St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

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

$1.31

Service Code	NDC 6075880105
Hospital Charge Code	6075880105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.89
Rate for Payer: EmblemHealth Commercial	$0.66
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.85

TIMOLOL MALEATE 0.5 % OP SOLN (WRAPPED)

Facility

$1.31

Service Code	NDC 6075880105
Hospital Charge Code	6075880105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.66
Max. Negotiated Rate	$0.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66

TIMOLOL MALEATE 0.5 % OP SOLN (WRAPPED)

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 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

TIOTROPIUM BROMIDE MONOHYDRATE 2.5 MCG/ACT IN AERS

Facility

$22.50

Service Code	NDC 0597010051
Hospital Charge Code	0597010051
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$11.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.25

TIOTROPIUM BROMIDE MONOHYDRATE 2.5 MCG/ACT IN AERS

Facility

$22.50

Service Code	NDC 0597010051
Hospital Charge Code	0597010051
Hospital Revenue Code	250
Min. Negotiated Rate	$7.88
Max. Negotiated Rate	$18.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.25
Rate for Payer: Aetna Government	$11.25
Rate for Payer: Brighton Health Commercial	$16.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.30
Rate for Payer: EmblemHealth Commercial	$11.25
Rate for Payer: Group Health Inc Commercial	$11.25
Rate for Payer: Group Health Inc Medicare	$7.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.25
Rate for Payer: Hamaspik Choice Inc Medicare	$11.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.62

TIOTROPIUM BROMIDE MONOHYDRATE 2.5 MCG/ACT IN AERS

Facility

$158.22

Service Code	NDC 0597010061
Hospital Charge Code	0597010061
Hospital Revenue Code	250
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$126.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.11
Rate for Payer: Aetna Government	$79.11
Rate for Payer: Brighton Health Commercial	$118.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$126.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.59
Rate for Payer: EmblemHealth Commercial	$79.11
Rate for Payer: Group Health Inc Commercial	$79.11
Rate for Payer: Group Health Inc Medicare	$55.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.11
Rate for Payer: Hamaspik Choice Inc Medicare	$79.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.84

TIOTROPIUM BROMIDE MONOHYDRATE 2.5 MCG/ACT IN AERS

Facility

$158.22

Service Code	NDC 0597010061
Hospital Charge Code	0597010061
Hospital Revenue Code	250
Min. Negotiated Rate	$79.11
Max. Negotiated Rate	$79.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.11

TIPRANAVIR 250 MG PO CAPS

Facility

$20.55

Service Code	NDC 0597000302
Hospital Charge Code	0597000302
Hospital Revenue Code	250
Min. Negotiated Rate	$7.19
Max. Negotiated Rate	$16.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.27
Rate for Payer: Aetna Government	$10.27
Rate for Payer: Brighton Health Commercial	$15.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.97
Rate for Payer: EmblemHealth Commercial	$10.27
Rate for Payer: Group Health Inc Commercial	$10.27
Rate for Payer: Group Health Inc Medicare	$7.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.27
Rate for Payer: Hamaspik Choice Inc Medicare	$10.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.35

TIPRANAVIR 250 MG PO CAPS

Facility

$20.55

Service Code	NDC 0597000302
Hospital Charge Code	0597000302
Hospital Revenue Code	250
Min. Negotiated Rate	$10.27
Max. Negotiated Rate	$10.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.27

TIRZEPATIDE 5 MG/0.5ML SC SOAJ

Facility

$641.45

Service Code	NDC 0002149580
Hospital Charge Code	0002149580
Hospital Revenue Code	250
Min. Negotiated Rate	$320.73
Max. Negotiated Rate	$320.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.73

TIRZEPATIDE 5 MG/0.5ML SC SOAJ

Facility

$641.45

Service Code	NDC 0002149580
Hospital Charge Code	0002149580
Hospital Revenue Code	250
Min. Negotiated Rate	$224.51
Max. Negotiated Rate	$513.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$352.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$320.73
Rate for Payer: Aetna Government	$320.73
Rate for Payer: Brighton Health Commercial	$481.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$513.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$436.19
Rate for Payer: EmblemHealth Commercial	$320.73
Rate for Payer: Group Health Inc Commercial	$320.73
Rate for Payer: Group Health Inc Medicare	$224.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.73
Rate for Payer: Hamaspik Choice Inc Medicare	$320.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$416.94

