St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TIB TRI AUG

Facility

$3,896.25

Service Code	HCPCS C1776
Hospital Charge Code	64907218
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,091.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,142.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,337.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,948.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,240.34
Rate for Payer: EmblemHealth Commercial	$1,948.12
Rate for Payer: Fidelis Medicare Advantage	$4,091.06
Rate for Payer: Group Health Inc Commercial	$1,948.12
Rate for Payer: Group Health Inc Medicare	$1,363.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,948.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,948.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,532.56

TIB TRI AUG

Facility

$3,896.25

Service Code	HCPCS C1776
Hospital Charge Code	64907218
Hospital Revenue Code	278
Min. Negotiated Rate	$1,948.12
Max. Negotiated Rate	$1,948.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,948.12
Rate for Payer: Hamaspik Choice Inc Medicare	$1,948.12

TIBULA, CEMENT 5 DEG SZ D L

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905519
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: EmblemHealth Commercial	$2,500.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

TIBULA, CEMENT 5 DEG SZ D L

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905519
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

TIBULA, CEMENT 5 DEG SZ E L

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905510
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$5,250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,750.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$3,000.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,500.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,875.00
Rate for Payer: EmblemHealth Commercial	$2,500.00
Rate for Payer: Fidelis Medicare Advantage	$5,250.00
Rate for Payer: Group Health Inc Commercial	$2,500.00
Rate for Payer: Group Health Inc Medicare	$1,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,250.00

TIBULA, CEMENT 5 DEG SZ E L

Facility

$5,000.00

Service Code	HCPCS C1713
Hospital Charge Code	64905510
Hospital Revenue Code	278
Min. Negotiated Rate	$2,500.00
Max. Negotiated Rate	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,500.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,500.00

TIBULA CMNTD PSN STM 5 DEG SZ D L

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204604
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

TIBULA CMNTD PSN STM 5 DEG SZ D L

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204604
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,640.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: EmblemHealth Commercial	$2,200.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TIBULA CMNTD PSN STM 5 DEG SZ E L

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204596
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

TIBULA CMNTD PSN STM 5 DEG SZ E L

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40204596
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,640.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: EmblemHealth Commercial	$2,200.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TIBULA,CMTD PSA STM 5 DEG SZ E L

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007515
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,640.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: EmblemHealth Commercial	$2,200.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TIBULA,CMTD PSA STM 5 DEG SZ E L

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007515
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

TIBULA,CMTD PSN STM 5 DEG SZ D L

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007523
Hospital Revenue Code	278
Min. Negotiated Rate	$2,200.00
Max. Negotiated Rate	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00

TIBULA,CMTD PSN STM 5 DEG SZ D L

Facility

$4,400.00

Service Code	HCPCS C1776
Hospital Charge Code	40007523
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$4,620.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,420.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$2,640.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,530.00
Rate for Payer: EmblemHealth Commercial	$2,200.00
Rate for Payer: Fidelis Medicare Advantage	$4,620.00
Rate for Payer: Group Health Inc Commercial	$2,200.00
Rate for Payer: Group Health Inc Medicare	$1,540.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,200.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,860.00

TICAGRELOR 60 MG PO TABS [130191]

Facility

$9.02

Service Code	NDC 00186077660
Hospital Charge Code	00186077660
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: 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 [110427]

Facility

$9.02

Service Code	NDC 00186077739
Hospital Charge Code	00186077739
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: 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 [110427]

Facility

$9.02

Service Code	NDC 00186077760
Hospital Charge Code	00186077760
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: 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 90MG TABLET

Facility

$7.56

Hospital Charge Code	41657008
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.78
Rate for Payer: Aetna Government	$3.78
Rate for Payer: Brighton Health Commercial	$5.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.14
Rate for Payer: Group Health Inc Commercial	$3.78
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.78
Rate for Payer: Hamaspik Choice Inc Medicare	$3.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.91

TICAGRELOR 90MG TABLET

Facility

$7.56

Hospital Charge Code	41647008
Hospital Revenue Code	250
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$6.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.78
Rate for Payer: Aetna Government	$3.78
Rate for Payer: Brighton Health Commercial	$5.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.14
Rate for Payer: Group Health Inc Commercial	$3.78
Rate for Payer: Group Health Inc Medicare	$2.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.78
Rate for Payer: Hamaspik Choice Inc Medicare	$3.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.91

TICAGRELOR - NF- ASTRAZENECA

Facility

$15.95

Hospital Charge Code	41650217
Hospital Revenue Code	250
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$12.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.98
Rate for Payer: Aetna Government	$7.98
Rate for Payer: Brighton Health Commercial	$11.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.85
Rate for Payer: Group Health Inc Commercial	$7.98
Rate for Payer: Group Health Inc Medicare	$5.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.98
Rate for Payer: Hamaspik Choice Inc Medicare	$7.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.37

TICAGRELOR - NF- ASTRAZENECA

Facility

$15.95

Hospital Charge Code	41640217
Hospital Revenue Code	250
Min. Negotiated Rate	$5.58
Max. Negotiated Rate	$12.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.98
Rate for Payer: Aetna Government	$7.98
Rate for Payer: Brighton Health Commercial	$11.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.85
Rate for Payer: Group Health Inc Commercial	$7.98
Rate for Payer: Group Health Inc Medicare	$5.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.98
Rate for Payer: Hamaspik Choice Inc Medicare	$7.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.37

TICRON BLUE SUTURE

Facility

$207.90

Hospital Charge Code	64907077
Hospital Revenue Code	270
Min. Negotiated Rate	$72.76
Max. Negotiated Rate	$166.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$114.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$103.95
Rate for Payer: Aetna Government	$103.95
Rate for Payer: Brighton Health Commercial	$155.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$166.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$141.37
Rate for Payer: Group Health Inc Commercial	$103.95
Rate for Payer: Group Health Inc Medicare	$72.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$103.95
Rate for Payer: Hamaspik Choice Inc Medicare	$103.95

TIDAL DRAINAGE SET

Facility

$6.03

Hospital Charge Code	40206030
Hospital Revenue Code	270
Min. Negotiated Rate	$2.11
Max. Negotiated Rate	$4.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.02
Rate for Payer: Aetna Government	$3.02
Rate for Payer: Brighton Health Commercial	$4.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.10
Rate for Payer: Group Health Inc Commercial	$3.02
Rate for Payer: Group Health Inc Medicare	$2.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.02
Rate for Payer: Hamaspik Choice Inc Medicare	$3.02

TIGECYCLINE 100MG/D5W 100ML - 1MG

Facility

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41658422
Hospital Revenue Code	636
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$5.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.12
Rate for Payer: Aetna Government	$1.12
Rate for Payer: Brighton Health Commercial	$4.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.60
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.71
Rate for Payer: SOMOS Essential	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

TIGECYCLINE 100MG/D5W 100ML - 1MG

Facility

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41658422
Hospital Revenue Code	636
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$4.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00

Know your out-of-pocket cost for care.

All Charges