St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CEFTAZIDIME 10MG/ML NS

Facility

$0.62

Service Code	HCPCS J0713
Hospital Charge Code	41640287
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

CEFTAZIDIME 1 G IJ SOLR [9474]

Facility

$6.24

Service Code	HCPCS J0713
Hospital Charge Code	25021012720
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$4.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$4.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.24
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.66
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.76
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.76
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

CEFTAZIDIME 1 G IJ SOLR [9474]

Facility

$5.40

Service Code	HCPCS J0713
Hospital Charge Code	44567023525
Hospital Revenue Code	250
Min. Negotiated Rate	$1.66
Max. Negotiated Rate	$4.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$4.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.67
Rate for Payer: Group Health Inc Commercial	$2.70
Rate for Payer: Group Health Inc Medicare	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.70
Rate for Payer: Hamaspik Choice Inc Medicare	$2.70
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.66
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.76
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.76
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.51

CEFTAZIDIME 2000 MG INJ

Facility

$2.92

Service Code	HCPCS J0713
Hospital Charge Code	41650188
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46

CEFTAZIDIME 2000 MG INJ

Facility

$2.92

Service Code	HCPCS J0713
Hospital Charge Code	41640188
Hospital Revenue Code	636
Min. Negotiated Rate	$1.46
Max. Negotiated Rate	$1.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46

CEFTAZIDIME 2000 MG INJ

Facility

$2.92

Service Code	HCPCS J0713
Hospital Charge Code	41650188
Hospital Revenue Code	636
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$1.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.76
Rate for Payer: SOMOS Essential	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.90

CEFTAZIDIME 2000 MG INJ

Facility

$2.92

Service Code	HCPCS J0713
Hospital Charge Code	41640188
Hospital Revenue Code	636
Min. Negotiated Rate	$1.02
Max. Negotiated Rate	$1.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$1.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.68
Rate for Payer: Group Health Inc Commercial	$1.46
Rate for Payer: Group Health Inc Medicare	$1.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.46
Rate for Payer: Hamaspik Choice Inc Medicare	$1.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.76
Rate for Payer: SOMOS Essential	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.90

CEFTAZIDIME 2 G IV SOLR [27291]

Facility

$12.00

Service Code	HCPCS J0713
Hospital Charge Code	44567023610
Hospital Revenue Code	278
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

CEFTAZIDIME 2 G IV SOLR [27291]

Facility

$13.20

Service Code	HCPCS J0713
Hospital Charge Code	25021012850
Hospital Revenue Code	278
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$13.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$7.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.59
Rate for Payer: EmblemHealth Commercial	$6.60
Rate for Payer: Fidelis Medicare Advantage	$13.86
Rate for Payer: Group Health Inc Commercial	$6.60
Rate for Payer: Group Health Inc Medicare	$4.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.60
Rate for Payer: Hamaspik Choice Inc Medicare	$6.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.58

CEFTAZIDIME 2 G IV SOLR [27291]

Facility

$13.20

Service Code	HCPCS J0713
Hospital Charge Code	25021012850
Hospital Revenue Code	278
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.60
Rate for Payer: Hamaspik Choice Inc Medicare	$6.60

CEFTAZIDIME 2 G IV SOLR [27291]

Facility

$12.00

Service Code	HCPCS J0713
Hospital Charge Code	44567023610
Hospital Revenue Code	278
Min. Negotiated Rate	$1.97
Max. Negotiated Rate	$12.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: EmblemHealth Commercial	$6.00
Rate for Payer: Fidelis Medicare Advantage	$12.60
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

CEFTAZIDIME 500 MG INJ

Facility

$11.20

Service Code	HCPCS J0713
Hospital Charge Code	41655099
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$7.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$6.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.44
Rate for Payer: Group Health Inc Commercial	$5.60
Rate for Payer: Group Health Inc Medicare	$3.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60
Rate for Payer: Hamaspik Choice Inc Medicare	$5.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.76
Rate for Payer: SOMOS Essential	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.28

CEFTAZIDIME 500 MG INJ

Facility

$11.20

Service Code	HCPCS J0713
Hospital Charge Code	41645099
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$7.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$6.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.44
Rate for Payer: Group Health Inc Commercial	$5.60
Rate for Payer: Group Health Inc Medicare	$3.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60
Rate for Payer: Hamaspik Choice Inc Medicare	$5.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.76
Rate for Payer: SOMOS Essential	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.28

CEFTAZIDIME 500 MG INJ

Facility

$11.20

Service Code	HCPCS J0713
Hospital Charge Code	41655099
Hospital Revenue Code	636
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60
Rate for Payer: Hamaspik Choice Inc Medicare	$5.60

CEFTAZIDIME 500 MG INJ

Facility

$11.20

Service Code	HCPCS J0713
Hospital Charge Code	41645099
Hospital Revenue Code	636
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$5.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.60
Rate for Payer: Hamaspik Choice Inc Medicare	$5.60

CEFTAZIDIME 50 MG/ML NEONATAL IV

Facility

$8.00

Service Code	HCPCS J0713
Hospital Charge Code	41641121
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

