St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TIGECYCLINE 100MG/DW 100ML - 1MG

Facility

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41648422
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/DW 100ML - 1MG

Facility

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41648422
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

TIGECYCLINE 50 MG INJ

Facility

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41644782
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

TIGECYCLINE 50 MG INJ

Facility

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41654782
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 50 MG INJ

Facility

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41654782
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

TIGECYCLINE 50 MG INJ

Facility

$8.00

Service Code	HCPCS J3243
Hospital Charge Code	41644782
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 50 MG IV SOLR [41652]

Facility

$120.00

Service Code	HCPCS J3243
Hospital Charge Code	00008499020
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$126.00
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	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Fidelis Medicare Advantage	$126.00
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

TIGECYCLINE 50 MG IV SOLR [41652]

Facility

$120.00

Service Code	HCPCS J3243
Hospital Charge Code	00008499019
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$126.00
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	$72.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.00
Rate for Payer: EmblemHealth Commercial	$60.00
Rate for Payer: Fidelis Medicare Advantage	$126.00
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$78.00

TIGECYCLINE 50 MG IV SOLR [41652]

Facility

$120.00

Service Code	HCPCS J3243
Hospital Charge Code	00008499019
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

TIGECYCLINE 50 MG IV SOLR [41652]

Facility

$124.80

Service Code	HCPCS J3243
Hospital Charge Code	70121164707
Hospital Revenue Code	278
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$131.04
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	$74.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$71.76
Rate for Payer: EmblemHealth Commercial	$62.40
Rate for Payer: Fidelis Medicare Advantage	$131.04
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$81.12

TIGECYCLINE 50 MG IV SOLR [41652]

Facility

$120.00

Service Code	HCPCS J3243
Hospital Charge Code	00008499020
Hospital Revenue Code	278
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$60.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$60.00
Rate for Payer: Hamaspik Choice Inc Medicare	$60.00

TIGECYCLINE 50 MG IV SOLR [41652]

Facility

$124.80

Service Code	HCPCS J3243
Hospital Charge Code	70121164707
Hospital Revenue Code	278
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$62.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$62.40
Rate for Payer: Hamaspik Choice Inc Medicare	$62.40

TIGEMINAL NERVE

Facility

$792.83

Service Code	HCPCS 64400
Hospital Charge Code	30105540
Hospital Revenue Code	450
Min. Negotiated Rate	$165.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Brighton Health Commercial	$874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid	$342.51
Rate for Payer: Carelon Behavioral Health Medicare Advantage	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$342.51
Rate for Payer: EmblemHealth Commercial	$525.00
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
Rate for Payer: Group Health Inc Commercial	$525.00
Rate for Payer: Group Health Inc Medicare	$525.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$165.00
Rate for Payer: Healthfirst Medicare Advantage	$225.00
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$342.51
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

TIGEMINAL NERVE

Facility

$792.83

Service Code	HCPCS 64400
Hospital Charge Code	30305020
Hospital Revenue Code	510
Min. Negotiated Rate	$233.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$342.51
Rate for Payer: Aetna Government	$342.51
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Cash Price	$342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$342.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$342.51
Rate for Payer: Fidelis Essential Plan Aliesa	$291.13
Rate for Payer: Fidelis Essential Plan QHP	$304.83
Rate for Payer: Fidelis Medicare Advantage	$342.51
Rate for Payer: Fidelis Qualified Health Plan	$304.83
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$396.42
Rate for Payer: Hamaspik Choice Inc Medicare	$342.51
Rate for Payer: Healthfirst Medicare Advantage	$291.13
Rate for Payer: Healthfirst QHP	$342.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$342.51
Rate for Payer: Senior Whole Health Medicare Advantage	$342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid	$274.01
Rate for Payer: Wellcare Medicare	$325.38

TIGEMINAL NERVE

Facility

$792.83

Service Code	HCPCS 64400
Hospital Charge Code	30305020
Hospital Revenue Code	510
Rate for Payer: Cash Price	$342.51

TIGEMINAL NERVE

Facility

$792.83

Service Code	HCPCS 64400
Hospital Charge Code	30105540
Hospital Revenue Code	450
Rate for Payer: Cash Price	$342.51