TIRZEPATIDE 5 MG/0.5ML SC SOAJ

Facility

$641.44

Service Code	NDC 0002149501
Hospital Charge Code	0002149501
Hospital Revenue Code	250
Min. Negotiated Rate	$224.50
Max. Negotiated Rate	$513.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$352.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$320.72
Rate for Payer: Aetna Government	$320.72
Rate for Payer: Brighton Health Commercial	$481.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$513.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$436.18
Rate for Payer: EmblemHealth Commercial	$320.72
Rate for Payer: Group Health Inc Commercial	$320.72
Rate for Payer: Group Health Inc Medicare	$224.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.72
Rate for Payer: Hamaspik Choice Inc Medicare	$320.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$416.94

TIRZEPATIDE 5 MG/0.5ML SC SOAJ

Facility

$641.44

Service Code	NDC 0002149501
Hospital Charge Code	0002149501
Hospital Revenue Code	250
Min. Negotiated Rate	$320.72
Max. Negotiated Rate	$320.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$320.72

TIXAGEVIMAB & CILGAVIMAB 150 & 150 MG/1.5ML IM SOLN

Facility

$0.00

Service Code	NDC 0310744202
Hospital Charge Code	0310744202
Hospital Revenue Code	250
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00

TIXAGEVIMAB & CILGAVIMAB 150 & 150 MG/1.5ML IM SOLN

Facility

$0.00

Service Code	NDC 0310744202
Hospital Charge Code	0310744202
Hospital Revenue Code	250
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.00
Rate for Payer: Aetna Government	$0.00
Rate for Payer: Brighton Health Commercial	$0.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.00
Rate for Payer: EmblemHealth Commercial	$0.00
Rate for Payer: Group Health Inc Commercial	$0.00
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.00
Rate for Payer: Hamaspik Choice Inc Medicare	$0.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.00

TOBRAMYCIN 0.3 % OP OINT

Facility

$87.35

Service Code	NDC 0078081301
Hospital Charge Code	0078081301
Hospital Revenue Code	250
Min. Negotiated Rate	$30.57
Max. Negotiated Rate	$69.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.68
Rate for Payer: Aetna Government	$43.68
Rate for Payer: Brighton Health Commercial	$65.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$69.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.40
Rate for Payer: EmblemHealth Commercial	$43.68
Rate for Payer: Group Health Inc Commercial	$43.68
Rate for Payer: Group Health Inc Medicare	$30.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.68
Rate for Payer: Hamaspik Choice Inc Medicare	$43.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.78

TOBRAMYCIN 0.3 % OP OINT

Facility

$87.35

Service Code	NDC 0078081301
Hospital Charge Code	0078081301
Hospital Revenue Code	250
Min. Negotiated Rate	$43.68
Max. Negotiated Rate	$43.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.68

TOBRAMYCIN 0.3 % OP SOLN

Facility

$6.80

Service Code	NDC 6233251805
Hospital Charge Code	6233251805
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.40

TOBRAMYCIN 0.3 % OP SOLN

Facility

$1.25

Service Code	NDC 7006913101
Hospital Charge Code	7006913101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$1.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.85
Rate for Payer: EmblemHealth Commercial	$0.63
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.81

TOBRAMYCIN 0.3 % OP SOLN

Facility

$1.25

Service Code	NDC 7006913101
Hospital Charge Code	7006913101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63

TOBRAMYCIN 0.3 % OP SOLN

Facility

$6.80

Service Code	NDC 6233251805
Hospital Charge Code	6233251805
Hospital Revenue Code	250
Min. Negotiated Rate	$2.38
Max. Negotiated Rate	$5.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.40
Rate for Payer: Aetna Government	$3.40
Rate for Payer: Brighton Health Commercial	$5.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.62
Rate for Payer: EmblemHealth Commercial	$3.40
Rate for Payer: Group Health Inc Commercial	$3.40
Rate for Payer: Group Health Inc Medicare	$2.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.40
Rate for Payer: Hamaspik Choice Inc Medicare	$3.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.42

TOBRAMYCIN 0.3 % OP SOLN

Facility

$2.82

Service Code	NDC 2420829005
Hospital Charge Code	2420829005
Hospital Revenue Code	250
Min. Negotiated Rate	$1.41
Max. Negotiated Rate	$1.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.41

Know your out-of-pocket cost for care.

All Charges