St. Barnabas Hospital

All Charges

Charge

Type

Price

TOBRAMYCIN 0.3% OPHTHALMIC SOLN

Facility OP

$2.00

Hospital Charge Code	41640461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

TOBRAMYCIN 10 MG/ML INJ NEONATAL

Facility OP

$5.54

Hospital Charge Code	41655554
Hospital Revenue Code	636
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$3.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.77
Rate for Payer: Aetna Government	$2.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.19
Rate for Payer: Group Health Inc Commercial	$2.77
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.60

TOBRAMYCIN 10 MG/ML INJ NEONATAL

Facility OP

$5.54

Hospital Charge Code	41645554
Hospital Revenue Code	636
Min. Negotiated Rate	$1.94
Max. Negotiated Rate	$3.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.77
Rate for Payer: Aetna Government	$2.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.19
Rate for Payer: Group Health Inc Commercial	$2.77
Rate for Payer: Group Health Inc Medicare	$1.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.60

TOBRAMYCIN 10 MG/ML INJ NEONATAL

Facility IP

$5.54

Hospital Charge Code	41655554
Hospital Revenue Code	636
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77

TOBRAMYCIN 10 MG/ML INJ NEONATAL

Facility IP

$5.54

Hospital Charge Code	41645554
Hospital Revenue Code	636
Min. Negotiated Rate	$2.77
Max. Negotiated Rate	$2.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.77
Rate for Payer: Hamaspik Choice Inc Medicare	$2.77

TOBRAMYCIN 1.2G POWDER

Facility OP

$29.05

Service Code	HCPCS J7682
Hospital Charge Code	41648163
Hospital Revenue Code	636
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$38.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.58
Rate for Payer: Aetna Government	$38.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.66
Rate for Payer: Group Health Inc Commercial	$14.52
Rate for Payer: Group Health Inc Medicare	$10.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.52
Rate for Payer: Hamaspik Choice Inc Medicare	$14.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.52
Rate for Payer: SOMOS Essential	$17.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.88

TOBRAMYCIN 1.2G POWDER

Facility OP

$29.05

Service Code	HCPCS J7682
Hospital Charge Code	41658163
Hospital Revenue Code	636
Min. Negotiated Rate	$10.17
Max. Negotiated Rate	$38.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.58
Rate for Payer: Aetna Government	$38.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.66
Rate for Payer: Group Health Inc Commercial	$14.52
Rate for Payer: Group Health Inc Medicare	$10.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.52
Rate for Payer: Hamaspik Choice Inc Medicare	$14.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.52
Rate for Payer: SOMOS Essential	$17.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.88

TOBRAMYCIN 1.2G POWDER

Facility IP

$29.05

Service Code	HCPCS J7682
Hospital Charge Code	41658163
Hospital Revenue Code	636
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$14.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.52
Rate for Payer: Hamaspik Choice Inc Medicare	$14.52

TOBRAMYCIN 1.2G POWDER

Facility IP

$29.05

Service Code	HCPCS J7682
Hospital Charge Code	41648163
Hospital Revenue Code	636
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$14.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.52
Rate for Payer: Hamaspik Choice Inc Medicare	$14.52

TOBRAMYCIN 300 MG/5 ML NEB SOLUTION

Facility OP

$158.00

Service Code	HCPCS J7682
Hospital Charge Code	41655610
Hospital Revenue Code	636
Min. Negotiated Rate	$17.52
Max. Negotiated Rate	$102.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.58
Rate for Payer: Aetna Government	$38.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.66
Rate for Payer: Group Health Inc Commercial	$79.00
Rate for Payer: Group Health Inc Medicare	$55.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.00
Rate for Payer: Hamaspik Choice Inc Medicare	$79.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.52
Rate for Payer: SOMOS Essential	$17.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.70

TOBRAMYCIN 300 MG/5 ML NEB SOLUTION

Facility IP

$158.00

Service Code	HCPCS J7682
Hospital Charge Code	41645610
Hospital Revenue Code	636
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$79.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.00
Rate for Payer: Hamaspik Choice Inc Medicare	$79.00

TOBRAMYCIN 300 MG/5 ML NEB SOLUTION

Facility IP

$158.00

Service Code	HCPCS J7682
Hospital Charge Code	41655610
Hospital Revenue Code	636
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$79.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.00
Rate for Payer: Hamaspik Choice Inc Medicare	$79.00

