St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

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 2 G IV SOLR

Facility

$12.00

Service Code	HCPCS J0694
Hospital Charge Code	2502111020
Hospital Revenue Code	258
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

CEFOXITIN SODIUM 2 G IV SOLR

Facility

$23.94

Service Code	HCPCS J0694
Hospital Charge Code	4456724625
Hospital Revenue Code	258
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$11.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.97

CEFOXITIN SODIUM 2 G IV SOLR

Facility

$12.00

Service Code	HCPCS J0694
Hospital Charge Code	2502111020
Hospital Revenue Code	258
Min. Negotiated Rate	$4.20
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
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	$4.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

CEFOXITIN SODIUM 2 G IV SOLR

Facility

$23.94

Service Code	HCPCS J0694
Hospital Charge Code	4456724625
Hospital Revenue Code	258
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$19.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$17.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.28
Rate for Payer: EmblemHealth Commercial	$11.97
Rate for Payer: Group Health Inc Commercial	$11.97
Rate for Payer: Group Health Inc Medicare	$8.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.97
Rate for Payer: Hamaspik Choice Inc Medicare	$11.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.56

CEFOXITIN SODIUM 2 G IV SOLR

Facility

$23.76

Service Code	HCPCS J0694
Hospital Charge Code	0143987725
Hospital Revenue Code	258
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$11.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.88

CEFOXITIN SODIUM 2 G IV SOLR

Facility

$23.76

Service Code	HCPCS J0694
Hospital Charge Code	0143987725
Hospital Revenue Code	258
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$19.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.61
Rate for Payer: Aetna Government	$4.61
Rate for Payer: Brighton Health Commercial	$17.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.16
Rate for Payer: EmblemHealth Commercial	$11.88
Rate for Payer: Group Health Inc Commercial	$11.88
Rate for Payer: Group Health Inc Medicare	$8.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.88
Rate for Payer: Hamaspik Choice Inc Medicare	$11.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.44

CEFPODOXIME PROXETIL 200 MG PO TABS

Facility

$8.46

Service Code	NDC 6586209620
Hospital Charge Code	6586209620
Hospital Revenue Code	250
Min. Negotiated Rate	$4.23
Max. Negotiated Rate	$4.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.23

CEFPODOXIME PROXETIL 200 MG PO TABS

Facility

$8.46

Service Code	NDC 6586209620
Hospital Charge Code	6586209620
Hospital Revenue Code	250
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$6.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.23
Rate for Payer: Aetna Government	$4.23
Rate for Payer: Brighton Health Commercial	$6.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.75
Rate for Payer: EmblemHealth Commercial	$4.23
Rate for Payer: Group Health Inc Commercial	$4.23
Rate for Payer: Group Health Inc Medicare	$2.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.23
Rate for Payer: Hamaspik Choice Inc Medicare	$4.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.50

CEFTAROLINE FOSAMIL 400 MG IV SOLR

Facility

$294.24

Service Code	HCPCS J0712
Hospital Charge Code	0456040010
Hospital Revenue Code	258
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$235.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.23
Rate for Payer: Aetna Government	$4.23
Rate for Payer: Affinity Essential Plan 1&2	$2.96
Rate for Payer: Affinity Essential Plan 3&4	$2.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.96
Rate for Payer: Brighton Health Commercial	$220.68
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$200.08
Rate for Payer: Elderplan Medicare Advantage	$4.23
Rate for Payer: EmblemHealth Commercial	$4.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.81
Rate for Payer: Fidelis Essential Plan Aliesa	$3.60
Rate for Payer: Fidelis Essential Plan QHP	$3.76
Rate for Payer: Fidelis Medicare Advantage	$4.23
Rate for Payer: Fidelis Qualified Health Plan	$3.76
Rate for Payer: Group Health Inc Commercial	$4.23
Rate for Payer: Group Health Inc Medicare	$4.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.23
Rate for Payer: Hamaspik Choice Inc Medicare	$4.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.23
Rate for Payer: Healthfirst Medicare Advantage	$3.60
Rate for Payer: Healthfirst QHP	$4.23
Rate for Payer: Humana Medicare	$4.31
Rate for Payer: Senior Whole Health Medicare Advantage	$4.23
Rate for Payer: United Healthcare Medicare Advantage	$4.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.02
Rate for Payer: Wellcare Medicare	$4.02

CEFTAROLINE FOSAMIL 400 MG IV SOLR

Facility

$294.24

Service Code	HCPCS J0712
Hospital Charge Code	0456040010
Hospital Revenue Code	258
Min. Negotiated Rate	$147.12
Max. Negotiated Rate	$147.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.12

CEFTAROLINE FOSAMIL 600 MG IV SOLR

Facility

$280.22

Service Code	HCPCS J0712
Hospital Charge Code	0456060001
Hospital Revenue Code	258
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$224.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$154.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.23
Rate for Payer: Aetna Government	$4.23
Rate for Payer: Affinity Essential Plan 1&2	$2.96
Rate for Payer: Affinity Essential Plan 3&4	$2.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.96
Rate for Payer: Brighton Health Commercial	$210.16
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$224.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$190.55
Rate for Payer: Elderplan Medicare Advantage	$4.23
Rate for Payer: EmblemHealth Commercial	$4.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.81
Rate for Payer: Fidelis Essential Plan Aliesa	$3.60
Rate for Payer: Fidelis Essential Plan QHP	$3.76
Rate for Payer: Fidelis Medicare Advantage	$4.23
Rate for Payer: Fidelis Qualified Health Plan	$3.76
Rate for Payer: Group Health Inc Commercial	$4.23
Rate for Payer: Group Health Inc Medicare	$4.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.23
Rate for Payer: Hamaspik Choice Inc Medicare	$4.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.23
Rate for Payer: Healthfirst Medicare Advantage	$3.60
Rate for Payer: Healthfirst QHP	$4.23
Rate for Payer: Humana Medicare	$4.31
Rate for Payer: Senior Whole Health Medicare Advantage	$4.23
Rate for Payer: United Healthcare Medicare Advantage	$4.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$182.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.02
Rate for Payer: Wellcare Medicare	$4.02

