St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRIAMCINOLONE REPOSITORY 10 MG/ML INJ

Facility

$21.88

Service Code	HCPCS J3301
Hospital Charge Code	41640513
Hospital Revenue Code	636
Min. Negotiated Rate	$1.15
Max. Negotiated Rate	$14.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.20
Rate for Payer: Aetna Government	$1.20
Rate for Payer: Brighton Health Commercial	$13.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.58
Rate for Payer: Group Health Inc Commercial	$10.94
Rate for Payer: Group Health Inc Medicare	$7.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.94
Rate for Payer: Hamaspik Choice Inc Medicare	$10.94
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.15
Rate for Payer: SOMOS Essential	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.22

TRIAMCINOLONE REPOSITORY 10 MG/ML INJ

Facility

$21.88

Service Code	HCPCS J3301
Hospital Charge Code	41640513
Hospital Revenue Code	636
Min. Negotiated Rate	$10.94
Max. Negotiated Rate	$10.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.94
Rate for Payer: Hamaspik Choice Inc Medicare	$10.94

TRIAMCINOLONE REPOSITORY 40 MG/ML INJ

Facility

$1.35

Service Code	HCPCS J3301
Hospital Charge Code	41652599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68

TRIAMCINOLONE REPOSITORY 40 MG/ML INJ

Facility

$1.35

Service Code	HCPCS J3301
Hospital Charge Code	41652599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.20
Rate for Payer: Aetna Government	$1.20
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.15
Rate for Payer: SOMOS Essential	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.88

TRIAMCINOLONE REPOSITORY 40 MG/ML INJ

Facility

$1.35

Service Code	HCPCS J3301
Hospital Charge Code	41642599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68

TRIAMCINOLONE REPOSITORY 40 MG/ML INJ

Facility

$1.35

Service Code	HCPCS J3301
Hospital Charge Code	41642599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.20
Rate for Payer: Aetna Government	$1.20
Rate for Payer: Brighton Health Commercial	$0.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.78
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.15
Rate for Payer: SOMOS Essential	$1.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.88

TRIAMICINOLONE 40MG/ML INJ

Facility

$6.41

Service Code	HCPCS J3300
Hospital Charge Code	41646581
Hospital Revenue Code	636
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$3.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.20
Rate for Payer: Hamaspik Choice Inc Medicare	$3.20

TRIAMICINOLONE 40MG/ML INJ

Facility

$6.41

Service Code	HCPCS J3300
Hospital Charge Code	41646581
Hospital Revenue Code	636
Min. Negotiated Rate	$2.24
Max. Negotiated Rate	$4.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.88
Rate for Payer: Aetna Government	$3.88
Rate for Payer: Brighton Health Commercial	$3.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.69
Rate for Payer: Group Health Inc Commercial	$3.20
Rate for Payer: Group Health Inc Medicare	$2.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.20
Rate for Payer: Hamaspik Choice Inc Medicare	$3.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.17

TRIAMTERENE 50 MG CAP

Facility

$2.61

Hospital Charge Code	41642318
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.30
Rate for Payer: Aetna Government	$1.30
Rate for Payer: Brighton Health Commercial	$1.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.70

TRIAMTERENE 50 MG CAP

Facility

$2.61

Hospital Charge Code	41652318
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.30
Rate for Payer: Aetna Government	$1.30
Rate for Payer: Brighton Health Commercial	$1.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.70

TRIAMTERENE 50 MG PO CAPS [11588]

Facility

$11.93

Service Code	NDC 66993083102
Hospital Charge Code	66993083102
Hospital Revenue Code	250
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$9.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.96
Rate for Payer: Aetna Government	$5.96
Rate for Payer: Brighton Health Commercial	$8.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.11
Rate for Payer: Group Health Inc Commercial	$5.96
Rate for Payer: Group Health Inc Medicare	$4.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.96
Rate for Payer: Hamaspik Choice Inc Medicare	$5.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.75

TRIAMTERENE-HCTZ 37.5-25 MG PO TABS [8132]

Facility

$0.39

Service Code	NDC 60505265601
Hospital Charge Code	60505265601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.29
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	$0.26

TRIAMTERENE-HCTZ 37.5-25 MG TAB

Facility

$0.03

Hospital Charge Code	41643488
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

TRIAMTERENE-HCTZ 37.5-25 MG TAB

Facility

$0.03

Hospital Charge Code	41653488
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.02

TRIATHLON T KNEE U TIB BP SZ5

Facility

$7,204.00

Service Code	HCPCS C1776
Hospital Charge Code	40205212
Hospital Revenue Code	278
Min. Negotiated Rate	$3,602.00
Max. Negotiated Rate	$3,602.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,602.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,602.00

TRIATHLON T KNEE U TIB BP SZ5

Facility

$7,204.00

Service Code	HCPCS C1776
Hospital Charge Code	40205212
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$7,564.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,962.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$4,322.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3,602.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,142.30
Rate for Payer: EmblemHealth Commercial	$3,602.00
Rate for Payer: Fidelis Medicare Advantage	$7,564.20
Rate for Payer: Group Health Inc Commercial	$3,602.00
Rate for Payer: Group Health Inc Medicare	$2,521.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,602.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3,602.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,682.60

TRIATHLON TL KNEE PS FEM COMP#4RT

Facility

$5,621.00

Service Code	HCPCS C1776
Hospital Charge Code	40009111
Hospital Revenue Code	278
Min. Negotiated Rate	$339.17
Max. Negotiated Rate	$5,902.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,091.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$339.17
Rate for Payer: Aetna Government	$339.17
Rate for Payer: Brighton Health Commercial	$3,372.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,810.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,232.08
Rate for Payer: EmblemHealth Commercial	$2,810.50
Rate for Payer: Fidelis Medicare Advantage	$5,902.05
Rate for Payer: Group Health Inc Commercial	$2,810.50
Rate for Payer: Group Health Inc Medicare	$1,967.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,810.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,810.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,653.65

