St. Barnabas Hospital

All Charges

Charge

Type

Price

TOPAZ EPF MICRODEBIDER

Facility OP

$700.00

Hospital Charge Code	40200964
Hospital Revenue Code	270
Min. Negotiated Rate	$245.00
Max. Negotiated Rate	$560.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$385.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$350.00
Rate for Payer: Aetna Government	$350.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$560.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$476.00
Rate for Payer: Group Health Inc Commercial	$350.00
Rate for Payer: Group Health Inc Medicare	$245.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$350.00
Rate for Payer: Hamaspik Choice Inc Medicare	$350.00

TOPICAL APPLICATION OF FLUORIDE E

Facility OP

$35.00

Service Code	HCPCS D1208
Hospital Charge Code	42300255
Hospital Revenue Code	361
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.68
Rate for Payer: Aetna Government	$9.68
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: Group Health Inc Commercial	$17.50
Rate for Payer: Group Health Inc Medicare	$12.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.50
Rate for Payer: Hamaspik Choice Inc Medicare	$17.50

TOPICAL FLUORIDE VARNISH

Facility OP

$20.00

Service Code	HCPCS D1206
Hospital Charge Code	30300087
Hospital Revenue Code	510
Min. Negotiated Rate	$10.00
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.51
Rate for Payer: Aetna Government	$16.51
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
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	$10.00
Rate for Payer: Hamaspik Choice Inc Medicare	$10.00

TOPICAL FLUORIDE VARNISH

Facility OP

$75.00

Service Code	HCPCS D1206
Hospital Charge Code	42303419
Hospital Revenue Code	361
Min. Negotiated Rate	$16.51
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.51
Rate for Payer: Aetna Government	$16.51
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: Group Health Inc Commercial	$37.50
Rate for Payer: Group Health Inc Medicare	$26.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.50
Rate for Payer: Hamaspik Choice Inc Medicare	$37.50

TOPIRAMATE 100 MG TAB

Facility OP

$0.39

Hospital Charge Code	41645129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

TOPIRAMATE 100 MG TAB

Facility OP

$0.39

Hospital Charge Code	41655129
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

TOPIRAMATE 15MG CAP

Facility OP

$1.62

Hospital Charge Code	41655157
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.10
Rate for Payer: Group Health Inc Commercial	$0.81
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.05

TOPIRAMATE 15MG CAP

Facility OP

$1.62

Hospital Charge Code	41645157
Hospital Revenue Code	250
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.10
Rate for Payer: Group Health Inc Commercial	$0.81
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.05

TOPIRAMATE 200 MG TAB

Facility OP

$0.83

Hospital Charge Code	41655130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

TOPIRAMATE 200 MG TAB

Facility OP

$0.83

Hospital Charge Code	41645130
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.56
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.54

TOPIRAMATE (TOPAMAX), SERUM

Facility OP

$29.80

Service Code	HCPCS 80201
Hospital Charge Code	40609811
Hospital Revenue Code	301
Min. Negotiated Rate	$9.54
Max. Negotiated Rate	$18.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.92
Rate for Payer: Aetna Government	$11.92
Rate for Payer: Cash Price	$11.92
Rate for Payer: Cash Price	$11.92
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.04
Rate for Payer: Elderplan Medicare Advantage	$11.92
Rate for Payer: EmblemHealth Commercial	$11.92
Rate for Payer: Fidelis CHP/HARP/Medicaid	$10.73
Rate for Payer: Fidelis Essential Plan Aliesa	$10.13
Rate for Payer: Fidelis Essential Plan QHP	$10.61
Rate for Payer: Fidelis Medicare Advantage	$11.92
Rate for Payer: Fidelis Qualified Health Plan	$10.61
Rate for Payer: Group Health Inc Commercial	$11.92
Rate for Payer: Group Health Inc Medicare	$11.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.90
Rate for Payer: Hamaspik Choice Inc Medicare	$11.92
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.92
Rate for Payer: Healthfirst Medicare Advantage	$11.92
Rate for Payer: Healthfirst QHP	$11.92
Rate for Payer: Senior Whole Health Medicare Advantage	$11.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.92
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.54
Rate for Payer: Wellcare Medicare	$10.73

