St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AZITHROMYCIN 600 MG PO TABS

Facility

$18.68

Service Code	NDC 6233225330
Hospital Charge Code	6233225330
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$14.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.34
Rate for Payer: Aetna Government	$9.34
Rate for Payer: Brighton Health Commercial	$14.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.70
Rate for Payer: EmblemHealth Commercial	$9.34
Rate for Payer: Group Health Inc Commercial	$9.34
Rate for Payer: Group Health Inc Medicare	$6.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.34
Rate for Payer: Hamaspik Choice Inc Medicare	$9.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.14

AZITHROMYCIN 600 MG PO TABS

Facility

$18.68

Service Code	NDC 5122422230
Hospital Charge Code	5122422230
Hospital Revenue Code	250
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$9.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.34

AZITHROMYCIN 600 MG PO TABS

Facility

$18.68

Service Code	NDC 5011178910
Hospital Charge Code	5011178910
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$14.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.34
Rate for Payer: Aetna Government	$9.34
Rate for Payer: Brighton Health Commercial	$14.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.70
Rate for Payer: EmblemHealth Commercial	$9.34
Rate for Payer: Group Health Inc Commercial	$9.34
Rate for Payer: Group Health Inc Medicare	$6.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.34
Rate for Payer: Hamaspik Choice Inc Medicare	$9.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.14

AZITHROMYCIN 600 MG PO TABS

Facility

$18.68

Service Code	NDC 5122422230
Hospital Charge Code	5122422230
Hospital Revenue Code	250
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$14.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.34
Rate for Payer: Aetna Government	$9.34
Rate for Payer: Brighton Health Commercial	$14.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.70
Rate for Payer: EmblemHealth Commercial	$9.34
Rate for Payer: Group Health Inc Commercial	$9.34
Rate for Payer: Group Health Inc Medicare	$6.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.34
Rate for Payer: Hamaspik Choice Inc Medicare	$9.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.14

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

AZTREONAM 1 G IJ SOLR

Facility

$43.30

Service Code	NDC 6332340101
Hospital Charge Code	6332340101
Hospital Revenue Code	250
Min. Negotiated Rate	$21.65
Max. Negotiated Rate	$21.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.65

AZTREONAM 1 G IJ SOLR

Facility

$43.30

Service Code	NDC 6332340101
Hospital Charge Code	6332340101
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$34.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.65
Rate for Payer: Aetna Government	$21.65
Rate for Payer: Brighton Health Commercial	$32.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.44
Rate for Payer: EmblemHealth Commercial	$21.65
Rate for Payer: Group Health Inc Commercial	$21.65
Rate for Payer: Group Health Inc Medicare	$15.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.65
Rate for Payer: Hamaspik Choice Inc Medicare	$21.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.14

AZTREONAM 1 G IJ SOLR

Facility

$43.30

Service Code	NDC 6332340120
Hospital Charge Code	6332340120
Hospital Revenue Code	250
Min. Negotiated Rate	$21.65
Max. Negotiated Rate	$21.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.65

AZTREONAM 1 G IJ SOLR

Facility

$32.77

Service Code	NDC 6332340124
Hospital Charge Code	6332340124
Hospital Revenue Code	250
Min. Negotiated Rate	$16.39
Max. Negotiated Rate	$16.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.39

AZTREONAM 1 G IJ SOLR

Facility

$43.30

Service Code	NDC 6332340120
Hospital Charge Code	6332340120
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$34.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.65
Rate for Payer: Aetna Government	$21.65
Rate for Payer: Brighton Health Commercial	$32.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$34.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$29.44
Rate for Payer: EmblemHealth Commercial	$21.65
Rate for Payer: Group Health Inc Commercial	$21.65
Rate for Payer: Group Health Inc Medicare	$15.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.65
Rate for Payer: Hamaspik Choice Inc Medicare	$21.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.14

AZTREONAM 1 G IJ SOLR

Facility

$35.67

Service Code	NDC 0003256016
Hospital Charge Code	0003256016
Hospital Revenue Code	250
Min. Negotiated Rate	$17.84
Max. Negotiated Rate	$17.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.84

AZTREONAM 1 G IJ SOLR

Facility

$32.77

Service Code	NDC 6332340124
Hospital Charge Code	6332340124
Hospital Revenue Code	250
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.39
Rate for Payer: Aetna Government	$16.39
Rate for Payer: Brighton Health Commercial	$24.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.28
Rate for Payer: EmblemHealth Commercial	$16.39
Rate for Payer: Group Health Inc Commercial	$16.39
Rate for Payer: Group Health Inc Medicare	$11.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.39
Rate for Payer: Hamaspik Choice Inc Medicare	$16.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.30

