St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

RIFAMPIN 10 MG/ML SUSP

Facility

$1.00

Hospital Charge Code	41644749
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

RIFAMPIN 300 MG CAP

Facility

$2.00

Hospital Charge Code	41642238
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

RIFAMPIN 300 MG CAP

Facility

$2.00

Hospital Charge Code	41652238
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

RIFAMPIN 300 MG PO CAPS [11293]

Facility

$2.23

Service Code	NDC 60687058611
Hospital Charge Code	60687058611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$1.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.52
Rate for Payer: Group Health Inc Commercial	$1.12
Rate for Payer: Group Health Inc Medicare	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.45

RIFAMPIN 300 MG PO CAPS [11293]

Facility

$2.01

Service Code	NDC 61748001801
Hospital Charge Code	61748001801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.01
Rate for Payer: Aetna Government	$1.01
Rate for Payer: Brighton Health Commercial	$1.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.37
Rate for Payer: Group Health Inc Commercial	$1.01
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.01
Rate for Payer: Hamaspik Choice Inc Medicare	$1.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.31

RIFAMPIN 300 MG PO CAPS [11293]

Facility

$4.59

Service Code	NDC 68180065907
Hospital Charge Code	68180065907
Hospital Revenue Code	250
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$3.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.30
Rate for Payer: Aetna Government	$2.30
Rate for Payer: Brighton Health Commercial	$3.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.12
Rate for Payer: Group Health Inc Commercial	$2.30
Rate for Payer: Group Health Inc Medicare	$1.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.30
Rate for Payer: Hamaspik Choice Inc Medicare	$2.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.98

RIFAMPIN 300 MG PO CAPS [11293]

Facility

$5.85

Service Code	NDC 42806079960
Hospital Charge Code	42806079960
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$4.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.92
Rate for Payer: Aetna Government	$2.92
Rate for Payer: Brighton Health Commercial	$4.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.98
Rate for Payer: Group Health Inc Commercial	$2.92
Rate for Payer: Group Health Inc Medicare	$2.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.92
Rate for Payer: Hamaspik Choice Inc Medicare	$2.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.80

RIFAMPIN 3 MG/ML INJ NEONATAL

Facility

$6.00

Hospital Charge Code	41652908
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

RIFAMPIN 3 MG/ML INJ NEONATAL

Facility

$6.00

Hospital Charge Code	41642908
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

RIFAMPIN 600 MG INJ

Facility

$314.46

Service Code	HCPCS J3490
Hospital Charge Code	41650603
Hospital Revenue Code	636
Min. Negotiated Rate	$157.23
Max. Negotiated Rate	$157.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.23
Rate for Payer: Hamaspik Choice Inc Medicare	$157.23

RIFAMPIN 600 MG INJ

Facility

$314.46

Service Code	HCPCS J3490
Hospital Charge Code	41640603
Hospital Revenue Code	636
Min. Negotiated Rate	$157.23
Max. Negotiated Rate	$157.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.23
Rate for Payer: Hamaspik Choice Inc Medicare	$157.23

RIFAMPIN 600 MG INJ

Facility

$314.46

Service Code	HCPCS J3490
Hospital Charge Code	41640603
Hospital Revenue Code	636
Min. Negotiated Rate	$110.06
Max. Negotiated Rate	$204.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.23
Rate for Payer: Aetna Government	$157.23
Rate for Payer: Brighton Health Commercial	$188.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.81
Rate for Payer: Group Health Inc Commercial	$157.23
Rate for Payer: Group Health Inc Medicare	$110.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.23
Rate for Payer: Hamaspik Choice Inc Medicare	$157.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.40

RIFAMPIN 600 MG INJ

Facility

$314.46

Service Code	HCPCS J3490
Hospital Charge Code	41650603
Hospital Revenue Code	636
Min. Negotiated Rate	$110.06
Max. Negotiated Rate	$204.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$172.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.23
Rate for Payer: Aetna Government	$157.23
Rate for Payer: Brighton Health Commercial	$188.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$157.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$180.81
Rate for Payer: Group Health Inc Commercial	$157.23
Rate for Payer: Group Health Inc Medicare	$110.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.23
Rate for Payer: Hamaspik Choice Inc Medicare	$157.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$204.40

RIFAMPIN 600 MG IV SOLR [11291]

Facility

$214.27

Service Code	NDC 00068059701
Hospital Charge Code	00068059701
Hospital Revenue Code	278
Min. Negotiated Rate	$74.99
Max. Negotiated Rate	$224.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$117.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.14
Rate for Payer: Aetna Government	$107.14
Rate for Payer: Brighton Health Commercial	$128.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$107.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$123.21
Rate for Payer: EmblemHealth Commercial	$107.14
Rate for Payer: Fidelis Medicare Advantage	$224.98
Rate for Payer: Group Health Inc Commercial	$107.14
Rate for Payer: Group Health Inc Medicare	$74.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.14
Rate for Payer: Hamaspik Choice Inc Medicare	$107.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$139.28

RIFAMPIN 600 MG IV SOLR [11291]

