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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

IP

$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

IP

$14.83

Service Code	HCPCS J0696
Hospital Charge Code	0781320695
Hospital Revenue Code	250
Min. Negotiated Rate	$7.42
Max. Negotiated Rate	$7.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.42

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

OP

$14.82

Service Code	HCPCS J0696
Hospital Charge Code	6050561511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$11.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$11.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.07
Rate for Payer: EmblemHealth Commercial	$7.41
Rate for Payer: Group Health Inc Commercial	$7.41
Rate for Payer: Group Health Inc Medicare	$5.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.41
Rate for Payer: Hamaspik Choice Inc Medicare	$7.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.63

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

IP

$0.91

Service Code	HCPCS J0696
Hospital Charge Code	0409733701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.46

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

OP

$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

CEFTRIAXONE SODIUM 250 MG IJ SOLR

Facility

IP

$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 2 G IJ SOLR

Facility

IP

$7.20

Service Code	HCPCS J0696
Hospital Charge Code	4456770225
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.60

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

OP

$91.41

Service Code	HCPCS J0696
Hospital Charge Code	0781320995
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$73.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$68.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.16
Rate for Payer: EmblemHealth Commercial	$45.70
Rate for Payer: Group Health Inc Commercial	$45.70
Rate for Payer: Group Health Inc Medicare	$31.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.70
Rate for Payer: Hamaspik Choice Inc Medicare	$45.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.42

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

IP

$3.60

Service Code	HCPCS J0696
Hospital Charge Code	0143985601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$1.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

IP

$91.41

Service Code	HCPCS J0696
Hospital Charge Code	0781320995
Hospital Revenue Code	250
Min. Negotiated Rate	$45.70
Max. Negotiated Rate	$45.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.70

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

OP

$7.20

Service Code	HCPCS J0696
Hospital Charge Code	4456770225
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$5.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
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	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.68

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

IP

$91.31

Service Code	HCPCS J0696
Hospital Charge Code	6050561494
Hospital Revenue Code	250
Min. Negotiated Rate	$45.65
Max. Negotiated Rate	$45.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.65

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

OP

$91.31

Service Code	HCPCS J0696
Hospital Charge Code	6050561494
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$73.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$50.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$68.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$73.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$62.09
Rate for Payer: EmblemHealth Commercial	$45.65
Rate for Payer: Group Health Inc Commercial	$45.65
Rate for Payer: Group Health Inc Medicare	$31.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$45.65
Rate for Payer: Hamaspik Choice Inc Medicare	$45.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$59.35

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

IP

$5.28

Service Code	HCPCS J0696
Hospital Charge Code	2502110720
Hospital Revenue Code	250
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$2.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

OP

$3.60

Service Code	HCPCS J0696
Hospital Charge Code	0143985601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$2.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$2.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.45
Rate for Payer: EmblemHealth Commercial	$1.80
Rate for Payer: Group Health Inc Commercial	$1.80
Rate for Payer: Group Health Inc Medicare	$1.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.80
Rate for Payer: Hamaspik Choice Inc Medicare	$1.80
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.34

CEFTRIAXONE SODIUM 2 G IJ SOLR

Facility

OP

$5.28

Service Code	HCPCS J0696
Hospital Charge Code	2502110720
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$4.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$3.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.59
Rate for Payer: EmblemHealth Commercial	$2.64
Rate for Payer: Group Health Inc Commercial	$2.64
Rate for Payer: Group Health Inc Medicare	$1.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.64
Rate for Payer: Hamaspik Choice Inc Medicare	$2.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.43

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

OP

$27.99

Service Code	HCPCS J0696
Hospital Charge Code	6050561524
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$22.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$20.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.03
Rate for Payer: EmblemHealth Commercial	$13.99
Rate for Payer: Group Health Inc Commercial	$13.99
Rate for Payer: Group Health Inc Medicare	$9.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.99
Rate for Payer: Hamaspik Choice Inc Medicare	$13.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.19

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

IP

$26.88

Service Code	HCPCS J0696
Hospital Charge Code	0781320795
Hospital Revenue Code	250
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$13.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.44

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

OP

$26.88

Service Code	HCPCS J0696
Hospital Charge Code	0781320785
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$21.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$20.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.28
Rate for Payer: EmblemHealth Commercial	$13.44
Rate for Payer: Group Health Inc Commercial	$13.44
Rate for Payer: Group Health Inc Medicare	$9.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.44
Rate for Payer: Hamaspik Choice Inc Medicare	$13.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.47

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

OP

$1.16

Service Code	HCPCS J0696
Hospital Charge Code	0409733801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$0.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.93
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.79
Rate for Payer: EmblemHealth Commercial	$0.58
Rate for Payer: Group Health Inc Commercial	$0.58
Rate for Payer: Group Health Inc Medicare	$0.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58
Rate for Payer: Hamaspik Choice Inc Medicare	$0.58
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.75

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

OP

$26.85

Service Code	HCPCS J0696
Hospital Charge Code	6050561521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$21.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$20.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.26
Rate for Payer: EmblemHealth Commercial	$13.43
Rate for Payer: Group Health Inc Commercial	$13.43
Rate for Payer: Group Health Inc Medicare	$9.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.43
Rate for Payer: Hamaspik Choice Inc Medicare	$13.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.46

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

IP

$1.16

Service Code	HCPCS J0696
Hospital Charge Code	0409733801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.58

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

IP

$26.85

Service Code	HCPCS J0696
Hospital Charge Code	6050561521
Hospital Revenue Code	250
Min. Negotiated Rate	$13.43
Max. Negotiated Rate	$13.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.43

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

OP

$26.88

Service Code	HCPCS J0696
Hospital Charge Code	0781320795
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$21.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$20.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.28
Rate for Payer: EmblemHealth Commercial	$13.44
Rate for Payer: Group Health Inc Commercial	$13.44
Rate for Payer: Group Health Inc Medicare	$9.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.44
Rate for Payer: Hamaspik Choice Inc Medicare	$13.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.47

CEFTRIAXONE SODIUM 500 MG IJ SOLR

Facility

IP

$26.88

Service Code	HCPCS J0696
Hospital Charge Code	0781320785
Hospital Revenue Code	250
Min. Negotiated Rate	$13.44
Max. Negotiated Rate	$13.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.44

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