St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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 300 MG/5ML IN NEBU

Facility

$35.30

Service Code	HCPCS J7682
Hospital Charge Code	0078049471
Hospital Revenue Code	250
Min. Negotiated Rate	$17.65
Max. Negotiated Rate	$17.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.65

TOBRAMYCIN 300 MG/5ML IN NEBU

Facility

$35.30

Service Code	HCPCS J7682
Hospital Charge Code	0078049471
Hospital Revenue Code	250
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$38.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.58
Rate for Payer: Aetna Government	$38.58
Rate for Payer: Brighton Health Commercial	$26.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.00
Rate for Payer: EmblemHealth Commercial	$17.65
Rate for Payer: Group Health Inc Commercial	$17.65
Rate for Payer: Group Health Inc Medicare	$12.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.65
Rate for Payer: Hamaspik Choice Inc Medicare	$17.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.94

TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT

Facility

$93.00

Service Code	NDC 0078087601
Hospital Charge Code	0078087601
Hospital Revenue Code	250
Min. Negotiated Rate	$32.55
Max. Negotiated Rate	$74.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$51.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$46.50
Rate for Payer: Aetna Government	$46.50
Rate for Payer: Brighton Health Commercial	$69.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$74.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$63.24
Rate for Payer: EmblemHealth Commercial	$46.50
Rate for Payer: Group Health Inc Commercial	$46.50
Rate for Payer: Group Health Inc Medicare	$32.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.50
Rate for Payer: Hamaspik Choice Inc Medicare	$46.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$60.45

TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP OINT

Facility

$93.00

Service Code	NDC 0078087601
Hospital Charge Code	0078087601
Hospital Revenue Code	250
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$46.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$46.50

TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP

Facility

$24.27

Service Code	NDC 2420829525
Hospital Charge Code	2420829525
Hospital Revenue Code	250
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$19.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.14
Rate for Payer: Aetna Government	$12.14
Rate for Payer: Brighton Health Commercial	$18.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.50
Rate for Payer: EmblemHealth Commercial	$12.14
Rate for Payer: Group Health Inc Commercial	$12.14
Rate for Payer: Group Health Inc Medicare	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.14
Rate for Payer: Hamaspik Choice Inc Medicare	$12.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.78

TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP

Facility

$24.27

Service Code	NDC 2420829525
Hospital Charge Code	2420829525
Hospital Revenue Code	250
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$12.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.14

TOBRAMYCIN SULFATE 1.2 G IJ SOLR

Facility

$100.00

Service Code	HCPCS J3260
Hospital Charge Code	3982204121
Hospital Revenue Code	250
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$50.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00

TOBRAMYCIN SULFATE 1.2 G IJ SOLR

Facility

$100.00

Service Code	HCPCS J3260
Hospital Charge Code	3982204121
Hospital Revenue Code	250
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Brighton Health Commercial	$75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$80.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$68.00
Rate for Payer: EmblemHealth Commercial	$50.00
Rate for Payer: Group Health Inc Commercial	$50.00
Rate for Payer: Group Health Inc Medicare	$35.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.00
Rate for Payer: Hamaspik Choice Inc Medicare	$50.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$65.00

TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN

Facility

$0.88

Service Code	HCPCS J3260
Hospital Charge Code	6332330630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: EmblemHealth Commercial	$0.44
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

TOBRAMYCIN SULFATE 1.2 GM/30ML IJ SOLN

Facility

$0.88

Service Code	HCPCS J3260
Hospital Charge Code	6332330630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44

TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN

Facility

$0.93

Service Code	HCPCS J3260
Hospital Charge Code	6332330626
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47

TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN

Facility

$1.19

Service Code	HCPCS J3260
Hospital Charge Code	6745747300
Hospital Revenue Code	250
Min. Negotiated Rate	$0.59
Max. Negotiated Rate	$0.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59

TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN

Facility

$1.19

Service Code	HCPCS J3260
Hospital Charge Code	6745747300
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Brighton Health Commercial	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: EmblemHealth Commercial	$0.59
Rate for Payer: Group Health Inc Commercial	$0.59
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.59
Rate for Payer: Hamaspik Choice Inc Medicare	$0.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.77

TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN

Facility

$0.93

Service Code	HCPCS J3260
Hospital Charge Code	6332330626
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Brighton Health Commercial	$0.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.63
Rate for Payer: EmblemHealth Commercial	$0.47
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.60

TOCILIZUMAB 400 MG/20ML IV SOLN

Facility

$159.35

Service Code	HCPCS J3262
Hospital Charge Code	5024213701
Hospital Revenue Code	258
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$127.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.71
Rate for Payer: Aetna Government	$5.71
Rate for Payer: Affinity Essential Plan 1&2	$4.00
Rate for Payer: Affinity Essential Plan 3&4	$4.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.00
Rate for Payer: Brighton Health Commercial	$119.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.36
Rate for Payer: Elderplan Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$5.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.14
Rate for Payer: Fidelis Essential Plan Aliesa	$4.85
Rate for Payer: Fidelis Essential Plan QHP	$5.08
Rate for Payer: Fidelis Medicare Advantage	$5.71
Rate for Payer: Fidelis Qualified Health Plan	$5.08
Rate for Payer: Group Health Inc Commercial	$5.71
Rate for Payer: Group Health Inc Medicare	$5.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.71
Rate for Payer: Hamaspik Choice Inc Medicare	$5.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.71
Rate for Payer: Healthfirst Medicare Advantage	$4.85
Rate for Payer: Healthfirst QHP	$5.71
Rate for Payer: Humana Medicare	$5.82
Rate for Payer: Senior Whole Health Medicare Advantage	$5.71
Rate for Payer: United Healthcare Medicare Advantage	$5.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.42
Rate for Payer: Wellcare Medicare	$5.42

