St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AZITHROMYCIN 250 MG PO TABS

Facility

$2.52

Service Code	NDC 0904735061
Hospital Charge Code	0904735061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$2.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.26
Rate for Payer: Aetna Government	$1.26
Rate for Payer: Brighton Health Commercial	$1.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.71
Rate for Payer: EmblemHealth Commercial	$1.26
Rate for Payer: Group Health Inc Commercial	$1.26
Rate for Payer: Group Health Inc Medicare	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26
Rate for Payer: Hamaspik Choice Inc Medicare	$1.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.63

AZITHROMYCIN 250 MG PO TABS

Facility

$2.52

Service Code	NDC 0904735061
Hospital Charge Code	0904735061
Hospital Revenue Code	250
Min. Negotiated Rate	$1.26
Max. Negotiated Rate	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.26

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

AZITHROMYCIN 250 MG PO TABS

Facility

$1.48

Service Code	NDC 0904735006
Hospital Charge Code	0904735006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.74
Rate for Payer: Aetna Government	$0.74
Rate for Payer: Brighton Health Commercial	$1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.01
Rate for Payer: EmblemHealth Commercial	$0.74
Rate for Payer: Group Health Inc Commercial	$0.74
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.74
Rate for Payer: Hamaspik Choice Inc Medicare	$0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.96

AZITHROMYCIN 250 MG PO TABS

Facility

$2.59

Service Code	NDC 0069406101
Hospital Charge Code	0069406101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.29
Rate for Payer: Aetna Government	$1.29
Rate for Payer: Brighton Health Commercial	$1.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.76
Rate for Payer: EmblemHealth Commercial	$1.29
Rate for Payer: Group Health Inc Commercial	$1.29
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.29
Rate for Payer: Hamaspik Choice Inc Medicare	$1.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.68

AZITHROMYCIN 250 MG PO TABS

Facility

$2.59

Service Code	NDC 0069406101
Hospital Charge Code	0069406101
Hospital Revenue Code	250
Min. Negotiated Rate	$1.29
Max. Negotiated Rate	$1.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.29

AZITHROMYCIN 250 MG PO TABS

Facility

$1.26

Service Code	NDC 5026807413
Hospital Charge Code	5026807413
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63

AZITHROMYCIN 250 MG PO TABS

Facility

$7.78

Service Code	NDC 5011178710
Hospital Charge Code	5011178710
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 6586264169
Hospital Charge Code	6586264169
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

$1.87

Service Code	NDC 6068774265
Hospital Charge Code	6068774265
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94

AZITHROMYCIN 250 MG PO TABS

Facility

$7.78

Service Code	NDC 0781808931
Hospital Charge Code	0781808931
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$6.23
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	$5.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.23
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	$5.06

AZITHROMYCIN 250 MG PO TABS

Facility

$7.78

Service Code	NDC 6586264169
Hospital Charge Code	6586264169
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$6.23
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	$5.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.23
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	$5.06

AZITHROMYCIN 250 MG PO TABS

Facility

$4.14

Service Code	NDC 0069406189
Hospital Charge Code	0069406189
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$2.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.07

AZITHROMYCIN 250 MG PO TABS

Facility

$1.26

Service Code	NDC 5026807413
Hospital Charge Code	5026807413
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: EmblemHealth Commercial	$0.63
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.82

AZITHROMYCIN 250 MG PO TABS

Facility

$1.87

Service Code	NDC 6068774265
Hospital Charge Code	6068774265
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$1.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.94
Rate for Payer: Aetna Government	$0.94
Rate for Payer: Brighton Health Commercial	$1.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.27
Rate for Payer: EmblemHealth Commercial	$0.94
Rate for Payer: Group Health Inc Commercial	$0.94
Rate for Payer: Group Health Inc Medicare	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.22

AZITHROMYCIN 250 MG PO TABS

Facility

$7.78

Service Code	NDC 5011178710
Hospital Charge Code	5011178710
Hospital Revenue Code	250
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$6.23
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	$5.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.23
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	$5.06

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

$4.14

Service Code	NDC 0069406189
Hospital Charge Code	0069406189
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$3.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.07
Rate for Payer: Aetna Government	$2.07
Rate for Payer: Brighton Health Commercial	$3.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.82
Rate for Payer: EmblemHealth Commercial	$2.07
Rate for Payer: Group Health Inc Commercial	$2.07
Rate for Payer: Group Health Inc Medicare	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.07
Rate for Payer: Hamaspik Choice Inc Medicare	$2.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.69

AZITHROMYCIN 500 MG IV SOLR

Facility

$8.92

Service Code	HCPCS J0456
Hospital Charge Code	6332339810
Hospital Revenue Code	258
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$7.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.49
Rate for Payer: Aetna Government	$2.49
Rate for Payer: Brighton Health Commercial	$6.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.06
Rate for Payer: EmblemHealth Commercial	$4.46
Rate for Payer: Group Health Inc Commercial	$4.46
Rate for Payer: Group Health Inc Medicare	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.46
Rate for Payer: Hamaspik Choice Inc Medicare	$4.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.80

AZITHROMYCIN 500 MG IV SOLR

Facility

$17.30

Service Code	HCPCS J0456
Hospital Charge Code	7043601982
Hospital Revenue Code	258
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$13.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.49
Rate for Payer: Aetna Government	$2.49
Rate for Payer: Brighton Health Commercial	$12.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.76
Rate for Payer: EmblemHealth Commercial	$8.65
Rate for Payer: Group Health Inc Commercial	$8.65
Rate for Payer: Group Health Inc Medicare	$6.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.65
Rate for Payer: Hamaspik Choice Inc Medicare	$8.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.24

AZITHROMYCIN 500 MG IV SOLR

Facility

$8.92

Service Code	HCPCS J0456
Hospital Charge Code	6332339810
Hospital Revenue Code	258
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$4.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.46

AZITHROMYCIN 500 MG IV SOLR

Facility

$17.30

Service Code	HCPCS J0456
Hospital Charge Code	7043601982
Hospital Revenue Code	258
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$8.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.65

AZITHROMYCIN 500 MG IV SOLR

Facility

$11.00

Service Code	HCPCS J0456
Hospital Charge Code	5515017410
Hospital Revenue Code	258
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.49
Rate for Payer: Aetna Government	$2.49
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: EmblemHealth Commercial	$5.50
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

AZITHROMYCIN 500 MG IV SOLR

Facility

$11.00

Service Code	HCPCS J0456
Hospital Charge Code	5515017410
Hospital Revenue Code	258
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50

AZITHROMYCIN 600 MG PO TABS

Facility

$18.68

Service Code	NDC 5011178910
Hospital Charge Code	5011178910
Hospital Revenue Code	250
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$9.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.34

Know your out-of-pocket cost for care.

All Charges