AZTREONAM 1 G IJ SOLR

Facility

$35.67

Service Code	NDC 0003256016
Hospital Charge Code	0003256016
Hospital Revenue Code	250
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$28.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.84
Rate for Payer: Aetna Government	$17.84
Rate for Payer: Brighton Health Commercial	$26.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.26
Rate for Payer: EmblemHealth Commercial	$17.84
Rate for Payer: Group Health Inc Commercial	$17.84
Rate for Payer: Group Health Inc Medicare	$12.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.84
Rate for Payer: Hamaspik Choice Inc Medicare	$17.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.19

AZTREONAM 2 G IJ SOLR

Facility

$71.34

Service Code	HCPCS J0457
Hospital Charge Code	0003257016
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$57.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.67
Rate for Payer: Aetna Government	$35.67
Rate for Payer: Brighton Health Commercial	$53.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$57.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$48.51
Rate for Payer: EmblemHealth Commercial	$35.67
Rate for Payer: Group Health Inc Commercial	$35.67
Rate for Payer: Group Health Inc Medicare	$24.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.67
Rate for Payer: Hamaspik Choice Inc Medicare	$35.67
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$46.37

AZTREONAM 2 G IJ SOLR

Facility

$87.97

Service Code	HCPCS J0457
Hospital Charge Code	6332340220
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$70.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.99
Rate for Payer: Aetna Government	$43.99
Rate for Payer: Brighton Health Commercial	$65.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.82
Rate for Payer: EmblemHealth Commercial	$43.99
Rate for Payer: Group Health Inc Commercial	$43.99
Rate for Payer: Group Health Inc Medicare	$30.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.99
Rate for Payer: Hamaspik Choice Inc Medicare	$43.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.18

AZTREONAM 2 G IJ SOLR

Facility

$71.34

Service Code	HCPCS J0457
Hospital Charge Code	0003257016
Hospital Revenue Code	250
Min. Negotiated Rate	$35.67
Max. Negotiated Rate	$35.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$35.67

AZTREONAM 2 G IJ SOLR

Facility

$78.00

Service Code	HCPCS J0457
Hospital Charge Code	0409083001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$62.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.00
Rate for Payer: Aetna Government	$39.00
Rate for Payer: Brighton Health Commercial	$58.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.04
Rate for Payer: EmblemHealth Commercial	$39.00
Rate for Payer: Group Health Inc Commercial	$39.00
Rate for Payer: Group Health Inc Medicare	$27.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00
Rate for Payer: Hamaspik Choice Inc Medicare	$39.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$50.70

AZTREONAM 2 G IJ SOLR

Facility

$65.54

Service Code	HCPCS J0457
Hospital Charge Code	6332340224
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$52.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$36.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.77
Rate for Payer: Aetna Government	$32.77
Rate for Payer: Brighton Health Commercial	$49.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$52.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$44.57
Rate for Payer: EmblemHealth Commercial	$32.77
Rate for Payer: Group Health Inc Commercial	$32.77
Rate for Payer: Group Health Inc Medicare	$22.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.77
Rate for Payer: Hamaspik Choice Inc Medicare	$32.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$42.60

AZTREONAM 2 G IJ SOLR

Facility

$87.97

Service Code	HCPCS J0457
Hospital Charge Code	6332340201
Hospital Revenue Code	250
Min. Negotiated Rate	$43.99
Max. Negotiated Rate	$43.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.99

AZTREONAM 2 G IJ SOLR

Facility

$65.54

Service Code	HCPCS J0457
Hospital Charge Code	6332340224
Hospital Revenue Code	250
Min. Negotiated Rate	$32.77
Max. Negotiated Rate	$32.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$32.77

AZTREONAM 2 G IJ SOLR

Facility

$87.97

Service Code	HCPCS J0457
Hospital Charge Code	6332340201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$70.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.99
Rate for Payer: Aetna Government	$43.99
Rate for Payer: Brighton Health Commercial	$65.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.82
Rate for Payer: EmblemHealth Commercial	$43.99
Rate for Payer: Group Health Inc Commercial	$43.99
Rate for Payer: Group Health Inc Medicare	$30.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.99
Rate for Payer: Hamaspik Choice Inc Medicare	$43.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$57.18

AZTREONAM 2 G IJ SOLR

Facility

$87.97

Service Code	HCPCS J0457
Hospital Charge Code	6332340220
Hospital Revenue Code	250
Min. Negotiated Rate	$43.99
Max. Negotiated Rate	$43.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.99

AZTREONAM 2 G IJ SOLR

Facility

$78.00

Service Code	HCPCS J0457
Hospital Charge Code	0409083001
Hospital Revenue Code	250
Min. Negotiated Rate	$39.00
Max. Negotiated Rate	$39.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.00

BACITRACIN 500 UNIT/GM EX OINT

Facility

$0.12

Service Code	NDC 0713028031
Hospital Charge Code	0713028031
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

BACITRACIN 500 UNIT/GM EX OINT

Facility

$0.12

Service Code	NDC 0713028031
Hospital Charge Code	0713028031
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

Know your out-of-pocket cost for care.

All Charges