TOPOTECAN 4 MG INJ

Facility OP

$18.79

Service Code	HCPCS J9351
Hospital Charge Code	41644506
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$12.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.77
Rate for Payer: Aetna Government	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.45
Rate for Payer: Group Health Inc Commercial	$9.40
Rate for Payer: Group Health Inc Medicare	$6.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.40
Rate for Payer: Hamaspik Choice Inc Medicare	$9.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.24
Rate for Payer: SOMOS Essential	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.21

TOPOTECAN 4 MG INJ

Facility IP

$18.79

Service Code	HCPCS J9351
Hospital Charge Code	41644506
Hospital Revenue Code	636
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$9.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.40
Rate for Payer: Hamaspik Choice Inc Medicare	$9.40

TOPOTECAN INJECTION 0.1 MG/2

Facility IP

$18.79

Service Code	HCPCS J9351
Hospital Charge Code	41654506
Hospital Revenue Code	636
Min. Negotiated Rate	$9.40
Max. Negotiated Rate	$9.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.40
Rate for Payer: Hamaspik Choice Inc Medicare	$9.40

TOPOTECAN INJECTION 0.1 MG/2

Facility OP

$18.79

Service Code	HCPCS J9351
Hospital Charge Code	41654506
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$12.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.77
Rate for Payer: Aetna Government	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.45
Rate for Payer: Group Health Inc Commercial	$9.40
Rate for Payer: Group Health Inc Medicare	$6.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.40
Rate for Payer: Hamaspik Choice Inc Medicare	$9.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.24
Rate for Payer: SOMOS Essential	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.21

TORQUE DEVICE ABBOTT

Facility OP

$10.00

Hospital Charge Code	66522093
Hospital Revenue Code	270
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$8.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.00
Rate for Payer: Aetna Government	$5.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: Group Health Inc Commercial	$5.00
Rate for Payer: Group Health Inc Medicare	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.00
Rate for Payer: Hamaspik Choice Inc Medicare	$5.00

TORSEMIDE 100MG TAB

Facility OP

$0.52

Hospital Charge Code	41646605
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.35
Rate for Payer: Group Health Inc Commercial	$0.26
Rate for Payer: Group Health Inc Medicare	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26
Rate for Payer: Hamaspik Choice Inc Medicare	$0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

TORSEMIDE 10 MG/ML INJ

Facility OP

$14.00

Service Code	HCPCS J3265
Hospital Charge Code	41653479
Hospital Revenue Code	636
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.46
Rate for Payer: Aetna Government	$2.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.10

TORSEMIDE 10 MG/ML INJ

Facility OP

$14.00

Service Code	HCPCS J3265
Hospital Charge Code	41643479
Hospital Revenue Code	636
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.46
Rate for Payer: Aetna Government	$2.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.10

TORSEMIDE 10 MG/ML INJ

Facility IP

$14.00

Service Code	HCPCS J3265
Hospital Charge Code	41653479
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

TORSEMIDE 10 MG/ML INJ

Facility IP

$14.00

Service Code	HCPCS J3265
Hospital Charge Code	41643479
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

TORSEMIDE 50 MG/ML INJ

Facility OP

$17.00

Service Code	HCPCS J3265
Hospital Charge Code	41653480
Hospital Revenue Code	636
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$11.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.46
Rate for Payer: Aetna Government	$2.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

TORSEMIDE 50 MG/ML INJ

Facility OP

$17.00

Service Code	HCPCS J3265
Hospital Charge Code	41643480
Hospital Revenue Code	636
Min. Negotiated Rate	$2.46
Max. Negotiated Rate	$11.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.46
Rate for Payer: Aetna Government	$2.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.78
Rate for Payer: Group Health Inc Commercial	$8.50
Rate for Payer: Group Health Inc Medicare	$5.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.05

TORSEMIDE 50 MG/ML INJ

Facility IP

$17.00

Service Code	HCPCS J3265
Hospital Charge Code	41653480
Hospital Revenue Code	636
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

TORSEMIDE 50 MG/ML INJ

Facility IP

$17.00

Service Code	HCPCS J3265
Hospital Charge Code	41643480
Hospital Revenue Code	636
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$8.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.50
Rate for Payer: Hamaspik Choice Inc Medicare	$8.50

Price Transparency.

All Charges