St. Barnabas Hospital

All Charges

Charge

Type

Price

CEFTAZIDIME 50 MG/ML NEONATAL IV

Facility IP

$8.00

Service Code	HCPCS J0713
Hospital Charge Code	41651121
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

CEFTAZIDIME 50 MG/ML NEONATAL IV

Facility OP

$8.00

Service Code	HCPCS J0713
Hospital Charge Code	41641121
Hospital Revenue Code	636
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.65
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: Healthfirst CHP/FHP/Medicaid	$1.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.76
Rate for Payer: SOMOS Essential	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

CEFTAZIDIME 50 MG/ML NEONATAL IV

Facility IP

$8.00

Service Code	HCPCS J0713
Hospital Charge Code	41641121
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

CEFTAZIDIME/AVIBACTAM 2-0.5G INJ

Facility OP

$706.80

Service Code	HCPCS J3490
Hospital Charge Code	41646601
Hospital Revenue Code	636
Min. Negotiated Rate	$247.38
Max. Negotiated Rate	$459.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$353.40
Rate for Payer: Aetna Government	$353.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$353.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.41
Rate for Payer: Group Health Inc Commercial	$353.40
Rate for Payer: Group Health Inc Medicare	$247.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.40
Rate for Payer: Hamaspik Choice Inc Medicare	$353.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$459.42

CEFTAZIDIME/AVIBACTAM 2-0.5G INJ

Facility IP

$706.80

Service Code	HCPCS J3490
Hospital Charge Code	41646601
Hospital Revenue Code	636
Min. Negotiated Rate	$353.40
Max. Negotiated Rate	$353.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.40
Rate for Payer: Hamaspik Choice Inc Medicare	$353.40

CEFTAZIDIME/AVIBACTAM 2-0.5G INJ

Facility OP

$706.80

Service Code	HCPCS J3490
Hospital Charge Code	41656601
Hospital Revenue Code	636
Min. Negotiated Rate	$247.38
Max. Negotiated Rate	$459.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$353.40
Rate for Payer: Aetna Government	$353.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$353.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.41
Rate for Payer: Group Health Inc Commercial	$353.40
Rate for Payer: Group Health Inc Medicare	$247.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.40
Rate for Payer: Hamaspik Choice Inc Medicare	$353.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$459.42

CEFTAZIDIME/AVIBACTAM 2-0.5G INJ

Facility IP

$706.80

Service Code	HCPCS J3490
Hospital Charge Code	41656601
Hospital Revenue Code	636
Min. Negotiated Rate	$353.40
Max. Negotiated Rate	$353.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.40
Rate for Payer: Hamaspik Choice Inc Medicare	$353.40

CEFTOLOZANE/TAZOBACTAM 1500MG

Facility OP

$13.18

Service Code	HCPCS J0695
Hospital Charge Code	41657842
Hospital Revenue Code	636
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$8.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.37
Rate for Payer: Aetna Government	$7.37
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cash Price	$7.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.58
Rate for Payer: Elderplan Medicare Advantage	$7.37
Rate for Payer: EmblemHealth Commercial	$7.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.37
Rate for Payer: Fidelis Essential Plan Aliesa	$7.37
Rate for Payer: Fidelis Essential Plan QHP	$7.74
Rate for Payer: Fidelis Medicare Advantage	$7.37
Rate for Payer: Fidelis Qualified Health Plan	$7.74
Rate for Payer: Group Health Inc Commercial	$7.37
Rate for Payer: Group Health Inc Medicare	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.59
Rate for Payer: Hamaspik Choice Inc Medicare	$6.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.54
Rate for Payer: Healthfirst Medicare Advantage	$6.26
Rate for Payer: Healthfirst QHP	$7.37
Rate for Payer: Senior Whole Health Medicare Advantage	$7.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.73
Rate for Payer: SOMOS Essential	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.90
Rate for Payer: Wellcare Medicare	$7.00

CEFTOLOZANE/TAZOBACTAM 1500MG

Facility IP

$13.18

Service Code	HCPCS J0695
Hospital Charge Code	41657842
Hospital Revenue Code	636
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$6.59
Rate for Payer: Cash Price	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.59
Rate for Payer: Hamaspik Choice Inc Medicare	$6.59

