St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TOBRAMYCIN 0.3 % OP SOLN [124422]

Facility

$6.80

Service Code	NDC 62332051805
Hospital Charge Code	62332051805
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: 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 [124422]

Facility

$2.82

Service Code	NDC 24208029005
Hospital Charge Code	24208029005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.41
Rate for Payer: Aetna Government	$1.41
Rate for Payer: Brighton Health Commercial	$2.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.92
Rate for Payer: Group Health Inc Commercial	$1.41
Rate for Payer: Group Health Inc Medicare	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.41
Rate for Payer: Hamaspik Choice Inc Medicare	$1.41
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.83

TOBRAMYCIN 10 MG/ML INJ NEONATAL

Facility

$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: Brighton Health Commercial	$3.32
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

$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 10 MG/ML INJ NEONATAL

Facility

$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: Brighton Health Commercial	$3.32
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

$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 1.2G POWDER

Facility

$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

$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: Brighton Health Commercial	$17.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.70
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: 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

$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: Brighton Health Commercial	$17.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.70
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: 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

$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/5ML IN NEBU [22240]

Facility

$35.30

Service Code	HCPCS J7682
Hospital Charge Code	00078049471
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$16.53
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$17.52
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$17.52
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$17.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.94

TOBRAMYCIN 300 MG/5 ML NEB SOLUTION

Facility

$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

$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: Brighton Health Commercial	$94.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.85
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: 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

$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: Brighton Health Commercial	$94.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$90.85
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: 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

$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 40 MG/ML INJ

Facility

$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

$55.00

Service Code	HCPCS J3260
Hospital Charge Code	41653320
Hospital Revenue Code	636
Min. Negotiated Rate	$2.71
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: Brighton Health Commercial	$33.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
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: 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

$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 40 MG/ML INJ

Facility

$55.00

Service Code	HCPCS J3260
Hospital Charge Code	41643320
Hospital Revenue Code	636
Min. Negotiated Rate	$2.71
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: Brighton Health Commercial	$33.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$31.62
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: 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 80 MG/2 ML INJ

Facility

$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: Brighton Health Commercial	$3.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.80
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: 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

$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: Brighton Health Commercial	$3.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.80
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: 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

$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

$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 IVPB PREMIX

Facility

$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

TOBRAMYCIN 80 MG IVPB PREMIX

Facility

$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: Brighton Health Commercial	$10.47
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

Know your out-of-pocket cost for care.

All Charges