TIGERLOOP

Facility

$13.44

Hospital Charge Code	64905873
Hospital Revenue Code	270
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$10.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.72
Rate for Payer: Aetna Government	$6.72
Rate for Payer: Brighton Health Commercial	$10.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.14
Rate for Payer: Group Health Inc Commercial	$6.72
Rate for Payer: Group Health Inc Medicare	$4.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.72
Rate for Payer: Hamaspik Choice Inc Medicare	$6.72

TIGER NEEDLE EXPRESS

Facility

$450.00

Hospital Charge Code	64906037
Hospital Revenue Code	270
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$360.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$247.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$225.00
Rate for Payer: Aetna Government	$225.00
Rate for Payer: Brighton Health Commercial	$337.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$360.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$306.00
Rate for Payer: Group Health Inc Commercial	$225.00
Rate for Payer: Group Health Inc Medicare	$157.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$225.00
Rate for Payer: Hamaspik Choice Inc Medicare	$225.00

TIGHTROPE BUTTON EXT

Facility

$805.00

Hospital Charge Code	64905887
Hospital Revenue Code	270
Min. Negotiated Rate	$281.75
Max. Negotiated Rate	$644.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$442.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$402.50
Rate for Payer: Aetna Government	$402.50
Rate for Payer: Brighton Health Commercial	$603.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$644.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$547.40
Rate for Payer: Group Health Inc Commercial	$402.50
Rate for Payer: Group Health Inc Medicare	$281.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$402.50
Rate for Payer: Hamaspik Choice Inc Medicare	$402.50

TIGHTROPE SYNDESMOSIS XP 8925

Facility

$2,990.00

Hospital Charge Code	64906656
Hospital Revenue Code	279
Min. Negotiated Rate	$1,046.50
Max. Negotiated Rate	$2,392.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,644.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,495.00
Rate for Payer: Aetna Government	$1,495.00
Rate for Payer: Brighton Health Commercial	$2,242.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,392.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,033.20
Rate for Payer: Group Health Inc Commercial	$1,495.00
Rate for Payer: Group Health Inc Medicare	$1,046.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,495.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,495.00

TI IM SPLINT MEDIUM-4MM WIDTH

Facility

$900.00

Hospital Charge Code	40209500
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

TI IM SPLINT SMALL-3 MM WIDTH

Facility

$900.00

Hospital Charge Code	40209499
Hospital Revenue Code	270
Min. Negotiated Rate	$315.00
Max. Negotiated Rate	$720.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$495.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$450.00
Rate for Payer: Aetna Government	$450.00
Rate for Payer: Brighton Health Commercial	$675.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$720.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$612.00
Rate for Payer: Group Health Inc Commercial	$450.00
Rate for Payer: Group Health Inc Medicare	$315.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$450.00
Rate for Payer: Hamaspik Choice Inc Medicare	$450.00

TI MATRIX MIDFACE SCRW SLF D 4MM

Facility

$164.00

Service Code	HCPCS C1776
Hospital Charge Code	40205118
Hospital Revenue Code	278
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$82.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00

TI MATRIX MIDFACE SCRW SLF D 4MM

Facility

$164.00

Service Code	HCPCS C1776
Hospital Charge Code	40205118
Hospital Revenue Code	278
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$339.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$90.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$98.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$82.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$94.30
Rate for Payer: EmblemHealth Commercial	$82.00
Rate for Payer: Fidelis Medicare Advantage	$172.20
Rate for Payer: Group Health Inc Commercial	$82.00
Rate for Payer: Group Health Inc Medicare	$57.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$82.00
Rate for Payer: Hamaspik Choice Inc Medicare	$82.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.60

TIME OUT BAG PBTO

Facility

$140.90

Hospital Charge Code	64905077
Hospital Revenue Code	270
Min. Negotiated Rate	$49.32
Max. Negotiated Rate	$112.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$77.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$70.45
Rate for Payer: Aetna Government	$70.45
Rate for Payer: Brighton Health Commercial	$105.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$112.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$95.81
Rate for Payer: Group Health Inc Commercial	$70.45
Rate for Payer: Group Health Inc Medicare	$49.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$70.45
Rate for Payer: Hamaspik Choice Inc Medicare	$70.45

Know your out-of-pocket cost for care.

All Charges