St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR [171664]

Facility

$263.59

Service Code	NDC 59630026610
Hospital Charge Code	59630026610
Hospital Revenue Code	278
Min. Negotiated Rate	$92.26
Max. Negotiated Rate	$276.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$131.80
Rate for Payer: Aetna Government	$131.80
Rate for Payer: Brighton Health Commercial	$158.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$131.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$151.57
Rate for Payer: EmblemHealth Commercial	$131.80
Rate for Payer: Fidelis Medicare Advantage	$276.77
Rate for Payer: Group Health Inc Commercial	$131.80
Rate for Payer: Group Health Inc Medicare	$92.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.80
Rate for Payer: Hamaspik Choice Inc Medicare	$131.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$171.33

CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR [171664]

Facility

$263.59

Service Code	NDC 59630026610
Hospital Charge Code	59630026610
Hospital Revenue Code	278
Min. Negotiated Rate	$131.80
Max. Negotiated Rate	$131.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.80
Rate for Payer: Hamaspik Choice Inc Medicare	$131.80

CEFIXIME 200 MG/5ML PO SUSR [81816]

Facility

$8.91

Service Code	NDC 65862075250
Hospital Charge Code	65862075250
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$7.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.45
Rate for Payer: Aetna Government	$4.45
Rate for Payer: Brighton Health Commercial	$6.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.06
Rate for Payer: Group Health Inc Commercial	$4.45
Rate for Payer: Group Health Inc Medicare	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.45
Rate for Payer: Hamaspik Choice Inc Medicare	$4.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.79

CEFIXIME 200MG/5ML SUSP

Facility

$7.00

Hospital Charge Code	41655090
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

CEFIXIME 200MG/5ML SUSP

Facility

$7.00

Hospital Charge Code	41645090
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

CEFIXIME 400 MG PO CAPS [121489]

Facility

$23.52

Service Code	NDC 68180042308
Hospital Charge Code	68180042308
Hospital Revenue Code	250
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$18.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.76
Rate for Payer: Aetna Government	$11.76
Rate for Payer: Brighton Health Commercial	$17.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.00
Rate for Payer: Group Health Inc Commercial	$11.76
Rate for Payer: Group Health Inc Medicare	$8.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.76
Rate for Payer: Hamaspik Choice Inc Medicare	$11.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.29

CEFIXIME 400 MG PO CAPS [121489]

Facility

$24.91

Service Code	NDC 68180042311
Hospital Charge Code	68180042311
Hospital Revenue Code	250
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$19.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.45
Rate for Payer: Aetna Government	$12.45
Rate for Payer: Brighton Health Commercial	$18.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.94
Rate for Payer: Group Health Inc Commercial	$12.45
Rate for Payer: Group Health Inc Medicare	$8.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.19

CEFIXIME 400 MG PO CAPS [121489]

Facility

$23.52

Service Code	NDC 67877058450
Hospital Charge Code	67877058450
Hospital Revenue Code	250
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$18.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.76
Rate for Payer: Aetna Government	$11.76
Rate for Payer: Brighton Health Commercial	$17.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.00
Rate for Payer: Group Health Inc Commercial	$11.76
Rate for Payer: Group Health Inc Medicare	$8.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.76
Rate for Payer: Hamaspik Choice Inc Medicare	$11.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.29

CEFIXIME 400 MG TAB

Facility

$31.00

Hospital Charge Code	41654910
Hospital Revenue Code	250
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$24.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.50
Rate for Payer: Aetna Government	$15.50
Rate for Payer: Brighton Health Commercial	$23.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.08
Rate for Payer: Group Health Inc Commercial	$15.50
Rate for Payer: Group Health Inc Medicare	$10.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.50
Rate for Payer: Hamaspik Choice Inc Medicare	$15.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.15

