St. Barnabas Hospital

All Charges

Charge

Type

Price

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 OP

$4.58

Service Code	HCPCS J0696
Hospital Charge Code	41657895
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 2000 MG INJ

Facility IP

$0.61

Service Code	HCPCS J0696
Hospital Charge Code	41654199
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

CEFTRIAXONE 2000 MG INJ

Facility IP

$0.61

Service Code	HCPCS J0696
Hospital Charge Code	41644199
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

CEFTRIAXONE 2000 MG INJ

Facility OP

$0.61

Service Code	HCPCS J0696
Hospital Charge Code	41654199
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
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	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
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: 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	$0.40

CEFTRIAXONE 2000 MG INJ

Facility OP

$0.61

Service Code	HCPCS J0696
Hospital Charge Code	41644199
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.34
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	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
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: 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	$0.40

CEFTRIAXONE 250 MG INJ

Facility OP

$1.31

Service Code	HCPCS J0696
Hospital Charge Code	41654196
Hospital Revenue Code	636
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.72
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	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
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	$0.85

CEFTRIAXONE 250 MG INJ

Facility IP

$1.31

Service Code	HCPCS J0696
Hospital Charge Code	41654196
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66

CEFTRIAXONE 250 MG INJ

Facility IP

$1.31

Service Code	HCPCS J0696
Hospital Charge Code	41644196
Hospital Revenue Code	636
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66

CEFTRIAXONE 250 MG INJ

Facility OP

$1.31

Service Code	HCPCS J0696
Hospital Charge Code	41644196
Hospital Revenue Code	636
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.72
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	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
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	$0.85

CEFTRIAXONE 250MG LIDOCAINE 1%IM

Facility IP

$3.11

Service Code	HCPCS J0696
Hospital Charge Code	41648406
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

CEFTRIAXONE 250MG LIDOCAINE 1%IM

Facility IP

$3.11

Service Code	HCPCS J0696
Hospital Charge Code	41658406
Hospital Revenue Code	636
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56

CEFTRIAXONE 250MG LIDOCAINE 1%IM

Facility OP

$3.11

Service Code	HCPCS J0696
Hospital Charge Code	41648406
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.71
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	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
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	$2.02

CEFTRIAXONE 250MG LIDOCAINE 1%IM

Facility OP

$3.11

Service Code	HCPCS J0696
Hospital Charge Code	41658406
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$2.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.71
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	$1.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.79
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$1.56
Rate for Payer: Group Health Inc Medicare	$1.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.56
Rate for Payer: Hamaspik Choice Inc Medicare	$1.56
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	$2.02

CEFTRIAXONE 250 MG/ML INJ (IM)

Facility OP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41641784
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 250 MG/ML INJ (IM)

Facility OP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41651784
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 250 MG/ML INJ (IM)

Facility IP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41641784
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 250 MG/ML INJ (IM)

Facility IP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41651784
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 350 MG/ML INJ (IM)

Facility OP

$3.00

Service Code	HCPCS J0696
Hospital Charge Code	41644564
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
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	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
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: 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	$1.95

CEFTRIAXONE 350 MG/ML INJ (IM)

Facility IP

$3.00

Service Code	HCPCS J0696
Hospital Charge Code	41644564
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

CEFTRIAXONE 350 MG/ML INJ (IM)

Facility IP

$3.00

Service Code	HCPCS J0696
Hospital Charge Code	41654564
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

CEFTRIAXONE 350 MG/ML INJ (IM)

Facility OP

$3.00

Service Code	HCPCS J0696
Hospital Charge Code	41654564
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
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	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
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: 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	$1.95

CEFTRIAXONE 40 MG/ML INJ NEONATAL (IV)

Facility OP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41654485
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 40 MG/ML INJ NEONATAL (IV)

Facility IP

$2.00

Service Code	HCPCS J0696
Hospital Charge Code	41654485
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 40 MG/ML INJ NEONATAL (IV)

Facility OP

$2.00

Hospital Charge Code	41644485
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	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.15
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

Price Transparency.

All Charges