St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TICAGRELOR 90 MG PO TABS

Facility

$9.02

Service Code	NDC 0186077760
Hospital Charge Code	0186077760
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$7.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.51
Rate for Payer: Aetna Government	$4.51
Rate for Payer: Brighton Health Commercial	$6.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.14
Rate for Payer: EmblemHealth Commercial	$4.51
Rate for Payer: Group Health Inc Commercial	$4.51
Rate for Payer: Group Health Inc Medicare	$3.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.51
Rate for Payer: Hamaspik Choice Inc Medicare	$4.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.87

TICAGRELOR 90 MG PO TABS

Facility

$9.02

Service Code	NDC 0186077739
Hospital Charge Code	0186077739
Hospital Revenue Code	250
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$7.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.51
Rate for Payer: Aetna Government	$4.51
Rate for Payer: Brighton Health Commercial	$6.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.14
Rate for Payer: EmblemHealth Commercial	$4.51
Rate for Payer: Group Health Inc Commercial	$4.51
Rate for Payer: Group Health Inc Medicare	$3.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.51
Rate for Payer: Hamaspik Choice Inc Medicare	$4.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.87

TICAGRELOR 90 MG PO TABS

Facility

$8.34

Service Code	NDC 6787749160
Hospital Charge Code	6787749160
Hospital Revenue Code	250
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$6.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.17
Rate for Payer: Aetna Government	$4.17
Rate for Payer: Brighton Health Commercial	$6.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.67
Rate for Payer: EmblemHealth Commercial	$4.17
Rate for Payer: Group Health Inc Commercial	$4.17
Rate for Payer: Group Health Inc Medicare	$2.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.17
Rate for Payer: Hamaspik Choice Inc Medicare	$4.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.42

TICAGRELOR 90 MG PO TABS

Facility

$8.34

Service Code	NDC 6787749160
Hospital Charge Code	6787749160
Hospital Revenue Code	250
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$4.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.17

TICAGRELOR 90 MG PO TABS

Facility

$0.17

Service Code	NDC 4265811503
Hospital Charge Code	4265811503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.08
Rate for Payer: Aetna Government	$0.08
Rate for Payer: Brighton Health Commercial	$0.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.11
Rate for Payer: EmblemHealth Commercial	$0.08
Rate for Payer: Group Health Inc Commercial	$0.08
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08
Rate for Payer: Hamaspik Choice Inc Medicare	$0.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

TICAGRELOR 90 MG PO TABS

Facility

$0.45

Service Code	NDC 7220536860
Hospital Charge Code	7220536860
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23

TICAGRELOR 90 MG PO TABS

Facility

$0.17

Service Code	NDC 4265811503
Hospital Charge Code	4265811503
Hospital Revenue Code	250
Min. Negotiated Rate	$0.08
Max. Negotiated Rate	$0.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.08

TIGECYCLINE 50 MG IV SOLR

Facility

$169.02

Service Code	HCPCS J3243
Hospital Charge Code	6050560980
Hospital Revenue Code	258
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$135.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$92.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$126.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$135.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$114.93
Rate for Payer: EmblemHealth Commercial	$84.51
Rate for Payer: Group Health Inc Commercial	$84.51
Rate for Payer: Group Health Inc Medicare	$59.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.51
Rate for Payer: Hamaspik Choice Inc Medicare	$84.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$109.86

TIGECYCLINE 50 MG IV SOLR

Facility

$124.80

Service Code	HCPCS J3243
Hospital Charge Code	7012116477
Hospital Revenue Code	258
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.40

TIGECYCLINE 50 MG IV SOLR

Facility

$120.00

Service Code	HCPCS J3243
Hospital Charge Code	0008499019
Hospital Revenue Code	258
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

TIGECYCLINE 50 MG IV SOLR

Facility

$124.80

Service Code	HCPCS J3243
Hospital Charge Code	7012116477
Hospital Revenue Code	258
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$99.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$68.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$93.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$84.86
Rate for Payer: EmblemHealth Commercial	$62.40
Rate for Payer: Group Health Inc Commercial	$62.40
Rate for Payer: Group Health Inc Medicare	$43.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.40
Rate for Payer: Hamaspik Choice Inc Medicare	$62.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.12

