St. Barnabas Hospital

All Charges

Charge

Type

Price

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 500MG/250MG 1%IM

Facility OP

$2.61

Service Code	HCPCS J0696
Hospital Charge Code	41648408
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
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	$1.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
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	$1.70

CEFTRIAXONE 500MG/250MG 1%IM

Facility IP

$2.61

Service Code	HCPCS J0696
Hospital Charge Code	41648408
Hospital Revenue Code	636
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30

CEFTRIAXONE 500MG/250MG 1%IM

Facility OP

$2.61

Service Code	HCPCS J0696
Hospital Charge Code	41658408
Hospital Revenue Code	636
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
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	$1.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
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	$1.70

CEFTRIAXONE 500MG/250MG 1%IM

Facility IP

$2.61

Service Code	HCPCS J0696
Hospital Charge Code	41658408
Hospital Revenue Code	636
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30

CEFTRIAXONE 500 MG INJ

Facility IP

$0.89

Service Code	HCPCS J0696
Hospital Charge Code	41654197
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45

CEFTRIAXONE 500 MG INJ

Facility OP

$0.89

Service Code	HCPCS J0696
Hospital Charge Code	41654197
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
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	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
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	$0.58

CEFTRIAXONE 500 MG INJ

Facility OP

$0.89

Service Code	HCPCS J0696
Hospital Charge Code	41644197
Hospital Revenue Code	636
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
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	$0.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.51
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
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	$0.58

CEFTRIAXONE 500 MG INJ

Facility IP

$0.89

Service Code	HCPCS J0696
Hospital Charge Code	41644197
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45

CEFTROLINE 300MMG/D5W 50ML IVPB

Facility IP

$7.00

Service Code	HCPCS J0712
Hospital Charge Code	41645723
Hospital Revenue Code	636
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Cash Price	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50

CEFTROLINE 300MMG/D5W 50ML IVPB

Facility OP

$7.00

Service Code	HCPCS J0712
Hospital Charge Code	41645723
Hospital Revenue Code	636
Min. Negotiated Rate	$3.07
Max. Negotiated Rate	$4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Cash Price	$3.84
Rate for Payer: Cash Price	$3.84
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.02
Rate for Payer: Elderplan Medicare Advantage	$3.84
Rate for Payer: EmblemHealth Commercial	$3.84
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.84
Rate for Payer: Fidelis Essential Plan Aliesa	$3.84
Rate for Payer: Fidelis Essential Plan QHP	$4.03
Rate for Payer: Fidelis Medicare Advantage	$3.84
Rate for Payer: Fidelis Qualified Health Plan	$4.03
Rate for Payer: Group Health Inc Commercial	$3.84
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.89
Rate for Payer: Healthfirst Medicare Advantage	$3.26
Rate for Payer: Healthfirst QHP	$3.84
Rate for Payer: Senior Whole Health Medicare Advantage	$3.84
Rate for Payer: SOMOS CHP/HARP/Medicaid	$4.09
Rate for Payer: SOMOS Essential	$4.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55
Rate for Payer: Wellcare CHP/FHP/Medicaid	$3.07
Rate for Payer: Wellcare Medicare	$3.64

CEFUROXIME 125 MG/5 ML SUSP PEDIATRICS

Facility OP

$2.00

Hospital Charge Code	41654001
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

CEFUROXIME 125 MG/5 ML SUSP PEDIATRICS

Facility OP

$2.00

Hospital Charge Code	41644001
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

CEFUROXIME 1500 MG INJ

Facility OP

$4.27

Service Code	HCPCS J0697
Hospital Charge Code	41643356
Hospital Revenue Code	636
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$2.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.01
Rate for Payer: Group Health Inc Commercial	$2.14
Rate for Payer: Group Health Inc Medicare	$1.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.01
Rate for Payer: SOMOS Essential	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.78

CEFUROXIME 1500 MG INJ

Facility IP

$4.27

Service Code	HCPCS J0697
Hospital Charge Code	41653356
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2.14

CEFUROXIME 1500 MG INJ

Facility OP

$4.27

Service Code	HCPCS J0697
Hospital Charge Code	41653356
Hospital Revenue Code	636
Min. Negotiated Rate	$1.49
Max. Negotiated Rate	$2.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.01
Rate for Payer: Group Health Inc Commercial	$2.14
Rate for Payer: Group Health Inc Medicare	$1.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.01
Rate for Payer: SOMOS Essential	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.78

CEFUROXIME 1500 MG INJ

Facility IP

$4.27

Service Code	HCPCS J0697
Hospital Charge Code	41643356
Hospital Revenue Code	636
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2.14

CEFUROXIME 225 MG/ML INJ (IM)

Facility OP

$4.00

Service Code	HCPCS J0697
Hospital Charge Code	41641774
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.01
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.01
Rate for Payer: SOMOS Essential	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CEFUROXIME 225 MG/ML INJ (IM)

Facility IP

$4.00

Service Code	HCPCS J0697
Hospital Charge Code	41651774
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

CEFUROXIME 225 MG/ML INJ (IM)

Facility IP

$4.00

Service Code	HCPCS J0697
Hospital Charge Code	41641774
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

CEFUROXIME 225 MG/ML INJ (IM)

Facility OP

$4.00

Service Code	HCPCS J0697
Hospital Charge Code	41651774
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$2.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.01
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.01
Rate for Payer: SOMOS Essential	$2.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

CEFUROXIME 250 MG/5 ML SUSP PEDIATRICS

Facility OP

$2.19

Hospital Charge Code	41654582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.10
Rate for Payer: Aetna Government	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.49
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.42

CEFUROXIME 250 MG/5 ML SUSP PEDIATRICS

Facility OP

$2.19

Hospital Charge Code	41644582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.10
Rate for Payer: Aetna Government	$1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.49
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.42

CEFUROXIME 250 MG TAB

Facility OP

$1.00

Hospital Charge Code	41645336
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: 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

CEFUROXIME 250 MG TAB

Facility OP

$1.00

Hospital Charge Code	41655336
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: 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

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