CEFTAROLINE FOSAMIL 600 MG IV SOLR

Facility

$294.24

Service Code	HCPCS J0712
Hospital Charge Code	0456060010
Hospital Revenue Code	258
Min. Negotiated Rate	$147.12
Max. Negotiated Rate	$147.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$147.12

CEFTAROLINE FOSAMIL 600 MG IV SOLR

Facility

$294.24

Service Code	HCPCS J0712
Hospital Charge Code	0456060010
Hospital Revenue Code	258
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$235.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$161.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.23
Rate for Payer: Aetna Government	$4.23
Rate for Payer: Affinity Essential Plan 1&2	$2.96
Rate for Payer: Affinity Essential Plan 3&4	$2.96
Rate for Payer: Affinity Medicaid/CHP/HARP	$2.96
Rate for Payer: Brighton Health Commercial	$220.68
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$4.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$235.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$200.08
Rate for Payer: Elderplan Medicare Advantage	$4.23
Rate for Payer: EmblemHealth Commercial	$4.23
Rate for Payer: Fidelis CHP/HARP/Medicaid	$3.81
Rate for Payer: Fidelis Essential Plan Aliesa	$3.60
Rate for Payer: Fidelis Essential Plan QHP	$3.76
Rate for Payer: Fidelis Medicare Advantage	$4.23
Rate for Payer: Fidelis Qualified Health Plan	$3.76
Rate for Payer: Group Health Inc Commercial	$4.23
Rate for Payer: Group Health Inc Medicare	$4.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.23
Rate for Payer: Hamaspik Choice Inc Medicare	$4.23
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$4.23
Rate for Payer: Healthfirst Medicare Advantage	$3.60
Rate for Payer: Healthfirst QHP	$4.23
Rate for Payer: Humana Medicare	$4.31
Rate for Payer: Senior Whole Health Medicare Advantage	$4.23
Rate for Payer: United Healthcare Medicare Advantage	$4.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$191.26
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.02
Rate for Payer: Wellcare Medicare	$4.02

CEFTAROLINE FOSAMIL 600 MG IV SOLR

Facility

$280.22

Service Code	HCPCS J0712
Hospital Charge Code	0456060001
Hospital Revenue Code	258
Min. Negotiated Rate	$140.11
Max. Negotiated Rate	$140.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$140.11

CEFTAZIDIME 1 G IJ SOLR

Facility

$5.40

Service Code	HCPCS J0713
Hospital Charge Code	4456723525
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$4.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$4.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.67
Rate for Payer: EmblemHealth Commercial	$2.70
Rate for Payer: Group Health Inc Commercial	$2.70
Rate for Payer: Group Health Inc Medicare	$1.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.70
Rate for Payer: Hamaspik Choice Inc Medicare	$2.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.51

CEFTAZIDIME 1 G IJ SOLR

Facility

$6.24

Service Code	HCPCS J0713
Hospital Charge Code	2502112720
Hospital Revenue Code	250
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$4.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$4.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.24
Rate for Payer: EmblemHealth Commercial	$3.12
Rate for Payer: Group Health Inc Commercial	$3.12
Rate for Payer: Group Health Inc Medicare	$2.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12
Rate for Payer: Hamaspik Choice Inc Medicare	$3.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.06

CEFTAZIDIME 1 G IJ SOLR

Facility

$5.40

Service Code	HCPCS J0713
Hospital Charge Code	4456723525
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.70

CEFTAZIDIME 1 G IJ SOLR

Facility

$6.24

Service Code	HCPCS J0713
Hospital Charge Code	2502112720
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$3.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.12

CEFTAZIDIME 2 G IV SOLR

Facility

$13.20

Service Code	HCPCS J0713
Hospital Charge Code	2502112850
Hospital Revenue Code	258
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$6.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.60

CEFTAZIDIME 2 G IV SOLR

Facility

$12.00

Service Code	HCPCS J0713
Hospital Charge Code	4456723610
Hospital Revenue Code	258
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$9.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
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	$1.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.80

CEFTAZIDIME 2 G IV SOLR

Facility

$13.20

Service Code	HCPCS J0713
Hospital Charge Code	2502112850
Hospital Revenue Code	258
Min. Negotiated Rate	$1.57
Max. Negotiated Rate	$10.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.97
Rate for Payer: Aetna Government	$1.97
Rate for Payer: Brighton Health Commercial	$9.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.98
Rate for Payer: EmblemHealth Commercial	$6.60
Rate for Payer: Group Health Inc Commercial	$6.60
Rate for Payer: Group Health Inc Medicare	$4.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.60
Rate for Payer: Hamaspik Choice Inc Medicare	$6.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.58

CEFTAZIDIME 2 G IV SOLR

Facility

$12.00

Service Code	HCPCS J0713
Hospital Charge Code	4456723610
Hospital Revenue Code	258
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00

CEFTAZIDIME-AVIBACTAM 2.5 (2-0.5) G IV SOLR

Facility

$474.70

Service Code	HCPCS J0714
Hospital Charge Code	0456270010
Hospital Revenue Code	258
Min. Negotiated Rate	$237.35
Max. Negotiated Rate	$237.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$237.35

Know your out-of-pocket cost for care.

All Charges