CEFIXIME 400 MG TAB

Facility

$31.00

Hospital Charge Code	41644910
Hospital Revenue Code	250
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$24.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.50
Rate for Payer: Aetna Government	$15.50
Rate for Payer: Brighton Health Commercial	$23.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$24.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.08
Rate for Payer: Group Health Inc Commercial	$15.50
Rate for Payer: Group Health Inc Medicare	$10.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.50
Rate for Payer: Hamaspik Choice Inc Medicare	$15.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.15

CEFOTAXIME 1000 MG INJ

Facility

$3.21

Service Code	HCPCS J0698
Hospital Charge Code	41641782
Hospital Revenue Code	636
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$1.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: Group Health Inc Commercial	$1.60
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.09

CEFOTAXIME 1000 MG INJ

Facility

$3.21

Service Code	HCPCS J0698
Hospital Charge Code	41651782
Hospital Revenue Code	636
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$1.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.85
Rate for Payer: Group Health Inc Commercial	$1.60
Rate for Payer: Group Health Inc Medicare	$1.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.09

CEFOTAXIME 1000 MG INJ

Facility

$3.21

Service Code	HCPCS J0698
Hospital Charge Code	41641782
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60

CEFOTAXIME 1000 MG INJ

Facility

$3.21

Service Code	HCPCS J0698
Hospital Charge Code	41651782
Hospital Revenue Code	636
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$1.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.60
Rate for Payer: Hamaspik Choice Inc Medicare	$1.60

CEFOTAXIME 2000 MG INJ

Facility

$3.72

Service Code	HCPCS J0698
Hospital Charge Code	41651790
Hospital Revenue Code	636
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86

CEFOTAXIME 2000 MG INJ

Facility

$3.72

Service Code	HCPCS J0698
Hospital Charge Code	41641790
Hospital Revenue Code	636
Min. Negotiated Rate	$1.86
Max. Negotiated Rate	$1.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86

CEFOTAXIME 2000 MG INJ

Facility

$3.72

Service Code	HCPCS J0698
Hospital Charge Code	41651790
Hospital Revenue Code	636
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$2.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.14
Rate for Payer: Group Health Inc Commercial	$1.86
Rate for Payer: Group Health Inc Medicare	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.42

CEFOTAXIME 2000 MG INJ

Facility

$3.72

Service Code	HCPCS J0698
Hospital Charge Code	41641790
Hospital Revenue Code	636
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$2.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.14
Rate for Payer: Group Health Inc Commercial	$1.86
Rate for Payer: Group Health Inc Medicare	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.42

CEFOTAXIME 230 MG/ML INJ PEDIATRIC (IM)

Facility

$2.00

Service Code	HCPCS J0698
Hospital Charge Code	41641778
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

CEFOTAXIME 230 MG/ML INJ PEDIATRIC (IM)

Facility

$2.00

Service Code	HCPCS J0698
Hospital Charge Code	41651778
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

CEFOTAXIME 230 MG/ML INJ PEDIATRIC (IM)

Facility

$2.00

Service Code	HCPCS J0698
Hospital Charge Code	41641778
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CEFOTAXIME 230 MG/ML INJ PEDIATRIC (IM)

Facility

$2.00

Service Code	HCPCS J0698
Hospital Charge Code	41651778
Hospital Revenue Code	636
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

CEFOTAXIME 300 MG/ML INJ PEDIATRIC (IM)

Facility

$1.00

Service Code	HCPCS J0698
Hospital Charge Code	41641771
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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

CEFOTAXIME 300 MG/ML INJ PEDIATRIC (IM)

Facility

$1.00

Service Code	HCPCS J0698
Hospital Charge Code	41651771
Hospital Revenue Code	636
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
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

CEFOTAXIME 300 MG/ML INJ PEDIATRIC (IM)

Facility

$1.00

Service Code	HCPCS J0698
Hospital Charge Code	41641771
Hospital Revenue Code	636
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50

Know your out-of-pocket cost for care.

All Charges