facility

$0.61

Service Code	HCPCS J1815
Hospital Charge Code	41642189
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31

INSULIN LISPRO INJ 3ML-5U

Facility

$0.61

Service Code	HCPCS J1815
Hospital Charge Code	41642189
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

INSULIN LISPRO INJEC 3ML-5U

Facility

$0.61

Service Code	HCPCS J1815
Hospital Charge Code	41652189
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31

INSULIN LISPRO INJEC 3ML-5U

Facility

$0.61

Service Code	HCPCS J1815
Hospital Charge Code	41652189
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.31
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.31
Rate for Payer: Hamaspik Choice Inc Medicare	$0.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.40

INSULIN LISPRO INJECTION

Facility

$0.44

Hospital Charge Code	41657026
Hospital Revenue Code	636
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

Know your out-of-pocket cost for care.

All Charges