St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

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

Facility

$452.10

Service Code	HCPCS J0714
Hospital Charge Code	0456270001
Hospital Revenue Code	258
Min. Negotiated Rate	$226.05
Max. Negotiated Rate	$226.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$226.05

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	$73.31
Max. Negotiated Rate	$379.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$261.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$104.73
Rate for Payer: Aetna Government	$104.73
Rate for Payer: Affinity Essential Plan 1&2	$73.31
Rate for Payer: Affinity Essential Plan 3&4	$73.31
Rate for Payer: Affinity Medicaid/CHP/HARP	$73.31
Rate for Payer: Brighton Health Commercial	$356.03
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$104.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$379.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$322.80
Rate for Payer: Elderplan Medicare Advantage	$104.73
Rate for Payer: EmblemHealth Commercial	$104.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$94.26
Rate for Payer: Fidelis Essential Plan Aliesa	$89.02
Rate for Payer: Fidelis Essential Plan QHP	$93.21
Rate for Payer: Fidelis Medicare Advantage	$104.73
Rate for Payer: Fidelis Qualified Health Plan	$93.21
Rate for Payer: Group Health Inc Commercial	$104.73
Rate for Payer: Group Health Inc Medicare	$104.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.73
Rate for Payer: Hamaspik Choice Inc Medicare	$104.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$104.73
Rate for Payer: Healthfirst Medicare Advantage	$89.02
Rate for Payer: Healthfirst QHP	$104.73
Rate for Payer: Humana Medicare	$106.82
Rate for Payer: Senior Whole Health Medicare Advantage	$104.73
Rate for Payer: United Healthcare Medicare Advantage	$104.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$308.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$99.49
Rate for Payer: Wellcare Medicare	$99.49

CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR

Facility

$190.38

Service Code	HCPCS J0695
Hospital Charge Code	6791903001
Hospital Revenue Code	258
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$152.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$104.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.07
Rate for Payer: Aetna Government	$9.07
Rate for Payer: Affinity Essential Plan 1&2	$6.35
Rate for Payer: Affinity Essential Plan 3&4	$6.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$6.35
Rate for Payer: Brighton Health Commercial	$142.78
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$9.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$152.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$129.46
Rate for Payer: Elderplan Medicare Advantage	$9.07
Rate for Payer: EmblemHealth Commercial	$9.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$8.16
Rate for Payer: Fidelis Essential Plan Aliesa	$7.71
Rate for Payer: Fidelis Essential Plan QHP	$8.07
Rate for Payer: Fidelis Medicare Advantage	$9.07
Rate for Payer: Fidelis Qualified Health Plan	$8.07
Rate for Payer: Group Health Inc Commercial	$9.07
Rate for Payer: Group Health Inc Medicare	$9.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.07
Rate for Payer: Hamaspik Choice Inc Medicare	$9.07
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$9.07
Rate for Payer: Healthfirst Medicare Advantage	$7.71
Rate for Payer: Healthfirst QHP	$9.07
Rate for Payer: Humana Medicare	$9.25
Rate for Payer: Senior Whole Health Medicare Advantage	$9.07
Rate for Payer: United Healthcare Medicare Advantage	$9.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$123.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$8.62
Rate for Payer: Wellcare Medicare	$8.62

CEFTOLOZANE-TAZOBACTAM 1.5 (1-0.5) G IV SOLR

Facility

$190.38

Service Code	HCPCS J0695
Hospital Charge Code	6791903001
Hospital Revenue Code	258
Min. Negotiated Rate	$95.19
Max. Negotiated Rate	$95.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$95.19

CEFTRIAXONE IM INJ 500 MG/2 ML - COMPOUNDED

Facility

$2.99

Service Code	HCPCS J0696
Hospital Charge Code	9999123447
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$2.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.03
Rate for Payer: EmblemHealth Commercial	$1.50
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.94

CEFTRIAXONE IM INJ 500 MG/2 ML - COMPOUNDED

Facility

$2.99

Service Code	HCPCS J0696
Hospital Charge Code	9999123447
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$46.00

Service Code	HCPCS J0696
Hospital Charge Code	0781320885
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$36.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$34.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.28
Rate for Payer: EmblemHealth Commercial	$23.00
Rate for Payer: Group Health Inc Commercial	$23.00
Rate for Payer: Group Health Inc Medicare	$16.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00
Rate for Payer: Hamaspik Choice Inc Medicare	$23.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.90

