St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AZITHROMYCIN 100 MG/5ML PO SUSR

Facility

$2.33

Service Code	NDC 7071014571
Hospital Charge Code	7071014571
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16

AZITHROMYCIN 100 MG/5ML PO SUSR

Facility

$2.33

Service Code	NDC 7071014571
Hospital Charge Code	7071014571
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.16
Rate for Payer: Aetna Government	$1.16
Rate for Payer: Brighton Health Commercial	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.58
Rate for Payer: EmblemHealth Commercial	$1.16
Rate for Payer: Group Health Inc Commercial	$1.16
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.51

AZITHROMYCIN 100 MG/5ML PO SUSR

Facility

$2.33

Service Code	NDC 0093202723
Hospital Charge Code	0093202723
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16

AZITHROMYCIN 1 G PO PACK

Facility

$29.13

Service Code	NDC 5976230512
Hospital Charge Code	5976230512
Hospital Revenue Code	250
Min. Negotiated Rate	$10.19
Max. Negotiated Rate	$23.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.56
Rate for Payer: Aetna Government	$14.56
Rate for Payer: Brighton Health Commercial	$21.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.81
Rate for Payer: EmblemHealth Commercial	$14.56
Rate for Payer: Group Health Inc Commercial	$14.56
Rate for Payer: Group Health Inc Medicare	$10.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.56
Rate for Payer: Hamaspik Choice Inc Medicare	$14.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.93

AZITHROMYCIN 1 G PO PACK

Facility

$149.60

Service Code	NDC 0069305107
Hospital Charge Code	0069305107
Hospital Revenue Code	250
Min. Negotiated Rate	$52.36
Max. Negotiated Rate	$119.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$82.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.80
Rate for Payer: Aetna Government	$74.80
Rate for Payer: Brighton Health Commercial	$112.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$119.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$101.73
Rate for Payer: EmblemHealth Commercial	$74.80
Rate for Payer: Group Health Inc Commercial	$74.80
Rate for Payer: Group Health Inc Medicare	$52.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.80
Rate for Payer: Hamaspik Choice Inc Medicare	$74.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$97.24

AZITHROMYCIN 1 G PO PACK

Facility

$29.13

Service Code	NDC 5976230512
Hospital Charge Code	5976230512
Hospital Revenue Code	250
Min. Negotiated Rate	$14.56
Max. Negotiated Rate	$14.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.56

AZITHROMYCIN 1 G PO PACK

Facility

$29.64

Service Code	NDC 0069305175
Hospital Charge Code	0069305175
Hospital Revenue Code	250
Min. Negotiated Rate	$10.37
Max. Negotiated Rate	$23.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.82
Rate for Payer: Aetna Government	$14.82
Rate for Payer: Brighton Health Commercial	$22.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.16
Rate for Payer: EmblemHealth Commercial	$14.82
Rate for Payer: Group Health Inc Commercial	$14.82
Rate for Payer: Group Health Inc Medicare	$10.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.82
Rate for Payer: Hamaspik Choice Inc Medicare	$14.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.27

AZITHROMYCIN 1 G PO PACK

Facility

$29.64

Service Code	NDC 0069305175
Hospital Charge Code	0069305175
Hospital Revenue Code	250
Min. Negotiated Rate	$14.82
Max. Negotiated Rate	$14.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.82

AZITHROMYCIN 1 G PO PACK

Facility

$149.60

Service Code	NDC 0069305107
Hospital Charge Code	0069305107
Hospital Revenue Code	250
Min. Negotiated Rate	$74.80
Max. Negotiated Rate	$74.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$74.80

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$2.33

Service Code	NDC 5965100815
Hospital Charge Code	5965100815
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.16
Rate for Payer: Aetna Government	$1.16
Rate for Payer: Brighton Health Commercial	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.58
Rate for Payer: EmblemHealth Commercial	$1.16
Rate for Payer: Group Health Inc Commercial	$1.16
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.51

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.16

Service Code	NDC 7071014602
Hospital Charge Code	7071014602
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.55

Service Code	NDC 7071014592
Hospital Charge Code	7071014592
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$1.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.78
Rate for Payer: Aetna Government	$0.78
Rate for Payer: Brighton Health Commercial	$1.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.05
Rate for Payer: EmblemHealth Commercial	$0.78
Rate for Payer: Group Health Inc Commercial	$0.78
Rate for Payer: Group Health Inc Medicare	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78
Rate for Payer: Hamaspik Choice Inc Medicare	$0.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.01

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.16

Service Code	NDC 7071014602
Hospital Charge Code	7071014602
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	$0.58
Rate for Payer: Aetna Government	$0.58
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: EmblemHealth Commercial	$0.58
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.76

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.16

Service Code	NDC 4280615134
Hospital Charge Code	4280615134
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.16

Service Code	NDC 5976231401
Hospital Charge Code	5976231401
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	$0.58
Rate for Payer: Aetna Government	$0.58
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: EmblemHealth Commercial	$0.58
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.76

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.06

Service Code	NDC 0069314019
Hospital Charge Code	0069314019
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.72
Rate for Payer: EmblemHealth Commercial	$0.53
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.69

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$2.33

Service Code	NDC 7071014582
Hospital Charge Code	7071014582
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.16
Rate for Payer: Aetna Government	$1.16
Rate for Payer: Brighton Health Commercial	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.58
Rate for Payer: EmblemHealth Commercial	$1.16
Rate for Payer: Group Health Inc Commercial	$1.16
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.51

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.16

Service Code	NDC 5976231401
Hospital Charge Code	5976231401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$2.33

Service Code	NDC 5965100815
Hospital Charge Code	5965100815
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.06

Service Code	NDC 0069314019
Hospital Charge Code	0069314019
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.55

Service Code	NDC 7071014592
Hospital Charge Code	7071014592
Hospital Revenue Code	250
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$0.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.78

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$1.16

Service Code	NDC 4280615134
Hospital Charge Code	4280615134
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	$0.58
Rate for Payer: Aetna Government	$0.58
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: EmblemHealth Commercial	$0.58
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.76

AZITHROMYCIN 200 MG/5ML PO SUSR

Facility

$2.33

Service Code	NDC 7071014582
Hospital Charge Code	7071014582
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16

AZITHROMYCIN 250 MG PO TABS

Facility

$7.78

Service Code	NDC 5122402230
Hospital Charge Code	5122402230
Hospital Revenue Code	250
Min. Negotiated Rate	$3.89
Max. Negotiated Rate	$3.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.89

AZITHROMYCIN 250 MG PO TABS

Facility

$7.78

Service Code	NDC 5122402230
Hospital Charge Code	5122402230
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$6.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.89
Rate for Payer: Aetna Government	$3.89
Rate for Payer: Brighton Health Commercial	$5.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.29
Rate for Payer: EmblemHealth Commercial	$3.89
Rate for Payer: Group Health Inc Commercial	$3.89
Rate for Payer: Group Health Inc Medicare	$2.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.89
Rate for Payer: Hamaspik Choice Inc Medicare	$3.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.05

Know your out-of-pocket cost for care.

All Charges