St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TOPIRAMATE 25 MG PO TABS

Facility

$0.33

Service Code	NDC 0904692861
Hospital Charge Code	0904692861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

TOPIRAMATE 25 MG PO TABS

Facility

$0.33

Service Code	NDC 0904692861
Hospital Charge Code	0904692861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.22
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.21

TOPIRAMATE 50 MG PO TABS

Facility

$0.50

Service Code	NDC 6808434311
Hospital Charge Code	6808434311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.25
Rate for Payer: Aetna Government	$0.25
Rate for Payer: Brighton Health Commercial	$0.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.34
Rate for Payer: EmblemHealth Commercial	$0.25
Rate for Payer: Group Health Inc Commercial	$0.25
Rate for Payer: Group Health Inc Medicare	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25
Rate for Payer: Hamaspik Choice Inc Medicare	$0.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.32

TOPIRAMATE 50 MG PO TABS

Facility

$0.50

Service Code	NDC 6808434311
Hospital Charge Code	6808434311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.25

TOPOTECAN HCL 4 MG/4ML IV SOLN

Facility

$20.79

Service Code	HCPCS J9351
Hospital Charge Code	0409030201
Hospital Revenue Code	258
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$10.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.39

TOPOTECAN HCL 4 MG/4ML IV SOLN

Facility

$20.79

Service Code	HCPCS J9351
Hospital Charge Code	0409030201
Hospital Revenue Code	258
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$16.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.77
Rate for Payer: Aetna Government	$0.77
Rate for Payer: Brighton Health Commercial	$15.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.63
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.13
Rate for Payer: EmblemHealth Commercial	$10.39
Rate for Payer: Group Health Inc Commercial	$10.39
Rate for Payer: Group Health Inc Medicare	$7.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.39
Rate for Payer: Hamaspik Choice Inc Medicare	$10.39
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.51

TORSEMIDE 100 MG PO TABS

Facility

$3.04

Service Code	NDC 3172253201
Hospital Charge Code	3172253201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: EmblemHealth Commercial	$1.52
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.98

TORSEMIDE 100 MG PO TABS

Facility

$2.89

Service Code	NDC 5026875711
Hospital Charge Code	5026875711
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45

TORSEMIDE 100 MG PO TABS

Facility

$3.04

Service Code	NDC 3172253201
Hospital Charge Code	3172253201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.52
Max. Negotiated Rate	$1.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52

TORSEMIDE 100 MG PO TABS

Facility

$2.89

Service Code	NDC 5026875715
Hospital Charge Code	5026875715
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.45
Rate for Payer: Aetna Government	$1.45
Rate for Payer: Brighton Health Commercial	$2.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.97
Rate for Payer: EmblemHealth Commercial	$1.45
Rate for Payer: Group Health Inc Commercial	$1.45
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.88

TORSEMIDE 100 MG PO TABS

Facility

$2.89

Service Code	NDC 5026875715
Hospital Charge Code	5026875715
Hospital Revenue Code	250
Min. Negotiated Rate	$1.45
Max. Negotiated Rate	$1.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45

TORSEMIDE 100 MG PO TABS

Facility

$2.89

Service Code	NDC 5026875711
Hospital Charge Code	5026875711
Hospital Revenue Code	250
Min. Negotiated Rate	$1.01
Max. Negotiated Rate	$2.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.45
Rate for Payer: Aetna Government	$1.45
Rate for Payer: Brighton Health Commercial	$2.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.97
Rate for Payer: EmblemHealth Commercial	$1.45
Rate for Payer: Group Health Inc Commercial	$1.45
Rate for Payer: Group Health Inc Medicare	$1.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.45
Rate for Payer: Hamaspik Choice Inc Medicare	$1.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.88

TORSEMIDE 10 MG PO TABS

Facility

$0.71

Service Code	NDC 5026875511
Hospital Charge Code	5026875511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

TORSEMIDE 10 MG PO TABS

Facility

$0.70

Service Code	NDC 3172253001
Hospital Charge Code	3172253001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.35
Rate for Payer: Aetna Government	$0.35
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: EmblemHealth Commercial	$0.35
Rate for Payer: Group Health Inc Commercial	$0.35
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35
Rate for Payer: Hamaspik Choice Inc Medicare	$0.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

TORSEMIDE 10 MG PO TABS

Facility

$0.70

Service Code	NDC 3172253001
Hospital Charge Code	3172253001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.35

TORSEMIDE 10 MG PO TABS

Facility

$0.71

Service Code	NDC 5026875515
Hospital Charge Code	5026875515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.25
Max. Negotiated Rate	$0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.36
Rate for Payer: Aetna Government	$0.36
Rate for Payer: Brighton Health Commercial	$0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.57
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: EmblemHealth Commercial	$0.36
Rate for Payer: Group Health Inc Commercial	$0.36
Rate for Payer: Group Health Inc Medicare	$0.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36
Rate for Payer: Hamaspik Choice Inc Medicare	$0.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.46

TORSEMIDE 10 MG PO TABS

Facility

$0.71

Service Code	NDC 5026875511
Hospital Charge Code	5026875511
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

TORSEMIDE 10 MG PO TABS

Facility

$0.71

Service Code	NDC 5026875515
Hospital Charge Code	5026875515
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.36