TOCILIZUMAB 400 MG/20ML IV SOLN

Facility

$159.35

Service Code	HCPCS J3262
Hospital Charge Code	5024213701
Hospital Revenue Code	258
Min. Negotiated Rate	$79.67
Max. Negotiated Rate	$79.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.67

TOCILIZUMAB 80 MG/4ML IV SOLN

Facility

$159.35

Service Code	HCPCS J3262
Hospital Charge Code	5024213501
Hospital Revenue Code	258
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$127.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.71
Rate for Payer: Aetna Government	$5.71
Rate for Payer: Affinity Essential Plan 1&2	$4.00
Rate for Payer: Affinity Essential Plan 3&4	$4.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.00
Rate for Payer: Brighton Health Commercial	$119.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$5.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.36
Rate for Payer: Elderplan Medicare Advantage	$5.71
Rate for Payer: EmblemHealth Commercial	$5.71
Rate for Payer: Fidelis CHP/HARP/Medicaid	$5.14
Rate for Payer: Fidelis Essential Plan Aliesa	$4.85
Rate for Payer: Fidelis Essential Plan QHP	$5.08
Rate for Payer: Fidelis Medicare Advantage	$5.71
Rate for Payer: Fidelis Qualified Health Plan	$5.08
Rate for Payer: Group Health Inc Commercial	$5.71
Rate for Payer: Group Health Inc Medicare	$5.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.71
Rate for Payer: Hamaspik Choice Inc Medicare	$5.71
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$5.71
Rate for Payer: Healthfirst Medicare Advantage	$4.85
Rate for Payer: Healthfirst QHP	$5.71
Rate for Payer: Humana Medicare	$5.82
Rate for Payer: Senior Whole Health Medicare Advantage	$5.71
Rate for Payer: United Healthcare Medicare Advantage	$5.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.42
Rate for Payer: Wellcare Medicare	$5.42

TOCILIZUMAB 80 MG/4ML IV SOLN

Facility

$159.35

Service Code	HCPCS J3262
Hospital Charge Code	5024213501
Hospital Revenue Code	258
Min. Negotiated Rate	$79.67
Max. Negotiated Rate	$79.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.67

TOLVAPTAN 15 MG PO TABS

Facility

$561.78

Service Code	NDC 4988476854
Hospital Charge Code	4988476854
Hospital Revenue Code	250
Min. Negotiated Rate	$280.89
Max. Negotiated Rate	$280.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.89

TOLVAPTAN 15 MG PO TABS

Facility

$561.78

Service Code	NDC 4988476854
Hospital Charge Code	4988476854
Hospital Revenue Code	250
Min. Negotiated Rate	$196.62
Max. Negotiated Rate	$449.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$280.89
Rate for Payer: Aetna Government	$280.89
Rate for Payer: Brighton Health Commercial	$421.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.01
Rate for Payer: EmblemHealth Commercial	$280.89
Rate for Payer: Group Health Inc Commercial	$280.89
Rate for Payer: Group Health Inc Medicare	$196.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.89
Rate for Payer: Hamaspik Choice Inc Medicare	$280.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$365.16

TOLVAPTAN 15 MG PO TABS

Facility

$624.24

Service Code	NDC 5914802050
Hospital Charge Code	5914802050
Hospital Revenue Code	250
Min. Negotiated Rate	$218.48
Max. Negotiated Rate	$499.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.12
Rate for Payer: Aetna Government	$312.12
Rate for Payer: Brighton Health Commercial	$468.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$499.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.48
Rate for Payer: EmblemHealth Commercial	$312.12
Rate for Payer: Group Health Inc Commercial	$312.12
Rate for Payer: Group Health Inc Medicare	$218.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.12
Rate for Payer: Hamaspik Choice Inc Medicare	$312.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$405.75

TOLVAPTAN 15 MG PO TABS

Facility

$624.24

Service Code	NDC 5914802050
Hospital Charge Code	5914802050
Hospital Revenue Code	250
Min. Negotiated Rate	$312.12
Max. Negotiated Rate	$312.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.12

TOLVAPTAN 30 MG PO TABS

Facility

$647.57

Service Code	NDC 5914802150
Hospital Charge Code	5914802150
Hospital Revenue Code	250
Min. Negotiated Rate	$323.79
Max. Negotiated Rate	$323.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$323.79

TOLVAPTAN 30 MG PO TABS

Facility

$647.57

Service Code	NDC 5914802150
Hospital Charge Code	5914802150
Hospital Revenue Code	250
Min. Negotiated Rate	$226.65
Max. Negotiated Rate	$518.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$356.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$323.79
Rate for Payer: Aetna Government	$323.79
Rate for Payer: Brighton Health Commercial	$485.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$518.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.35
Rate for Payer: EmblemHealth Commercial	$323.79
Rate for Payer: Group Health Inc Commercial	$323.79
Rate for Payer: Group Health Inc Medicare	$226.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$323.79
Rate for Payer: Hamaspik Choice Inc Medicare	$323.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$420.92

Know your out-of-pocket cost for care.

All Charges