TOBRAMYCIN 300 MG/5 ML NEB SOLUTION

Facility OP

$158.00

Service Code	HCPCS J7682
Hospital Charge Code	41645610
Hospital Revenue Code	636
Min. Negotiated Rate	$17.52
Max. Negotiated Rate	$102.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$86.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.58
Rate for Payer: Aetna Government	$38.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.85
Rate for Payer: Fidelis CHP/HARP/Medicaid	$26.66
Rate for Payer: Group Health Inc Commercial	$79.00
Rate for Payer: Group Health Inc Medicare	$55.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.00
Rate for Payer: Hamaspik Choice Inc Medicare	$79.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$29.62
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17.52
Rate for Payer: SOMOS Essential	$17.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$102.70

TOBRAMYCIN 40 MG/ML INJ

Facility IP

$55.00

Service Code	HCPCS J3260
Hospital Charge Code	41643320
Hospital Revenue Code	636
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$27.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50

TOBRAMYCIN 40 MG/ML INJ

Facility OP

$55.00

Service Code	HCPCS J3260
Hospital Charge Code	41653320
Hospital Revenue Code	636
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$35.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.39
Rate for Payer: Group Health Inc Commercial	$27.50
Rate for Payer: Group Health Inc Medicare	$19.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.75

TOBRAMYCIN 40 MG/ML INJ

Facility OP

$55.00

Service Code	HCPCS J3260
Hospital Charge Code	41643320
Hospital Revenue Code	636
Min. Negotiated Rate	$2.39
Max. Negotiated Rate	$35.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$30.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.39
Rate for Payer: Group Health Inc Commercial	$27.50
Rate for Payer: Group Health Inc Medicare	$19.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.75

TOBRAMYCIN 40 MG/ML INJ

Facility IP

$55.00

Service Code	HCPCS J3260
Hospital Charge Code	41653320
Hospital Revenue Code	636
Min. Negotiated Rate	$27.50
Max. Negotiated Rate	$27.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.50
Rate for Payer: Hamaspik Choice Inc Medicare	$27.50

TOBRAMYCIN 80 MG/2 ML INJ

Facility IP

$6.61

Service Code	HCPCS J3260
Hospital Charge Code	41652221
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.30
Rate for Payer: Hamaspik Choice Inc Medicare	$3.30

TOBRAMYCIN 80 MG/2 ML INJ

Facility OP

$6.61

Service Code	HCPCS J3260
Hospital Charge Code	41642221
Hospital Revenue Code	636
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.39
Rate for Payer: Group Health Inc Commercial	$3.30
Rate for Payer: Group Health Inc Medicare	$2.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.30
Rate for Payer: Hamaspik Choice Inc Medicare	$3.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.30

TOBRAMYCIN 80 MG/2 ML INJ

Facility IP

$6.61

Service Code	HCPCS J3260
Hospital Charge Code	41642221
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.30
Rate for Payer: Hamaspik Choice Inc Medicare	$3.30

TOBRAMYCIN 80 MG/2 ML INJ

Facility OP

$6.61

Service Code	HCPCS J3260
Hospital Charge Code	41652221
Hospital Revenue Code	636
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$4.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.39
Rate for Payer: Group Health Inc Commercial	$3.30
Rate for Payer: Group Health Inc Medicare	$2.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.30
Rate for Payer: Hamaspik Choice Inc Medicare	$3.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.65
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.71
Rate for Payer: SOMOS Essential	$2.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.30

TOBRAMYCIN 80 MG IVPB PREMIX

Facility IP

$17.45

Hospital Charge Code	41654279
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$8.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

TOBRAMYCIN 80 MG IVPB PREMIX

Facility OP

$17.45

Hospital Charge Code	41654279
Hospital Revenue Code	636
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.03
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.34

TOBRAMYCIN 80 MG IVPB PREMIX

Facility OP

$17.45

Hospital Charge Code	41644279
Hospital Revenue Code	636
Min. Negotiated Rate	$6.11
Max. Negotiated Rate	$11.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.72
Rate for Payer: Aetna Government	$8.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.03
Rate for Payer: Group Health Inc Commercial	$8.72
Rate for Payer: Group Health Inc Medicare	$6.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.34

TOBRAMYCIN 80 MG IVPB PREMIX

Facility IP

$17.45

Hospital Charge Code	41644279
Hospital Revenue Code	636
Min. Negotiated Rate	$8.72
Max. Negotiated Rate	$8.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.72
Rate for Payer: Hamaspik Choice Inc Medicare	$8.72

Price Transparency.

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