St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TOLVAPTAN 30 MG PO TABS

Facility

$582.75

Service Code	NDC 3172286903
Hospital Charge Code	3172286903
Hospital Revenue Code	250
Min. Negotiated Rate	$291.38
Max. Negotiated Rate	$291.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$291.38

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

Tonsil & adenoid procedures

Facility

$40,532.51

Service Code	APR-DRG 0971
Min. Negotiated Rate	$5,472.00
Max. Negotiated Rate	$40,532.51
Rate for Payer: Affinity Essential Plan 1&2	$40,532.51
Rate for Payer: Affinity Essential Plan 3&4	$40,532.51
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,014.45
Rate for Payer: Amida Care Medicaid	$18,014.45
Rate for Payer: EmblemHealth Essential Plan 1&2	$40,532.51
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,014.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,014.45
Rate for Payer: Fidelis Qualified Health Plan	$21,617.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,014.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,014.45
Rate for Payer: Healthfirst Commercial	$9,684.00
Rate for Payer: Healthfirst Essential Plan	$40,532.51
Rate for Payer: Healthfirst QHP	$5,472.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,014.45
Rate for Payer: SOMOS Essential	$40,532.51
Rate for Payer: United Healthcare Essential Plan 1&2	$40,532.51
Rate for Payer: United Healthcare Essential Plan 3&4	$40,532.51
Rate for Payer: United Healthcare Medicaid	$18,014.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,014.45

Tonsil & adenoid procedures

Facility

$44,162.57

Service Code	APR-DRG 0972
Min. Negotiated Rate	$7,669.00
Max. Negotiated Rate	$44,162.57
Rate for Payer: Affinity Essential Plan 1&2	$44,162.57
Rate for Payer: Affinity Essential Plan 3&4	$44,162.57
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,627.81
Rate for Payer: Amida Care Medicaid	$19,627.81
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,162.57
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,627.81
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,627.81
Rate for Payer: Fidelis Qualified Health Plan	$23,553.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,627.81
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,627.81
Rate for Payer: Healthfirst Commercial	$13,001.00
Rate for Payer: Healthfirst Essential Plan	$44,162.57
Rate for Payer: Healthfirst QHP	$7,669.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,627.81
Rate for Payer: SOMOS Essential	$44,162.57
Rate for Payer: United Healthcare Essential Plan 1&2	$44,162.57
Rate for Payer: United Healthcare Essential Plan 3&4	$44,162.57
Rate for Payer: United Healthcare Medicaid	$19,627.81
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,627.81

Tonsil & adenoid procedures

Facility

$58,030.29

Service Code	APR-DRG 0973
Min. Negotiated Rate	$14,506.00
Max. Negotiated Rate	$58,030.29
Rate for Payer: Affinity Essential Plan 1&2	$58,030.29
Rate for Payer: Affinity Essential Plan 3&4	$58,030.29
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,791.24
Rate for Payer: Amida Care Medicaid	$25,791.24
Rate for Payer: EmblemHealth Essential Plan 1&2	$58,030.29
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,791.24
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,791.24
Rate for Payer: Fidelis Qualified Health Plan	$30,949.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,791.24
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,791.24
Rate for Payer: Healthfirst Commercial	$26,419.00
Rate for Payer: Healthfirst Essential Plan	$58,030.29
Rate for Payer: Healthfirst QHP	$14,506.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,791.24
Rate for Payer: SOMOS Essential	$58,030.29
Rate for Payer: United Healthcare Essential Plan 1&2	$58,030.29
Rate for Payer: United Healthcare Essential Plan 3&4	$58,030.29
Rate for Payer: United Healthcare Medicaid	$25,791.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,791.24

Tonsil & adenoid procedures

Facility

$101,912.76

Service Code	APR-DRG 0974
Min. Negotiated Rate	$16,890.00
Max. Negotiated Rate	$101,912.76
Rate for Payer: Affinity Essential Plan 1&2	$101,912.76
Rate for Payer: Affinity Essential Plan 3&4	$101,912.76
Rate for Payer: Affinity Medicaid/CHP/HARP	$45,294.56
Rate for Payer: Amida Care Medicaid	$45,294.56
Rate for Payer: EmblemHealth Essential Plan 1&2	$101,912.76
Rate for Payer: EmblemHealth Essential Plan 3&4	$45,294.56
Rate for Payer: Fidelis CHP/HARP/Medicaid	$45,294.56
Rate for Payer: Fidelis Qualified Health Plan	$54,353.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$45,294.56
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$45,294.56
Rate for Payer: Healthfirst Commercial	$31,354.00
Rate for Payer: Healthfirst Essential Plan	$101,912.76
Rate for Payer: Healthfirst QHP	$16,890.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$45,294.56
Rate for Payer: SOMOS Essential	$101,912.76
Rate for Payer: United Healthcare Essential Plan 1&2	$101,912.76
Rate for Payer: United Healthcare Essential Plan 3&4	$101,912.76
Rate for Payer: United Healthcare Medicaid	$45,294.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$45,294.56

TONSIL AND ADENOID PROCEDURES

Facility

$2,509.53

Service Code	EAPG 00256
Min. Negotiated Rate	$1,821.35
Max. Negotiated Rate	$2,509.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1,821.35
Rate for Payer: Healthfirst Commercial	$2,509.53

TOPIRAMATE 100 MG PO TABS

Facility

$0.59

Service Code	NDC 0904692961
Hospital Charge Code	0904692961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29

