St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$11.64

Service Code	HCPCS J0692
Hospital Charge Code	7128800920
Hospital Revenue Code	250
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$5.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.82

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$11.76

Service Code	HCPCS J0692
Hospital Charge Code	7059409002
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$9.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.85
Rate for Payer: Aetna Government	$1.85
Rate for Payer: Brighton Health Commercial	$8.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.00
Rate for Payer: EmblemHealth Commercial	$5.88
Rate for Payer: Group Health Inc Commercial	$5.88
Rate for Payer: Group Health Inc Medicare	$4.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.88
Rate for Payer: Hamaspik Choice Inc Medicare	$5.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.64

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$11.64

Service Code	HCPCS J0692
Hospital Charge Code	7128800920
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$9.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.85
Rate for Payer: Aetna Government	$1.85
Rate for Payer: Brighton Health Commercial	$8.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.92
Rate for Payer: EmblemHealth Commercial	$5.82
Rate for Payer: Group Health Inc Commercial	$5.82
Rate for Payer: Group Health Inc Medicare	$4.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.82
Rate for Payer: Hamaspik Choice Inc Medicare	$5.82
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.57

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$12.00

Service Code	HCPCS J0692
Hospital Charge Code	2502112250
Hospital Revenue Code	250
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$40.36

Service Code	HCPCS J0692
Hospital Charge Code	6050561474
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$20.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.18

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$12.06

Service Code	HCPCS J0692
Hospital Charge Code	0409973501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$9.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.85
Rate for Payer: Aetna Government	$1.85
Rate for Payer: Brighton Health Commercial	$9.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.65
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.20
Rate for Payer: EmblemHealth Commercial	$6.03
Rate for Payer: Group Health Inc Commercial	$6.03
Rate for Payer: Group Health Inc Medicare	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.03
Rate for Payer: Hamaspik Choice Inc Medicare	$6.03
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.84

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$12.00

Service Code	HCPCS J0692
Hospital Charge Code	2502112250
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.85
Rate for Payer: Aetna Government	$1.85
Rate for Payer: Brighton Health Commercial	$9.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.16
Rate for Payer: EmblemHealth Commercial	$6.00
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: Healthfirst CHP/FHP/Medicaid	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$40.36

Service Code	HCPCS J0692
Hospital Charge Code	6050561474
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$32.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.85
Rate for Payer: Aetna Government	$1.85
Rate for Payer: Brighton Health Commercial	$30.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.44
Rate for Payer: EmblemHealth Commercial	$20.18
Rate for Payer: Group Health Inc Commercial	$20.18
Rate for Payer: Group Health Inc Medicare	$14.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.18
Rate for Payer: Hamaspik Choice Inc Medicare	$20.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.23

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$40.36

Service Code	HCPCS J0692
Hospital Charge Code	6050561470
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$20.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.18

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$11.76

Service Code	HCPCS J0692
Hospital Charge Code	7059409002
Hospital Revenue Code	250
Min. Negotiated Rate	$5.88
Max. Negotiated Rate	$5.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.88

CEFEPIME HCL 2 G SOLR (WRAPPED)

Facility

$12.06

Service Code	HCPCS J0692
Hospital Charge Code	0409973501
Hospital Revenue Code	250
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.03

CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR

Facility

$263.59

Service Code	NDC 5963026610
Hospital Charge Code	5963026610
Hospital Revenue Code	258
Min. Negotiated Rate	$92.26
Max. Negotiated Rate	$210.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$131.80
Rate for Payer: Aetna Government	$131.80
Rate for Payer: Brighton Health Commercial	$197.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$210.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$179.24
Rate for Payer: EmblemHealth Commercial	$131.80
Rate for Payer: Group Health Inc Commercial	$131.80
Rate for Payer: Group Health Inc Medicare	$92.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.80
Rate for Payer: Hamaspik Choice Inc Medicare	$131.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$171.33

CEFIDEROCOL SULFATE TOSYLATE 1 G IV SOLR

Facility

$263.59

Service Code	NDC 5963026610
Hospital Charge Code	5963026610
Hospital Revenue Code	258
Min. Negotiated Rate	$131.80
Max. Negotiated Rate	$131.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.80

