St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AZITHROMYCIN 250 MG TAB

Facility

$20.60

Service Code	HCPCS Q0144
Hospital Charge Code	41654340
Hospital Revenue Code	636
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$10.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.30
Rate for Payer: Hamaspik Choice Inc Medicare	$10.30

AZITHROMYCIN 500 MG INJ

Facility

$7.91

Service Code	HCPCS J0456
Hospital Charge Code	41651724
Hospital Revenue Code	636
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$5.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.49
Rate for Payer: Aetna Government	$2.49
Rate for Payer: Brighton Health Commercial	$4.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.55
Rate for Payer: Group Health Inc Commercial	$3.96
Rate for Payer: Group Health Inc Medicare	$2.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.55
Rate for Payer: SOMOS Essential	$2.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.14

AZITHROMYCIN 500 MG INJ

Facility

$7.91

Service Code	HCPCS J0456
Hospital Charge Code	41651724
Hospital Revenue Code	636
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3.96

AZITHROMYCIN 500 MG INJ

Facility

$7.91

Service Code	HCPCS J0456
Hospital Charge Code	41641724
Hospital Revenue Code	636
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$3.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3.96

AZITHROMYCIN 500 MG INJ

Facility

$7.91

Service Code	HCPCS J0456
Hospital Charge Code	41641724
Hospital Revenue Code	636
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$5.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.49
Rate for Payer: Aetna Government	$2.49
Rate for Payer: Brighton Health Commercial	$4.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.55
Rate for Payer: Group Health Inc Commercial	$3.96
Rate for Payer: Group Health Inc Medicare	$2.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.96
Rate for Payer: Hamaspik Choice Inc Medicare	$3.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.55
Rate for Payer: SOMOS Essential	$2.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.14

AZITHROMYCIN 500 MG IV SOLR [21063]

Facility

$17.30

Service Code	HCPCS J0456
Hospital Charge Code	70436001982
Hospital Revenue Code	278
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$18.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.49
Rate for Payer: Aetna Government	$2.49
Rate for Payer: Brighton Health Commercial	$10.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.95
Rate for Payer: EmblemHealth Commercial	$8.65
Rate for Payer: Fidelis Medicare Advantage	$18.16
Rate for Payer: Group Health Inc Commercial	$8.65
Rate for Payer: Group Health Inc Medicare	$6.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.65
Rate for Payer: Hamaspik Choice Inc Medicare	$8.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.24

AZITHROMYCIN 500 MG IV SOLR [21063]

Facility

$11.00

Service Code	HCPCS J0456
Hospital Charge Code	55150017410
Hospital Revenue Code	278
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$11.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.49
Rate for Payer: Aetna Government	$2.49
Rate for Payer: Brighton Health Commercial	$6.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.32
Rate for Payer: EmblemHealth Commercial	$5.50
Rate for Payer: Fidelis Medicare Advantage	$11.55
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

AZITHROMYCIN 500 MG IV SOLR [21063]

Facility

$8.92

Service Code	HCPCS J0456
Hospital Charge Code	63323039810
Hospital Revenue Code	278
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$4.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.46
Rate for Payer: Hamaspik Choice Inc Medicare	$4.46

AZITHROMYCIN 500 MG IV SOLR [21063]

Facility

$11.00

Service Code	HCPCS J0456
Hospital Charge Code	55150017410
Hospital Revenue Code	278
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50

AZITHROMYCIN 500 MG IV SOLR [21063]

Facility

$8.92

Service Code	HCPCS J0456
Hospital Charge Code	63323039810
Hospital Revenue Code	278
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$9.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.49
Rate for Payer: Aetna Government	$2.49
Rate for Payer: Brighton Health Commercial	$5.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.13
Rate for Payer: EmblemHealth Commercial	$4.46
Rate for Payer: Fidelis Medicare Advantage	$9.36
Rate for Payer: Group Health Inc Commercial	$4.46
Rate for Payer: Group Health Inc Medicare	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.46
Rate for Payer: Hamaspik Choice Inc Medicare	$4.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.80

