St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CEFTRIAXONE SODIUM 500 MG IJ SOLR [9490]

Facility

$26.88

Service Code	HCPCS J0696
Hospital Charge Code	00781320785
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$21.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$20.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.28
Rate for Payer: Group Health Inc Commercial	$13.44
Rate for Payer: Group Health Inc Medicare	$9.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.44
Rate for Payer: Hamaspik Choice Inc Medicare	$13.44
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.45
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.48
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.48
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.47

CEFTRIAXONE SODIUM 500 MG IJ SOLR [9490]

Facility

$26.85

Service Code	HCPCS J0696
Hospital Charge Code	60505615201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$21.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$20.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.26
Rate for Payer: Group Health Inc Commercial	$13.43
Rate for Payer: Group Health Inc Medicare	$9.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.43
Rate for Payer: Hamaspik Choice Inc Medicare	$13.43
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.45
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.48
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.48
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.46

CEFTRIAXONE SODIUM 500 MG IJ SOLR [9490]

Facility

$27.99

Service Code	HCPCS J0696
Hospital Charge Code	60505615204
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$22.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$20.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.03
Rate for Payer: Group Health Inc Commercial	$14.00
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.00
Rate for Payer: Hamaspik Choice Inc Medicare	$14.00
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.45
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.48
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.48
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.19

CEFTRIAXONE SODIUM 500 MG IJ SOLR [9490]

Facility

$1.50

Service Code	HCPCS J0696
Hospital Charge Code	00143985801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.02
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.45
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.48
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.48
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.98

CEFTRIAXONE SODIUM 500 MG IJ SOLR [9490]

Facility

$1.16

Service Code	HCPCS J0696
Hospital Charge Code	00409733801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.45
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.48
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.48
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.75

CEFTRIAXONE SODIUM-DEXTROSE 1-3.74 GM-%(50ML) IV SOLR [163111]

Facility

$23.62

Service Code	HCPCS J0696
Hospital Charge Code	00264315311
Hospital Revenue Code	278
Min. Negotiated Rate	$11.81
Max. Negotiated Rate	$11.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.81
Rate for Payer: Hamaspik Choice Inc Medicare	$11.81

CEFTRIAXONE SODIUM-DEXTROSE 1-3.74 GM-%(50ML) IV SOLR [163111]

Facility

$23.62

Service Code	HCPCS J0696
Hospital Charge Code	00264315311
Hospital Revenue Code	278
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$24.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$14.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.58
Rate for Payer: EmblemHealth Commercial	$11.81
Rate for Payer: Fidelis Medicare Advantage	$24.80
Rate for Payer: Group Health Inc Commercial	$11.81
Rate for Payer: Group Health Inc Medicare	$8.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.81
Rate for Payer: Hamaspik Choice Inc Medicare	$11.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.35

CEFTROLINE 300MMG/D5W 50ML IVPB

Facility

$7.00

Service Code	HCPCS J0712
Hospital Charge Code	41645723
Hospital Revenue Code	636
Min. Negotiated Rate	$2.68
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: Affinity Essential Plan 1&2	$2.68
Rate for Payer: Affinity Essential Plan 3&4	$2.68
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.68
Rate for Payer: Brighton Health Commercial	$4.20
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 Medicare Advantage	$3.26
Rate for Payer: Healthfirst QHP	$3.84
Rate for Payer: Humana Medicare	$3.91
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: United Healthcare Commercial	$3.78
Rate for Payer: United Healthcare Medicare Advantage	$3.84
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

CEFTROLINE 300MMG/D5W 50ML IVPB

Facility

$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

CEFUROXIME 125 MG/5 ML SUSP PEDIATRICS

Facility

$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: 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

CEFUROXIME 125 MG/5 ML SUSP PEDIATRICS

Facility

$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: 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

CEFUROXIME 1500 MG INJ

Facility

$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: Brighton Health Commercial	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.46
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: 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

$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 1500 MG INJ

Facility

$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: Brighton Health Commercial	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.46
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: 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

$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 225 MG/ML INJ (IM)

Facility

$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: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
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: 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

$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

$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: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
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: 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

$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 250 MG/5 ML SUSP PEDIATRICS

Facility

$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: Brighton Health Commercial	$1.64
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

$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: Brighton Health Commercial	$1.64
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

$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: Brighton Health Commercial	$0.75
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

$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: Brighton Health Commercial	$0.75
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 3MG/0.3 ML INJ

Facility

$0.01

Service Code	HCPCS J0697
Hospital Charge Code	41646640
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

CEFUROXIME 3MG/0.3 ML INJ

Facility

$0.01

Service Code	HCPCS J0697
Hospital Charge Code	41646640
Hospital Revenue Code	636
Max. Negotiated Rate	$2.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.01
Rate for Payer: Aetna Government	$2.01
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
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	$0.01

Know your out-of-pocket cost for care.

All Charges