St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TOPOTECAN 4 MG INJ

Facility

$18.79

Service Code	HCPCS J9351
Hospital Charge Code	41644506
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
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: Brighton Health Commercial	$11.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
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: 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

$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 HCL 4 MG/4ML IV SOLN [108590]

Facility

$20.79

Service Code	HCPCS J9351
Hospital Charge Code	00409030201
Hospital Revenue Code	278
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$10.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.39
Rate for Payer: Hamaspik Choice Inc Medicare	$10.39

TOPOTECAN HCL 4 MG/4ML IV SOLN [108590]

Facility

$20.79

Service Code	HCPCS J9351
Hospital Charge Code	00409030201
Hospital Revenue Code	278
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$21.82
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	$12.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.95
Rate for Payer: EmblemHealth Commercial	$10.39
Rate for Payer: Fidelis Medicare Advantage	$21.82
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.51

TOPOTECAN INJECTION 0.1 MG/2

Facility

$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

$18.79

Service Code	HCPCS J9351
Hospital Charge Code	41654506
Hospital Revenue Code	636
Min. Negotiated Rate	$0.77
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: Brighton Health Commercial	$11.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.80
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: 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

$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: Brighton Health Commercial	$7.50
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 100 MG PO TABS [18294]

Facility

$2.89

Service Code	NDC 50268075715
Hospital Charge Code	50268075715
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: 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 [18294]

Facility

$2.89

Service Code	NDC 50268075711
Hospital Charge Code	50268075711
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: 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 [18294]

Facility

$3.04

Service Code	NDC 31722053201
Hospital Charge Code	31722053201
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: 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 100MG TAB

Facility

$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: Brighton Health Commercial	$0.39
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

$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 10 MG/ML INJ

Facility

$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: Brighton Health Commercial	$8.40
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

$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

$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: Brighton Health Commercial	$8.40
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 PO TABS [18292]

Facility

$0.71

Service Code	NDC 50268075511
Hospital Charge Code	50268075511
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: 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 [18292]

Facility

$0.70

Service Code	NDC 31722053001
Hospital Charge Code	31722053001
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: 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 [18292]

Facility

$0.71

Service Code	NDC 50268075515
Hospital Charge Code	50268075515
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: 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 TAB

Facility

$0.13

Hospital Charge Code	41654034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

TORSEMIDE 10 MG TAB

Facility

$0.13

Hospital Charge Code	41644034
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

TORSEMIDE 50 MG/ML INJ

Facility

$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: Brighton Health Commercial	$10.20
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

$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: Brighton Health Commercial	$10.20
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

$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

$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

TOSEMIDE 100MG TAB

Facility

$0.52

Hospital Charge Code	41656605
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: Brighton Health Commercial	$0.39
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

Know your out-of-pocket cost for care.

All Charges