St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CEFAZOLIN 225 MG/ML INJ PEDIATRIC

Facility

$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

$2.00

Service Code	HCPCS J0690
Hospital Charge Code	41640684
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: Brighton Health Commercial	$1.20
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: 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 225 MG/ML INJ PEDIATRIC

Facility

$2.00

Service Code	HCPCS J0690
Hospital Charge Code	41650684
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: Brighton Health Commercial	$1.20
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: 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 225 MG/ML INJ PEDIATRIC

Facility

$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

$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: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.64
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: 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

$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

$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

$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: Brighton Health Commercial	$1.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.64
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: 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

$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/D5W 100ML IVVPB

Facility

$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: Brighton Health Commercial	$2.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.69
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: 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

$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: Brighton Health Commercial	$2.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.69
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: 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

$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

$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

$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: Brighton Health Commercial	$2.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.69
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: 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

$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

$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

$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: Brighton Health Commercial	$1.20
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: 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

$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: Brighton Health Commercial	$1.20
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: 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

$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

$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: Brighton Health Commercial	$0.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
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: 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

$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

$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: Brighton Health Commercial	$0.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
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: 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

$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: Brighton Health Commercial	$1.50
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

$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: Brighton Health Commercial	$1.50
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 IV SYRINGE 20 MG/ML IN D5W (NEO/PED) [400057]

Facility

$3.28

Service Code	NDC 09999123460
Hospital Charge Code	00409258501
Hospital Revenue Code	278
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$1.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.64
Rate for Payer: Hamaspik Choice Inc Medicare	$1.64

Know your out-of-pocket cost for care.

All Charges