St. Barnabas Hospital

All Charges

Charge

Type

Price

CEFAZOLIN 225 MG/ML INJ PEDIATRIC

Facility IP

$2.00

Service Code	HCPCS J0690
Hospital Charge Code	41640684
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

CEFAZOLIN 225 MG/ML INJ PEDIATRIC

Facility IP

$2.00

Service Code	HCPCS J0690
Hospital Charge Code	41650684
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

CEFAZOLIN 2G/D3W 50ML PREMIX500MG

Facility OP

$2.86

Service Code	HCPCS J0690
Hospital Charge Code	41648859
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
Rate for Payer: Group Health Inc Commercial	$1.43
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.86

CEFAZOLIN 2G/D3W 50ML PREMIX500MG

Facility IP

$2.86

Service Code	HCPCS J0690
Hospital Charge Code	41648859
Hospital Revenue Code	636
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43

CEFAZOLIN 2G/D3W 50ML PREMIX500MG

Facility IP

$2.86

Service Code	HCPCS J0690
Hospital Charge Code	41658859
Hospital Revenue Code	636
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$1.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43

CEFAZOLIN 2G/D3W 50ML PREMIX500MG

Facility OP

$2.86

Service Code	HCPCS J0690
Hospital Charge Code	41658859
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.64
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
Rate for Payer: Group Health Inc Commercial	$1.43
Rate for Payer: Group Health Inc Medicare	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.43
Rate for Payer: Hamaspik Choice Inc Medicare	$1.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.86

CEFAZOLIN 2G/D5W 100ML IVVPB

Facility OP

$4.67

Service Code	HCPCS J0690
Hospital Charge Code	41648457
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$3.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
Rate for Payer: Group Health Inc Commercial	$2.34
Rate for Payer: Group Health Inc Medicare	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.04

CEFAZOLIN 2G/D5W 100ML IVVPB

Facility IP

$4.67

Service Code	HCPCS J0690
Hospital Charge Code	41648457
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34

CEFAZOLIN 2G/NS 100ML IVPB

Facility IP

$4.67

Service Code	HCPCS J0690
Hospital Charge Code	41648458
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34

CEFAZOLIN 2G/NS 100ML IVPB

Facility IP

$4.67

Service Code	HCPCS J0690
Hospital Charge Code	41658458
Hospital Revenue Code	636
Min. Negotiated Rate	$2.34
Max. Negotiated Rate	$2.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34

CEFAZOLIN 2G/NS 100ML IVPB

Facility OP

$4.67

Service Code	HCPCS J0690
Hospital Charge Code	41648458
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$3.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
Rate for Payer: Group Health Inc Commercial	$2.34
Rate for Payer: Group Health Inc Medicare	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.04

CEFAZOLIN 2G/NS 100ML IVPB

Facility OP

$4.67

Service Code	HCPCS J0690
Hospital Charge Code	41658458
Hospital Revenue Code	636
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$3.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.69
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
Rate for Payer: Group Health Inc Commercial	$2.34
Rate for Payer: Group Health Inc Medicare	$1.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.34
Rate for Payer: Hamaspik Choice Inc Medicare	$2.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.04

CEFAZOLIN 330 MG/ML INJ (IM)

Facility IP

$2.00

Service Code	HCPCS J0690
Hospital Charge Code	41654081
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

CEFAZOLIN 330 MG/ML INJ (IM)

Facility OP

$2.00

Service Code	HCPCS J0690
Hospital Charge Code	41644081
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
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: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CEFAZOLIN 330 MG/ML INJ (IM)

Facility IP

$2.00

Service Code	HCPCS J0690
Hospital Charge Code	41644081
Hospital Revenue Code	636
Min. Negotiated Rate	$1.00
Max. Negotiated Rate	$1.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00

CEFAZOLIN 330 MG/ML INJ (IM)

Facility OP

$2.00

Service Code	HCPCS J0690
Hospital Charge Code	41654081
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
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: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CEFAZOLIN 500 MG INJ

Facility IP

$1.63

Service Code	HCPCS J0690
Hospital Charge Code	41644082
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82

CEFAZOLIN 500 MG INJ

Facility OP

$1.63

Service Code	HCPCS J0690
Hospital Charge Code	41644082
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
Rate for Payer: Group Health Inc Commercial	$0.82
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.06

CEFAZOLIN 500 MG INJ

Facility IP

$1.63

Service Code	HCPCS J0690
Hospital Charge Code	41654082
Hospital Revenue Code	636
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$0.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82

CEFAZOLIN 500 MG INJ

Facility OP

$1.63

Service Code	HCPCS J0690
Hospital Charge Code	41654082
Hospital Revenue Code	636
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.78
Rate for Payer: Group Health Inc Commercial	$0.82
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.86
Rate for Payer: SOMOS Essential	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.06

CEFAZOLIN FLUSH 5 MG/ML INJ

Facility OP

$2.00

Hospital Charge Code	41652596
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: 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

CEFAZOLIN FLUSH 5 MG/ML INJ

Facility OP

$2.00

Hospital Charge Code	41642596
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: 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

CEFDINIR CP 300MG TABLET

Facility OP

$12.78

Hospital Charge Code	41650307
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$10.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.39
Rate for Payer: Aetna Government	$6.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.69
Rate for Payer: Group Health Inc Commercial	$6.39
Rate for Payer: Group Health Inc Medicare	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.39
Rate for Payer: Hamaspik Choice Inc Medicare	$6.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.31

CEFDINIR CP 300MG TABLET

Facility OP

$12.78

Hospital Charge Code	41640307
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$10.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.39
Rate for Payer: Aetna Government	$6.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.69
Rate for Payer: Group Health Inc Commercial	$6.39
Rate for Payer: Group Health Inc Medicare	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.39
Rate for Payer: Hamaspik Choice Inc Medicare	$6.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.31

CEFEPIME 0.5 GRAMS INJ

Facility IP

$10.26

Service Code	HCPCS J0692
Hospital Charge Code	41653344
Hospital Revenue Code	636
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$5.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.13
Rate for Payer: Hamaspik Choice Inc Medicare	$5.13

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