AZITHROMYCIN 500 MG IV SOLR [21063]

Facility

$17.30

Service Code	HCPCS J0456
Hospital Charge Code	70436001982
Hospital Revenue Code	278
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.65
Rate for Payer: Hamaspik Choice Inc Medicare	$8.65

AZITHROMYCIN 500MG TAB

Facility

$0.01

Hospital Charge Code	41650219
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

AZITHROMYCIN 500MG TAB

Facility

$0.01

Hospital Charge Code	41640219
Hospital Revenue Code	250
Max. Negotiated Rate	$0.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

AZITHROMYCIN 600 MG PO TABS [17387]

Facility

$18.68

Service Code	NDC 50111078910
Hospital Charge Code	50111078910
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$14.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.34
Rate for Payer: Aetna Government	$9.34
Rate for Payer: Brighton Health Commercial	$14.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.70
Rate for Payer: Group Health Inc Commercial	$9.34
Rate for Payer: Group Health Inc Medicare	$6.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.34
Rate for Payer: Hamaspik Choice Inc Medicare	$9.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.14

AZITHROMYCIN 600 MG PO TABS [17387]

Facility

$18.68

Service Code	NDC 51224022230
Hospital Charge Code	51224022230
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$14.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.34
Rate for Payer: Aetna Government	$9.34
Rate for Payer: Brighton Health Commercial	$14.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.70
Rate for Payer: Group Health Inc Commercial	$9.34
Rate for Payer: Group Health Inc Medicare	$6.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.34
Rate for Payer: Hamaspik Choice Inc Medicare	$9.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.14

AZITHROMYCIN 600 MG TAB

Facility

$8.01

Service Code	HCPCS Q0144
Hospital Charge Code	41650419
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

AZITHROMYCIN 600 MG TAB

Facility

$8.01

Service Code	HCPCS Q0144
Hospital Charge Code	41640419
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

AZITHROMYCIN 600 MG TAB

Facility

$8.01

Service Code	HCPCS Q0144
Hospital Charge Code	41640419
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Brighton Health Commercial	$4.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.61
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.21

AZITHROMYCIN 600 MG TAB

Facility

$8.01

Service Code	HCPCS Q0144
Hospital Charge Code	41650419
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$20.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.10
Rate for Payer: Aetna Government	$20.10
Rate for Payer: Brighton Health Commercial	$4.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.61
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.21

AZTREONAM 1000 MG INJ

Facility

$50.58

Hospital Charge Code	41643098
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$40.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.29
Rate for Payer: Aetna Government	$25.29
Rate for Payer: Brighton Health Commercial	$37.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.39
Rate for Payer: Group Health Inc Commercial	$25.29
Rate for Payer: Group Health Inc Medicare	$17.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.29
Rate for Payer: Hamaspik Choice Inc Medicare	$25.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.88

AZTREONAM 1000 MG INJ

Facility

$50.58

Hospital Charge Code	41653098
Hospital Revenue Code	250
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$40.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.29
Rate for Payer: Aetna Government	$25.29
Rate for Payer: Brighton Health Commercial	$37.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.39
Rate for Payer: Group Health Inc Commercial	$25.29
Rate for Payer: Group Health Inc Medicare	$17.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.29
Rate for Payer: Hamaspik Choice Inc Medicare	$25.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.88

AZTREONAM 100 MG/ML INJ NEONATAL

Facility

$6.00

Hospital Charge Code	41650395
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

AZTREONAM 100 MG/ML INJ NEONATAL

Facility

$6.00

Hospital Charge Code	41640395
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

AZTREONAM 1G/D5W 50ML IVPB

Facility

$28.00

Hospital Charge Code	41644303
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.20

AZTREONAM 1G/D5W 50ML IVPB

Facility

$28.00

Hospital Charge Code	41654303
Hospital Revenue Code	250
Min. Negotiated Rate	$9.80
Max. Negotiated Rate	$22.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.00
Rate for Payer: Aetna Government	$14.00
Rate for Payer: Brighton Health Commercial	$21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.04
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.20

Know your out-of-pocket cost for care.

All Charges