TRIATHLON TL KNEE PS FEM COMP#4RT

Facility

$5,621.00

Service Code	HCPCS C1776
Hospital Charge Code	40009111
Hospital Revenue Code	278
Min. Negotiated Rate	$2,810.50
Max. Negotiated Rate	$2,810.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,810.50
Rate for Payer: Hamaspik Choice Inc Medicare	$2,810.50

TRICHLOROACETIC ACID 80% W/V SOLUTION

Facility

$76.00

Hospital Charge Code	41652259
Hospital Revenue Code	250
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$60.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.00
Rate for Payer: Aetna Government	$38.00
Rate for Payer: Brighton Health Commercial	$57.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.68
Rate for Payer: Group Health Inc Commercial	$38.00
Rate for Payer: Group Health Inc Medicare	$26.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.00
Rate for Payer: Hamaspik Choice Inc Medicare	$38.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.40

TRICHLOROACETIC ACID 80% W/V SOLUTION

Facility

$76.00

Hospital Charge Code	41642259
Hospital Revenue Code	250
Min. Negotiated Rate	$26.60
Max. Negotiated Rate	$60.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.00
Rate for Payer: Aetna Government	$38.00
Rate for Payer: Brighton Health Commercial	$57.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.68
Rate for Payer: Group Health Inc Commercial	$38.00
Rate for Payer: Group Health Inc Medicare	$26.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.00
Rate for Payer: Hamaspik Choice Inc Medicare	$38.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.40

TRICHOMONAS CULTURE

Facility

$16.58

Service Code	HCPCS 87081
Hospital Charge Code	40619851
Hospital Revenue Code	309
Min. Negotiated Rate	$5.30
Max. Negotiated Rate	$12.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.63
Rate for Payer: Aetna Government	$6.63
Rate for Payer: Brighton Health Commercial	$12.44
Rate for Payer: Cash Price	$6.63
Rate for Payer: Cash Price	$6.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.91
Rate for Payer: Elderplan Medicare Advantage	$6.63
Rate for Payer: EmblemHealth Commercial	$6.63
Rate for Payer: Fidelis Essential Plan Aliesa	$5.64
Rate for Payer: Fidelis Essential Plan QHP	$5.90
Rate for Payer: Fidelis Medicare Advantage	$6.63
Rate for Payer: Fidelis Qualified Health Plan	$5.90
Rate for Payer: Group Health Inc Commercial	$6.63
Rate for Payer: Group Health Inc Medicare	$6.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.29
Rate for Payer: Hamaspik Choice Inc Medicare	$6.63
Rate for Payer: Healthfirst Medicare Advantage	$6.63
Rate for Payer: Healthfirst QHP	$6.63
Rate for Payer: Senior Whole Health Medicare Advantage	$6.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$5.30
Rate for Payer: Wellcare Medicare	$5.97

TRICHOMONAS CULTURE

Facility

$16.58

Service Code	HCPCS 87081
Hospital Charge Code	40619851
Hospital Revenue Code	309
Rate for Payer: Cash Price	$6.63

TRICH VAG BY NAA

Facility

$87.50

Service Code	HCPCS 87661
Hospital Charge Code	40619759
Hospital Revenue Code	306
Rate for Payer: Cash Price	$35.09

TRICH VAG BY NAA

Facility

$87.50

Service Code	HCPCS 87661
Hospital Charge Code	40619759
Hospital Revenue Code	306
Min. Negotiated Rate	$28.07
Max. Negotiated Rate	$70.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$35.09
Rate for Payer: Aetna Government	$35.09
Rate for Payer: Brighton Health Commercial	$65.62
Rate for Payer: Cash Price	$35.09
Rate for Payer: Cash Price	$35.09
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$35.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.50
Rate for Payer: Elderplan Medicare Advantage	$35.09
Rate for Payer: EmblemHealth Commercial	$35.09
Rate for Payer: Fidelis Essential Plan Aliesa	$29.83
Rate for Payer: Fidelis Essential Plan QHP	$31.23
Rate for Payer: Fidelis Medicare Advantage	$35.09
Rate for Payer: Fidelis Qualified Health Plan	$31.23
Rate for Payer: Group Health Inc Commercial	$35.09
Rate for Payer: Group Health Inc Medicare	$35.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$35.09
Rate for Payer: Healthfirst Medicare Advantage	$35.09
Rate for Payer: Healthfirst QHP	$35.09
Rate for Payer: Senior Whole Health Medicare Advantage	$35.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$35.09
Rate for Payer: Wellcare CHP/FHP/Medicaid	$28.07
Rate for Payer: Wellcare Medicare	$31.58

TRICUT BLADE

Facility

$515.00

Hospital Charge Code	64905965
Hospital Revenue Code	270
Min. Negotiated Rate	$180.25
Max. Negotiated Rate	$412.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$283.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$257.50
Rate for Payer: Aetna Government	$257.50
Rate for Payer: Brighton Health Commercial	$386.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$412.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$350.20
Rate for Payer: Group Health Inc Commercial	$257.50
Rate for Payer: Group Health Inc Medicare	$180.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$257.50
Rate for Payer: Hamaspik Choice Inc Medicare	$257.50

Know your out-of-pocket cost for care.

All Charges