Facility

$183.60

Service Code	NDC 63323035120
Hospital Charge Code	63323035120
Hospital Revenue Code	278
Min. Negotiated Rate	$64.26
Max. Negotiated Rate	$192.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$100.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$91.80
Rate for Payer: Aetna Government	$91.80
Rate for Payer: Brighton Health Commercial	$110.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$105.57
Rate for Payer: EmblemHealth Commercial	$91.80
Rate for Payer: Fidelis Medicare Advantage	$192.78
Rate for Payer: Group Health Inc Commercial	$91.80
Rate for Payer: Group Health Inc Medicare	$64.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.80
Rate for Payer: Hamaspik Choice Inc Medicare	$91.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.34

RIFAMPIN 600 MG IV SOLR [11291]

Facility

$214.27

Service Code	NDC 00068059701
Hospital Charge Code	00068059701
Hospital Revenue Code	278
Min. Negotiated Rate	$107.14
Max. Negotiated Rate	$107.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.14
Rate for Payer: Hamaspik Choice Inc Medicare	$107.14

RIFAMPIN 600 MG IV SOLR [11291]

Facility

$192.63

Service Code	NDC 67457044560
Hospital Charge Code	67457044560
Hospital Revenue Code	278
Min. Negotiated Rate	$67.42
Max. Negotiated Rate	$202.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$105.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$96.32
Rate for Payer: Aetna Government	$96.32
Rate for Payer: Brighton Health Commercial	$115.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.76
Rate for Payer: EmblemHealth Commercial	$96.32
Rate for Payer: Fidelis Medicare Advantage	$202.26
Rate for Payer: Group Health Inc Commercial	$96.32
Rate for Payer: Group Health Inc Medicare	$67.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.32
Rate for Payer: Hamaspik Choice Inc Medicare	$96.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$125.21

RIFAMPIN 600 MG IV SOLR [11291]

Facility

$192.63

Service Code	NDC 67457044560
Hospital Charge Code	67457044560
Hospital Revenue Code	278
Min. Negotiated Rate	$96.32
Max. Negotiated Rate	$96.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$96.32
Rate for Payer: Hamaspik Choice Inc Medicare	$96.32

RIFAMPIN 600 MG IV SOLR [11291]

Facility

$183.60

Service Code	NDC 63323035120
Hospital Charge Code	63323035120
Hospital Revenue Code	278
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$91.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$91.80
Rate for Payer: Hamaspik Choice Inc Medicare	$91.80

RIFAMPIN (RIFADIN)

Facility

$325.00

Service Code	HCPCS 80375
Hospital Charge Code	40609893
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$260.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$178.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$243.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$260.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$221.00
Rate for Payer: Group Health Inc Commercial	$162.50
Rate for Payer: Group Health Inc Medicare	$113.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$162.50
Rate for Payer: Hamaspik Choice Inc Medicare	$162.50
Rate for Payer: United Healthcare Commercial	$19.94

RIFAXIMIN 200 MG PO TABS [39063]

Facility

$12.71

Service Code	NDC 65649030103
Hospital Charge Code	65649030103
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$10.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.35
Rate for Payer: Aetna Government	$6.35
Rate for Payer: Brighton Health Commercial	$9.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.64
Rate for Payer: Group Health Inc Commercial	$6.35
Rate for Payer: Group Health Inc Medicare	$4.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.35
Rate for Payer: Hamaspik Choice Inc Medicare	$6.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.26

RIFAXIMIN 200 MG TAB

Facility

$19.87

Hospital Charge Code	41655085
Hospital Revenue Code	250
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$15.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.94
Rate for Payer: Aetna Government	$9.94
Rate for Payer: Brighton Health Commercial	$14.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.51
Rate for Payer: Group Health Inc Commercial	$9.94
Rate for Payer: Group Health Inc Medicare	$6.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.94
Rate for Payer: Hamaspik Choice Inc Medicare	$9.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.92

RIFAXIMIN 200 MG TAB

Facility

$19.87

Hospital Charge Code	41645085
Hospital Revenue Code	250
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$15.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.94
Rate for Payer: Aetna Government	$9.94
Rate for Payer: Brighton Health Commercial	$14.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.51
Rate for Payer: Group Health Inc Commercial	$9.94
Rate for Payer: Group Health Inc Medicare	$6.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.94
Rate for Payer: Hamaspik Choice Inc Medicare	$9.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.92

RIFAXIMIN 500MG TAB

Facility

$26.51

Hospital Charge Code	41655597
Hospital Revenue Code	250
Min. Negotiated Rate	$9.28
Max. Negotiated Rate	$21.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.26
Rate for Payer: Aetna Government	$13.26
Rate for Payer: Brighton Health Commercial	$19.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.03
Rate for Payer: Group Health Inc Commercial	$13.26
Rate for Payer: Group Health Inc Medicare	$9.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.26
Rate for Payer: Hamaspik Choice Inc Medicare	$13.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.23

RIFAXIMIN 550 MG PO TABS [104604]

Facility

$65.35

Service Code	NDC 65649030302
Hospital Charge Code	65649030302
Hospital Revenue Code	250
Min. Negotiated Rate	$22.87
Max. Negotiated Rate	$52.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.67
Rate for Payer: Aetna Government	$32.67
Rate for Payer: Brighton Health Commercial	$49.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.43
Rate for Payer: Group Health Inc Commercial	$32.67
Rate for Payer: Group Health Inc Medicare	$22.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.67
Rate for Payer: Hamaspik Choice Inc Medicare	$32.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.47

Know your out-of-pocket cost for care.

All Charges