TOPIRAMATE 100 MG PO TABS

Facility

$0.59

Service Code	NDC 0904692961
Hospital Charge Code	0904692961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Brighton Health Commercial	$0.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: EmblemHealth Commercial	$0.29
Rate for Payer: Group Health Inc Commercial	$0.29
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29
Rate for Payer: Hamaspik Choice Inc Medicare	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.38

TOPIRAMATE 100 MG PO TABS

Facility

$21.43

Service Code	NDC 5045864165
Hospital Charge Code	5045864165
Hospital Revenue Code	250
Min. Negotiated Rate	$10.72
Max. Negotiated Rate	$10.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.72

TOPIRAMATE 100 MG PO TABS

Facility

$6.20

Service Code	NDC 6808434411
Hospital Charge Code	6808434411
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$4.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.10
Rate for Payer: Aetna Government	$3.10
Rate for Payer: Brighton Health Commercial	$4.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.22
Rate for Payer: EmblemHealth Commercial	$3.10
Rate for Payer: Group Health Inc Commercial	$3.10
Rate for Payer: Group Health Inc Medicare	$2.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.10
Rate for Payer: Hamaspik Choice Inc Medicare	$3.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.03

TOPIRAMATE 100 MG PO TABS

Facility

$6.96

Service Code	NDC 6838214014
Hospital Charge Code	6838214014
Hospital Revenue Code	250
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$3.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48

TOPIRAMATE 100 MG PO TABS

Facility

$6.20

Service Code	NDC 6808434411
Hospital Charge Code	6808434411
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$3.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.10

TOPIRAMATE 100 MG PO TABS

Facility

$6.20

Service Code	NDC 6808434401
Hospital Charge Code	6808434401
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$4.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.10
Rate for Payer: Aetna Government	$3.10
Rate for Payer: Brighton Health Commercial	$4.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.22
Rate for Payer: EmblemHealth Commercial	$3.10
Rate for Payer: Group Health Inc Commercial	$3.10
Rate for Payer: Group Health Inc Medicare	$2.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.10
Rate for Payer: Hamaspik Choice Inc Medicare	$3.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.03

TOPIRAMATE 100 MG PO TABS

Facility

$6.20

Service Code	NDC 6808434401
Hospital Charge Code	6808434401
Hospital Revenue Code	250
Min. Negotiated Rate	$3.10
Max. Negotiated Rate	$3.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.10

TOPIRAMATE 100 MG PO TABS

Facility

$21.43

Service Code	NDC 5045864165
Hospital Charge Code	5045864165
Hospital Revenue Code	250
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$17.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.72
Rate for Payer: Aetna Government	$10.72
Rate for Payer: Brighton Health Commercial	$16.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.57
Rate for Payer: EmblemHealth Commercial	$10.72
Rate for Payer: Group Health Inc Commercial	$10.72
Rate for Payer: Group Health Inc Medicare	$7.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.72
Rate for Payer: Hamaspik Choice Inc Medicare	$10.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.93

TOPIRAMATE 100 MG PO TABS

Facility

$6.96

Service Code	NDC 6838214014
Hospital Charge Code	6838214014
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.48
Rate for Payer: Aetna Government	$3.48
Rate for Payer: Brighton Health Commercial	$5.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.73
Rate for Payer: EmblemHealth Commercial	$3.48
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.53

TOPIRAMATE 200 MG PO TABS

Facility

$1.12

Service Code	NDC 6808434521
Hospital Charge Code	6808434521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

TOPIRAMATE 200 MG PO TABS

Facility

$1.12

Service Code	NDC 6808434511
Hospital Charge Code	6808434511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56

TOPIRAMATE 200 MG PO TABS

Facility

$1.12

Service Code	NDC 6808434521
Hospital Charge Code	6808434521
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Brighton Health Commercial	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: EmblemHealth Commercial	$0.56
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.73

TOPIRAMATE 200 MG PO TABS

Facility

$1.12

Service Code	NDC 6808434511
Hospital Charge Code	6808434511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.56
Rate for Payer: Aetna Government	$0.56
Rate for Payer: Brighton Health Commercial	$0.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.76
Rate for Payer: EmblemHealth Commercial	$0.56
Rate for Payer: Group Health Inc Commercial	$0.56
Rate for Payer: Group Health Inc Medicare	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.56
Rate for Payer: Hamaspik Choice Inc Medicare	$0.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.73

TOPIRAMATE 25 MG PO TABS

Facility

$2.55

Service Code	NDC 4733570786
Hospital Charge Code	4733570786
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$2.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.28
Rate for Payer: Aetna Government	$1.28
Rate for Payer: Brighton Health Commercial	$1.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.74
Rate for Payer: EmblemHealth Commercial	$1.28
Rate for Payer: Group Health Inc Commercial	$1.28
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.66

TOPIRAMATE 25 MG PO TABS

Facility

$2.55

Service Code	NDC 4733570786
Hospital Charge Code	4733570786
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28

TOPIRAMATE 25 MG PO TABS

Facility

$2.56

Service Code	NDC 6838213814
Hospital Charge Code	6838213814
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$2.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.28
Rate for Payer: Aetna Government	$1.28
Rate for Payer: Brighton Health Commercial	$1.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.74
Rate for Payer: EmblemHealth Commercial	$1.28
Rate for Payer: Group Health Inc Commercial	$1.28
Rate for Payer: Group Health Inc Medicare	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28
Rate for Payer: Hamaspik Choice Inc Medicare	$1.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.66

TOPIRAMATE 25 MG PO TABS

Facility

$2.56

Service Code	NDC 6838213814
Hospital Charge Code	6838213814
Hospital Revenue Code	250
Min. Negotiated Rate	$1.28
Max. Negotiated Rate	$1.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.28

Know your out-of-pocket cost for care.

All Charges