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$2.88

Service Code	HCPCS J0696
Hospital Charge Code	2502110610
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$2.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$2.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.96
Rate for Payer: EmblemHealth Commercial	$1.44
Rate for Payer: Group Health Inc Commercial	$1.44
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.44
Rate for Payer: Hamaspik Choice Inc Medicare	$1.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.87

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$45.95

Service Code	HCPCS J0696
Hospital Charge Code	6050561480
Hospital Revenue Code	250
Min. Negotiated Rate	$22.98
Max. Negotiated Rate	$22.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.98

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$1.83

Service Code	HCPCS J0696
Hospital Charge Code	0409733201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$1.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$1.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.24
Rate for Payer: EmblemHealth Commercial	$0.91
Rate for Payer: Group Health Inc Commercial	$0.91
Rate for Payer: Group Health Inc Medicare	$0.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.91
Rate for Payer: Hamaspik Choice Inc Medicare	$0.91
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.19

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$45.95

Service Code	HCPCS J0696
Hospital Charge Code	6050561484
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$36.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$34.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.25
Rate for Payer: EmblemHealth Commercial	$22.97
Rate for Payer: Group Health Inc Commercial	$22.97
Rate for Payer: Group Health Inc Medicare	$16.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.97
Rate for Payer: Hamaspik Choice Inc Medicare	$22.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.87

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$45.95

Service Code	HCPCS J0696
Hospital Charge Code	6050561480
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$36.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$34.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.25
Rate for Payer: EmblemHealth Commercial	$22.98
Rate for Payer: Group Health Inc Commercial	$22.98
Rate for Payer: Group Health Inc Medicare	$16.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.98
Rate for Payer: Hamaspik Choice Inc Medicare	$22.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.87

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$46.00

Service Code	HCPCS J0696
Hospital Charge Code	0781320895
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$36.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$34.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.28
Rate for Payer: EmblemHealth Commercial	$23.00
Rate for Payer: Group Health Inc Commercial	$23.00
Rate for Payer: Group Health Inc Medicare	$16.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00
Rate for Payer: Hamaspik Choice Inc Medicare	$23.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.90

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$1.49

Service Code	HCPCS J0696
Hospital Charge Code	2502110667
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.02
Rate for Payer: EmblemHealth Commercial	$0.75
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.97

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$45.95

Service Code	HCPCS J0696
Hospital Charge Code	6050561484
Hospital Revenue Code	250
Min. Negotiated Rate	$22.97
Max. Negotiated Rate	$22.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.97

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$46.00

Service Code	HCPCS J0696
Hospital Charge Code	0781320895
Hospital Revenue Code	250
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$23.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$46.00

Service Code	HCPCS J0696
Hospital Charge Code	0781320885
Hospital Revenue Code	250
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$23.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$23.00

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$1.49

Service Code	HCPCS J0696
Hospital Charge Code	2502110667
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$1.83

Service Code	HCPCS J0696
Hospital Charge Code	0409733201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.91

CEFTRIAXONE SODIUM 1 G IJ SOLR

Facility

$2.88

Service Code	HCPCS J0696
Hospital Charge Code	2502110610
Hospital Revenue Code	250
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$1.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.44

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

$1.78

Service Code	HCPCS J0696
Hospital Charge Code	0781320685
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

$14.82

Service Code	HCPCS J0696
Hospital Charge Code	6050561511
Hospital Revenue Code	250
Min. Negotiated Rate	$7.41
Max. Negotiated Rate	$7.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.41

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

$0.91

Service Code	HCPCS J0696
Hospital Charge Code	0409733701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.73
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.62
Rate for Payer: EmblemHealth Commercial	$0.46
Rate for Payer: Group Health Inc Commercial	$0.46
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46
Rate for Payer: Hamaspik Choice Inc Medicare	$0.46
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

$14.83

Service Code	HCPCS J0696
Hospital Charge Code	0781320695
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$11.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$11.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.09
Rate for Payer: EmblemHealth Commercial	$7.42
Rate for Payer: Group Health Inc Commercial	$7.42
Rate for Payer: Group Health Inc Medicare	$5.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.42
Rate for Payer: Hamaspik Choice Inc Medicare	$7.42
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.64

Know your out-of-pocket cost for care.

All Charges