St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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 500 MG INJ

Facility

$1.35

Service Code	HCPCS J0698
Hospital Charge Code	41651053
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.88

CEFOTAXIME 500 MG INJ

Facility

$1.35

Service Code	HCPCS J0698
Hospital Charge Code	41641053
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.88

CEFOTAXIME 500 MG INJ

Facility

$1.35

Service Code	HCPCS J0698
Hospital Charge Code	41641053
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68

CEFOTAXIME 500 MG INJ

Facility

$1.35

Service Code	HCPCS J0698
Hospital Charge Code	41651053
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68

CEFOTAXIME 50 MG/ML INJ PEDIATRIC (IV)

Facility

$2.00

Service Code	HCPCS J0698
Hospital Charge Code	41641788
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 50 MG/ML INJ PEDIATRIC (IV)

Facility

$2.00

Service Code	HCPCS J0698
Hospital Charge Code	41641788
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 50 MG/ML INJ PEDIATRIC (IV)

Facility

$2.00

Service Code	HCPCS J0698
Hospital Charge Code	41651788
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 50 MG/ML INJ PEDIATRIC (IV)

Facility

$2.00

Service Code	HCPCS J0698
Hospital Charge Code	41651788
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 95 MG/ML INJ PEDIATRIC (IV)

Facility

$3.00

Service Code	HCPCS J0698
Hospital Charge Code	41641789
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

CEFOTAXIME 95 MG/ML INJ PEDIATRIC (IV)

Facility

$3.00

Service Code	HCPCS J0698
Hospital Charge Code	41641789
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

CEFOTAXIME 95 MG/ML INJ PEDIATRIC (IV)

Facility

$3.00

Service Code	HCPCS J0698
Hospital Charge Code	41651789
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$8.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.11
Rate for Payer: Aetna Government	$8.11
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

CEFOTAXIME 95 MG/ML INJ PEDIATRIC (IV)

Facility

$3.00

Service Code	HCPCS J0698
Hospital Charge Code	41651789
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

CEFOXITIN 1000 MG INJ

Facility

$8.00

Service Code	HCPCS J0694
Hospital Charge Code	41644472
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
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: SOMOS CHP/HARP/Medicaid	$5.19
Rate for Payer: SOMOS Essential	$5.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

CEFOXITIN 1000 MG INJ

Facility

$8.00

Service Code	HCPCS J0694
Hospital Charge Code	41654472
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

CEFOXITIN 1000 MG INJ

Facility

$8.00

Service Code	HCPCS J0694
Hospital Charge Code	41644472
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

CEFOXITIN 1000 MG INJ

Facility

$8.00

Service Code	HCPCS J0694
Hospital Charge Code	41654472
Hospital Revenue Code	636
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
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: SOMOS CHP/HARP/Medicaid	$5.19
Rate for Payer: SOMOS Essential	$5.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

CEFOXITIN 2000 MG INJ

Facility

$6.48

Service Code	HCPCS J0694
Hospital Charge Code	41643262
Hospital Revenue Code	636
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$3.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$3.24

CEFOXITIN 2000 MG INJ

Facility

$6.48

Service Code	HCPCS J0694
Hospital Charge Code	41653262
Hospital Revenue Code	636
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$3.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$3.24

CEFOXITIN 2000 MG INJ

Facility

$6.48

Service Code	HCPCS J0694
Hospital Charge Code	41653262
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$5.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$3.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.73
Rate for Payer: Group Health Inc Commercial	$3.24
Rate for Payer: Group Health Inc Medicare	$2.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$3.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.19
Rate for Payer: SOMOS Essential	$5.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.21

CEFOXITIN 2000 MG INJ

Facility

$6.48

Service Code	HCPCS J0694
Hospital Charge Code	41643262
Hospital Revenue Code	636
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$5.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$3.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.73
Rate for Payer: Group Health Inc Commercial	$3.24
Rate for Payer: Group Health Inc Medicare	$2.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$3.24
Rate for Payer: SOMOS CHP/HARP/Medicaid	$5.19
Rate for Payer: SOMOS Essential	$5.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.21

CEFOXITIN 40 MG/ML INJ NEONATAL

Facility

$400.00

Hospital Charge Code	41650117
Hospital Revenue Code	250
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.00
Rate for Payer: Aetna Government	$200.00
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.00

CEFOXITIN 40 MG/ML INJ NEONATAL

Facility

$400.00

Hospital Charge Code	41640117
Hospital Revenue Code	250
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$200.00
Rate for Payer: Aetna Government	$200.00
Rate for Payer: Brighton Health Commercial	$300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$320.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.00
Rate for Payer: Group Health Inc Commercial	$200.00
Rate for Payer: Group Health Inc Medicare	$140.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$260.00

CEFOXITIN 95 MG/ML INJ PEDIATRIC

Facility

$9.00

Hospital Charge Code	41655359
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

CEFOXITIN 95 MG/ML INJ PEDIATRIC

Facility

$9.00

Hospital Charge Code	41645359
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

Know your out-of-pocket cost for care.

All Charges