TIGECYCLINE 50 MG IV SOLR

Facility

$120.00

Service Code	HCPCS J3243
Hospital Charge Code	0008499019
Hospital Revenue Code	258
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

TIGECYCLINE 50 MG IV SOLR

Facility

$169.02

Service Code	HCPCS J3243
Hospital Charge Code	6050560980
Hospital Revenue Code	258
Min. Negotiated Rate	$84.51
Max. Negotiated Rate	$84.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$84.51

TIGECYCLINE 50 MG IV SOLR

Facility

$120.00

Service Code	HCPCS J3243
Hospital Charge Code	0008499020
Hospital Revenue Code	258
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$96.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$66.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$96.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$81.60
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Group Health Inc Commercial	$60.00
Rate for Payer: Group Health Inc Medicare	$42.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

TIGECYCLINE 50 MG IV SOLR

Facility

$120.00

Service Code	HCPCS J3243
Hospital Charge Code	0008499020
Hospital Revenue Code	258
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00

TIMOLOL HEMIHYDRATE 0.25 % OP SOLN

Facility

$33.12

Service Code	NDC 7647800105
Hospital Charge Code	7647800105
Hospital Revenue Code	250
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$26.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.56
Rate for Payer: Aetna Government	$16.56
Rate for Payer: Brighton Health Commercial	$24.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.52
Rate for Payer: EmblemHealth Commercial	$16.56
Rate for Payer: Group Health Inc Commercial	$16.56
Rate for Payer: Group Health Inc Medicare	$11.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56
Rate for Payer: Hamaspik Choice Inc Medicare	$16.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.53

TIMOLOL HEMIHYDRATE 0.25 % OP SOLN

Facility

$33.12

Service Code	NDC 7647800105
Hospital Charge Code	7647800105
Hospital Revenue Code	250
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$16.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.56

TIMOLOL MALEATE 0.25 % OP SOLN

Facility

$3.00

Service Code	NDC 6131422605
Hospital Charge Code	6131422605
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

TIMOLOL MALEATE 0.25 % OP SOLN

Facility

$3.00

Service Code	NDC 6131422605
Hospital Charge Code	6131422605
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50

TIMOLOL MALEATE 0.5 % OP SOLN

Facility

$0.91

Service Code	NDC 4257140421
Hospital Charge Code	4257140421
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

TIMOLOL MALEATE 0.5 % OP SOLN

Facility

$0.91

Service Code	NDC 4257140421
Hospital Charge Code	4257140421
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.62
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

TIMOLOL MALEATE 0.5 % OP SOLN

Facility

$3.40

Service Code	NDC 6131422705
Hospital Charge Code	6131422705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70

TIMOLOL MALEATE 0.5 % OP SOLN

Facility

$3.40

Service Code	NDC 6131422705
Hospital Charge Code	6131422705
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$2.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.31
Rate for Payer: EmblemHealth Commercial	$1.70
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.21

TIMOLOL MALEATE 0.5 % OP SOLN (WRAPPED)

Facility

$3.40

Service Code	NDC 6498051405
Hospital Charge Code	6498051405
Hospital Revenue Code	250
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70

TIMOLOL MALEATE 0.5 % OP SOLN (WRAPPED)

Facility

$3.40

Service Code	NDC 6498051405
Hospital Charge Code	6498051405
Hospital Revenue Code	250
Min. Negotiated Rate	$1.19
Max. Negotiated Rate	$2.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$2.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.31
Rate for Payer: EmblemHealth Commercial	$1.70
Rate for Payer: Group Health Inc Commercial	$1.70
Rate for Payer: Group Health Inc Medicare	$1.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.70
Rate for Payer: Hamaspik Choice Inc Medicare	$1.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.21

Know your out-of-pocket cost for care.

All Charges