CEFIXIME 200 MG/5ML PO SUSR

Facility

$8.91

Service Code	NDC 6586275250
Hospital Charge Code	6586275250
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$7.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.45
Rate for Payer: Aetna Government	$4.45
Rate for Payer: Brighton Health Commercial	$6.68
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	$4.45
Rate for Payer: Group Health Inc Commercial	$4.45
Rate for Payer: Group Health Inc Medicare	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.45
Rate for Payer: Hamaspik Choice Inc Medicare	$4.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.79

CEFIXIME 200 MG/5ML PO SUSR

Facility

$8.91

Service Code	NDC 6586275250
Hospital Charge Code	6586275250
Hospital Revenue Code	250
Min. Negotiated Rate	$4.45
Max. Negotiated Rate	$4.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.45

CEFIXIME 400 MG PO CAPS

Facility

$23.52

Service Code	NDC 6787758450
Hospital Charge Code	6787758450
Hospital Revenue Code	250
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$11.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.76

CEFIXIME 400 MG PO CAPS

Facility

$23.52

Service Code	NDC 6818042308
Hospital Charge Code	6818042308
Hospital Revenue Code	250
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$18.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.76
Rate for Payer: Aetna Government	$11.76
Rate for Payer: Brighton Health Commercial	$17.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.00
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Group Health Inc Commercial	$11.76
Rate for Payer: Group Health Inc Medicare	$8.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.76
Rate for Payer: Hamaspik Choice Inc Medicare	$11.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.29

CEFIXIME 400 MG PO CAPS

Facility

$24.91

Service Code	NDC 6818042311
Hospital Charge Code	6818042311
Hospital Revenue Code	250
Min. Negotiated Rate	$12.45
Max. Negotiated Rate	$12.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45

CEFIXIME 400 MG PO CAPS

Facility

$24.91

Service Code	NDC 6818042311
Hospital Charge Code	6818042311
Hospital Revenue Code	250
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$19.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.45
Rate for Payer: Aetna Government	$12.45
Rate for Payer: Brighton Health Commercial	$18.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.94
Rate for Payer: EmblemHealth Commercial	$12.45
Rate for Payer: Group Health Inc Commercial	$12.45
Rate for Payer: Group Health Inc Medicare	$8.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.45
Rate for Payer: Hamaspik Choice Inc Medicare	$12.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.19

CEFIXIME 400 MG PO CAPS

Facility

$23.52

Service Code	NDC 6818042308
Hospital Charge Code	6818042308
Hospital Revenue Code	250
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$11.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.76

CEFIXIME 400 MG PO CAPS

Facility

$23.52

Service Code	NDC 6787758450
Hospital Charge Code	6787758450
Hospital Revenue Code	250
Min. Negotiated Rate	$8.23
Max. Negotiated Rate	$18.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.76
Rate for Payer: Aetna Government	$11.76
Rate for Payer: Brighton Health Commercial	$17.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.00
Rate for Payer: EmblemHealth Commercial	$11.76
Rate for Payer: Group Health Inc Commercial	$11.76
Rate for Payer: Group Health Inc Medicare	$8.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.76
Rate for Payer: Hamaspik Choice Inc Medicare	$11.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.29

CEFOXITIN SODIUM 1 G IV SOLR

Facility

$7.20

Service Code	HCPCS J0694
Hospital Charge Code	2502110910
Hospital Revenue Code	258
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60

CEFOXITIN SODIUM 1 G IV SOLR

Facility

$11.88

Service Code	HCPCS J0694
Hospital Charge Code	0143987825
Hospital Revenue Code	258
Min. Negotiated Rate	$5.94
Max. Negotiated Rate	$5.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.94

CEFOXITIN SODIUM 1 G IV SOLR

Facility

$7.20

Service Code	HCPCS J0694
Hospital Charge Code	2502110910
Hospital Revenue Code	258
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.90
Rate for Payer: EmblemHealth Commercial	$3.60
Rate for Payer: Group Health Inc Commercial	$3.60
Rate for Payer: Group Health Inc Medicare	$2.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60
Rate for Payer: Hamaspik Choice Inc Medicare	$3.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

CEFOXITIN SODIUM 1 G IV SOLR

Facility

$11.94

Service Code	HCPCS J0694
Hospital Charge Code	4456724525
Hospital Revenue Code	258
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$9.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$8.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.12
Rate for Payer: EmblemHealth Commercial	$5.97
Rate for Payer: Group Health Inc Commercial	$5.97
Rate for Payer: Group Health Inc Medicare	$4.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.97
Rate for Payer: Hamaspik Choice Inc Medicare	$5.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.76

Know your out-of-pocket cost for care.

All Charges