CEFTOLOZANE/TAZOBACTUM 1500MG

Facility OP

$13.18

Service Code	HCPCS J0695
Hospital Charge Code	41647842
Hospital Revenue Code	636
Min. Negotiated Rate	$5.90
Max. Negotiated Rate	$8.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.37
Rate for Payer: Aetna Government	$7.37
Rate for Payer: Cash Price	$7.37
Rate for Payer: Cash Price	$7.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$7.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.59
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.58
Rate for Payer: Elderplan Medicare Advantage	$7.37
Rate for Payer: EmblemHealth Commercial	$7.37
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.37
Rate for Payer: Fidelis Essential Plan Aliesa	$7.37
Rate for Payer: Fidelis Essential Plan QHP	$7.74
Rate for Payer: Fidelis Medicare Advantage	$7.37
Rate for Payer: Fidelis Qualified Health Plan	$7.74
Rate for Payer: Group Health Inc Commercial	$7.37
Rate for Payer: Group Health Inc Medicare	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.59
Rate for Payer: Hamaspik Choice Inc Medicare	$6.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.54
Rate for Payer: Healthfirst Medicare Advantage	$6.26
Rate for Payer: Healthfirst QHP	$7.37
Rate for Payer: Senior Whole Health Medicare Advantage	$7.37
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.73
Rate for Payer: SOMOS Essential	$7.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.57
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.90
Rate for Payer: Wellcare Medicare	$7.00

CEFTOLOZANE/TAZOBACTUM 1500MG

Facility IP

$13.18

Service Code	HCPCS J0695
Hospital Charge Code	41647842
Hospital Revenue Code	636
Min. Negotiated Rate	$6.59
Max. Negotiated Rate	$6.59
Rate for Payer: Cash Price	$7.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.59
Rate for Payer: Hamaspik Choice Inc Medicare	$6.59

CEFTRIAXONE 1000MG/250MG 1%IM

Facility IP

$0.82

Service Code	HCPCS J0696
Hospital Charge Code	41658407
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41

CEFTRIAXONE 1000MG/250MG 1%IM

Facility OP

$0.82

Service Code	HCPCS J0696
Hospital Charge Code	41658407
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

CEFTRIAXONE 1000MG/250MG 1%IM

Facility IP

$0.82

Service Code	HCPCS J0696
Hospital Charge Code	41648407
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41

CEFTRIAXONE 1000MG/250MG 1%IM

Facility OP

$0.82

Service Code	HCPCS J0696
Hospital Charge Code	41648407
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$0.41
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.41
Rate for Payer: Hamaspik Choice Inc Medicare	$0.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.53

CEFTRIAXONE 1000 MG INJ

Facility IP

$0.41

Service Code	HCPCS J0696
Hospital Charge Code	41644665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21

CEFTRIAXONE 1000 MG INJ

Facility OP

$0.41

Service Code	HCPCS J0696
Hospital Charge Code	41654665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

CEFTRIAXONE 1000 MG INJ

Facility OP

$0.41

Service Code	HCPCS J0696
Hospital Charge Code	41644665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

CEFTRIAXONE 1000 MG INJ

Facility IP

$0.41

Service Code	HCPCS J0696
Hospital Charge Code	41654665
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21

CEFTRIAXONE 100 MG/ML INJ PEDIATRIC (IV)

Facility OP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41651179
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
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	$0.51
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	$0.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CEFTRIAXONE 100 MG/ML INJ PEDIATRIC (IV)

Facility OP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41641179
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
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	$0.51
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	$0.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CEFTRIAXONE 100 MG/ML INJ PEDIATRIC (IV)

Facility IP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41651179
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

CEFTRIAXONE 100 MG/ML INJ PEDIATRIC (IV)

Facility IP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41641179
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

CEFTRIAXONE 1G/50ML DEXT

Facility OP

$4.58

Service Code	HCPCS J0696
Hospital Charge Code	41647895
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.63
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$2.29
Rate for Payer: Group Health Inc Medicare	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.29
Rate for Payer: Hamaspik Choice Inc Medicare	$2.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.57
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.48
Rate for Payer: SOMOS Essential	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.98

CEFTRIAXONE 1G/50ML DEXT

Facility IP

$4.58

Service Code	HCPCS J0696
Hospital Charge Code	41657895
Hospital Revenue Code	636
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$2.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.29
Rate for Payer: Hamaspik Choice Inc Medicare	$2.29

Price Transparency.

All Charges