Toxic effects of non-medicinal substances

Facility

$39,895.85

Service Code	APR-DRG 8161
Min. Negotiated Rate	$4,795.00
Max. Negotiated Rate	$39,895.85
Rate for Payer: Affinity Essential Plan 1&2	$39,895.85
Rate for Payer: Affinity Essential Plan 3&4	$39,895.85
Rate for Payer: Affinity Medicaid/CHP/HARP	$17,731.49
Rate for Payer: Amida Care Medicaid	$17,731.49
Rate for Payer: EmblemHealth Essential Plan 1&2	$39,895.85
Rate for Payer: EmblemHealth Essential Plan 3&4	$17,731.49
Rate for Payer: Fidelis CHP/HARP/Medicaid	$17,731.49
Rate for Payer: Fidelis Qualified Health Plan	$21,277.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$17,731.49
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$17,731.49
Rate for Payer: Healthfirst Commercial	$8,661.00
Rate for Payer: Healthfirst Essential Plan	$39,895.85
Rate for Payer: Healthfirst QHP	$4,795.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$17,731.49
Rate for Payer: SOMOS Essential	$39,895.85
Rate for Payer: United Healthcare Essential Plan 1&2	$39,895.85
Rate for Payer: United Healthcare Essential Plan 3&4	$39,895.85
Rate for Payer: United Healthcare Medicaid	$17,731.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$17,731.49

Toxic effects of non-medicinal substances

Facility

$41,978.21

Service Code	APR-DRG 8162
Min. Negotiated Rate	$5,969.00
Max. Negotiated Rate	$41,978.21
Rate for Payer: Affinity Essential Plan 1&2	$41,978.21
Rate for Payer: Affinity Essential Plan 3&4	$41,978.21
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,656.98
Rate for Payer: Amida Care Medicaid	$18,656.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,978.21
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,656.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,656.98
Rate for Payer: Fidelis Qualified Health Plan	$22,388.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,656.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,656.98
Rate for Payer: Healthfirst Commercial	$10,676.00
Rate for Payer: Healthfirst Essential Plan	$41,978.21
Rate for Payer: Healthfirst QHP	$5,969.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,656.98
Rate for Payer: SOMOS Essential	$41,978.21
Rate for Payer: United Healthcare Essential Plan 1&2	$41,978.21
Rate for Payer: United Healthcare Essential Plan 3&4	$41,978.21
Rate for Payer: United Healthcare Medicaid	$18,656.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,656.98

Toxic effects of non-medicinal substances

Facility

$47,512.98

Service Code	APR-DRG 8163
Min. Negotiated Rate	$8,947.00
Max. Negotiated Rate	$47,512.98
Rate for Payer: Affinity Essential Plan 1&2	$47,512.98
Rate for Payer: Affinity Essential Plan 3&4	$47,512.98
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,116.88
Rate for Payer: Amida Care Medicaid	$21,116.88
Rate for Payer: EmblemHealth Essential Plan 1&2	$47,512.98
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,116.88
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,116.88
Rate for Payer: Fidelis Qualified Health Plan	$25,340.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,116.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,116.88
Rate for Payer: Healthfirst Commercial	$16,026.00
Rate for Payer: Healthfirst Essential Plan	$47,512.98
Rate for Payer: Healthfirst QHP	$8,947.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,116.88
Rate for Payer: SOMOS Essential	$47,512.98
Rate for Payer: United Healthcare Essential Plan 1&2	$47,512.98
Rate for Payer: United Healthcare Essential Plan 3&4	$47,512.98
Rate for Payer: United Healthcare Medicaid	$21,116.88
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,116.88

Toxic effects of non-medicinal substances

Facility

$68,844.82

Service Code	APR-DRG 8164
Min. Negotiated Rate	$22,054.00
Max. Negotiated Rate	$68,844.82
Rate for Payer: Affinity Essential Plan 1&2	$68,844.82
Rate for Payer: Affinity Essential Plan 3&4	$68,844.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$30,597.70
Rate for Payer: Amida Care Medicaid	$30,597.70
Rate for Payer: EmblemHealth Essential Plan 1&2	$68,844.82
Rate for Payer: EmblemHealth Essential Plan 3&4	$30,597.70
Rate for Payer: Fidelis CHP/HARP/Medicaid	$30,597.70
Rate for Payer: Fidelis Qualified Health Plan	$36,717.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$30,597.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$30,597.70
Rate for Payer: Healthfirst Commercial	$38,329.00
Rate for Payer: Healthfirst Essential Plan	$68,844.82
Rate for Payer: Healthfirst QHP	$22,054.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$30,597.70
Rate for Payer: SOMOS Essential	$68,844.82
Rate for Payer: United Healthcare Essential Plan 1&2	$68,844.82
Rate for Payer: United Healthcare Essential Plan 3&4	$68,844.82
Rate for Payer: United Healthcare Medicaid	$30,597.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$30,597.70

TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$249.54

Service Code	EAPG 00854
Min. Negotiated Rate	$180.52
Max. Negotiated Rate	$249.54
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$180.52
Rate for Payer: Healthfirst Commercial	$249.54

TOXICOLOGY TESTS

Facility

$37.69

Service Code	EAPG 00404
Min. Negotiated Rate	$27.77
Max. Negotiated Rate	$37.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.77
Rate for Payer: Healthfirst Commercial	$37.69

TRACE MINERALS CR-CU-MN-ZN 1-100-25-1000 MCG/ML IV SOLN

Facility

$4.86

Service Code	NDC 0517920325
Hospital Charge Code	0517920325
Hospital Revenue Code	258
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$3.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.43
Rate for Payer: Aetna Government	$2.43
Rate for Payer: Brighton Health Commercial	$3.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.30
Rate for Payer: EmblemHealth Commercial	$2.43
Rate for Payer: Group Health Inc Commercial	$2.43
Rate for Payer: Group Health Inc Medicare	$1.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.43
Rate for Payer: Hamaspik Choice Inc Medicare	$2.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.16

Know your out-of-pocket cost for care.

All Charges