CEFTAZIDIME 50 MG/ML NEONATAL IV

Facility

$8.00

Service Code	HCPCS J0713
Hospital Charge Code	41651121
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

CEFTAZIDIME 50 MG/ML NEONATAL IV

Facility

$8.00

Service Code	HCPCS J0713
Hospital Charge Code	41651121
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
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	$1.76
Rate for Payer: SOMOS Essential	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

CEFTAZIDIME 50 MG/ML NEONATAL IV

Facility

$8.00

Service Code	HCPCS J0713
Hospital Charge Code	41641121
Hospital Revenue Code	636
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
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	$1.76
Rate for Payer: SOMOS Essential	$1.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

CEFTAZIDIME/AVIBACTAM 2-0.5G INJ

Facility

$706.80

Service Code	HCPCS J3490
Hospital Charge Code	41656601
Hospital Revenue Code	636
Min. Negotiated Rate	$247.38
Max. Negotiated Rate	$459.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$353.40
Rate for Payer: Aetna Government	$353.40
Rate for Payer: Brighton Health Commercial	$424.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$353.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.41
Rate for Payer: Group Health Inc Commercial	$353.40
Rate for Payer: Group Health Inc Medicare	$247.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.40
Rate for Payer: Hamaspik Choice Inc Medicare	$353.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$459.42

CEFTAZIDIME/AVIBACTAM 2-0.5G INJ

Facility

$706.80

Service Code	HCPCS J3490
Hospital Charge Code	41656601
Hospital Revenue Code	636
Min. Negotiated Rate	$353.40
Max. Negotiated Rate	$353.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.40
Rate for Payer: Hamaspik Choice Inc Medicare	$353.40

CEFTAZIDIME/AVIBACTAM 2-0.5G INJ

Facility

$706.80

Service Code	HCPCS J3490
Hospital Charge Code	41646601
Hospital Revenue Code	636
Min. Negotiated Rate	$247.38
Max. Negotiated Rate	$459.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$388.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$353.40
Rate for Payer: Aetna Government	$353.40
Rate for Payer: Brighton Health Commercial	$424.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$353.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$406.41
Rate for Payer: Group Health Inc Commercial	$353.40
Rate for Payer: Group Health Inc Medicare	$247.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.40
Rate for Payer: Hamaspik Choice Inc Medicare	$353.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$459.42

CEFTAZIDIME/AVIBACTAM 2-0.5G INJ

Facility

$706.80

Service Code	HCPCS J3490
Hospital Charge Code	41646601
Hospital Revenue Code	636
Min. Negotiated Rate	$353.40
Max. Negotiated Rate	$353.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$353.40
Rate for Payer: Hamaspik Choice Inc Medicare	$353.40

CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR [128163]

Facility

$452.10

Service Code	HCPCS J0714
Hospital Charge Code	00456270001
Hospital Revenue Code	278
Min. Negotiated Rate	$76.36
Max. Negotiated Rate	$293.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$248.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.45
Rate for Payer: Aetna Government	$95.45
Rate for Payer: Brighton Health Commercial	$271.26
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$95.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$226.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$259.96
Rate for Payer: Elderplan Medicare Advantage	$95.45
Rate for Payer: EmblemHealth Commercial	$226.05
Rate for Payer: Fidelis Medicare Advantage	$95.45
Rate for Payer: Group Health Inc Commercial	$95.45
Rate for Payer: Group Health Inc Medicare	$95.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.05
Rate for Payer: Hamaspik Choice Inc Medicare	$226.05
Rate for Payer: Healthfirst Medicare Advantage	$81.13
Rate for Payer: Healthfirst QHP	$95.45
Rate for Payer: Humana Medicare	$97.36
Rate for Payer: Senior Whole Health Medicare Advantage	$95.45
Rate for Payer: United Healthcare Medicare Advantage	$95.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$293.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.36

CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR [128163]

Facility

$474.70

Service Code	HCPCS J0714
Hospital Charge Code	00456270010
Hospital Revenue Code	278
Min. Negotiated Rate	$76.36
Max. Negotiated Rate	$308.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$95.45
Rate for Payer: Aetna Government	$95.45
Rate for Payer: Brighton Health Commercial	$284.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$95.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$237.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$272.95
Rate for Payer: Elderplan Medicare Advantage	$95.45
Rate for Payer: EmblemHealth Commercial	$237.35
Rate for Payer: Fidelis Medicare Advantage	$95.45
Rate for Payer: Group Health Inc Commercial	$95.45
Rate for Payer: Group Health Inc Medicare	$95.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.35
Rate for Payer: Hamaspik Choice Inc Medicare	$237.35
Rate for Payer: Healthfirst Medicare Advantage	$81.13
Rate for Payer: Healthfirst QHP	$95.45
Rate for Payer: Humana Medicare	$97.36
Rate for Payer: Senior Whole Health Medicare Advantage	$95.45
Rate for Payer: United Healthcare Medicare Advantage	$95.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$308.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$76.36

Know your out-of-pocket cost for care.

All Charges