St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TACROLIMUS 1 MG CAP

Facility

$5.22

Hospital Charge Code	41653973
Hospital Revenue Code	636
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$3.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.61
Rate for Payer: Aetna Government	$2.61
Rate for Payer: Brighton Health Commercial	$3.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.00
Rate for Payer: Group Health Inc Commercial	$2.61
Rate for Payer: Group Health Inc Medicare	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.61
Rate for Payer: Hamaspik Choice Inc Medicare	$2.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.39

TACROLIMUS 1 MG CAP

Facility

$5.22

Hospital Charge Code	41643973
Hospital Revenue Code	636
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.61
Rate for Payer: Hamaspik Choice Inc Medicare	$2.61

TACROLIMUS 1 MG CAP

Facility

$5.22

Hospital Charge Code	41653973
Hospital Revenue Code	636
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$2.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.61
Rate for Payer: Hamaspik Choice Inc Medicare	$2.61

TACROLIMUS 1 MG CAP

Facility

$5.22

Hospital Charge Code	41643973
Hospital Revenue Code	636
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$3.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.61
Rate for Payer: Aetna Government	$2.61
Rate for Payer: Brighton Health Commercial	$3.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.00
Rate for Payer: Group Health Inc Commercial	$2.61
Rate for Payer: Group Health Inc Medicare	$1.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.61
Rate for Payer: Hamaspik Choice Inc Medicare	$2.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.39

TACROLIMUS 1 MG PO CAPS [12933]

Facility

$4.46

Service Code	HCPCS J7507
Hospital Charge Code	67877027901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$3.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$3.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.03
Rate for Payer: Group Health Inc Commercial	$2.23
Rate for Payer: Group Health Inc Medicare	$1.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.23
Rate for Payer: Hamaspik Choice Inc Medicare	$2.23
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.27
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.29
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.90

TACROLIMUS 1 MG PO CAPS [12933]

Facility

$1.64

Service Code	HCPCS J7507
Hospital Charge Code	00904709761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$1.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.12
Rate for Payer: Group Health Inc Commercial	$0.82
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.82
Rate for Payer: Hamaspik Choice Inc Medicare	$0.82
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.27
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.29
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.07

TACROLIMUS 5MG CAP

Facility

$2.46

Service Code	HCPCS J7507
Hospital Charge Code	41646551
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.41
Rate for Payer: Group Health Inc Commercial	$1.23
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.60

TACROLIMUS 5MG CAP

Facility

$2.46

Service Code	HCPCS J7507
Hospital Charge Code	41656551
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.41
Rate for Payer: Group Health Inc Commercial	$1.23
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.29
Rate for Payer: SOMOS Essential	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.60

TACROLIMUS 5MG CAP

Facility

$2.46

Service Code	HCPCS J7507
Hospital Charge Code	41646551
Hospital Revenue Code	636
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23

TACROLIMUS 5MG CAP

Facility

$2.46

Service Code	HCPCS J7507
Hospital Charge Code	41656551
Hospital Revenue Code	636
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23

TACROLIMUS 5 MG PO CAPS [12934]

Facility

$22.30

Service Code	HCPCS J7507
Hospital Charge Code	16729004301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$17.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$16.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.16
Rate for Payer: Group Health Inc Commercial	$11.15
Rate for Payer: Group Health Inc Medicare	$7.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.15
Rate for Payer: Hamaspik Choice Inc Medicare	$11.15
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.27
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.29
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.49

TACROLIMUS 5 MG PO CAPS [12934]

Facility

$10.80

Service Code	HCPCS J7507
Hospital Charge Code	00904662461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$8.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$8.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.34
Rate for Payer: Group Health Inc Commercial	$5.40
Rate for Payer: Group Health Inc Medicare	$3.78
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.40
Rate for Payer: Hamaspik Choice Inc Medicare	$5.40
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.27
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.29
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.02

TACROLIMUS 5 MG PO CAPS [12934]

Facility

$22.30

Service Code	HCPCS J7507
Hospital Charge Code	70377001611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$17.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.55
Rate for Payer: Aetna Government	$0.55
Rate for Payer: Brighton Health Commercial	$16.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.16
Rate for Payer: Group Health Inc Commercial	$11.15
Rate for Payer: Group Health Inc Medicare	$7.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.15
Rate for Payer: Hamaspik Choice Inc Medicare	$11.15
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.27
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.29
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.29
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.49

TACROLIMUS (FK506), BLOOD

Facility

$34.33

Service Code	HCPCS 80197
Hospital Charge Code	40609005
Hospital Revenue Code	300
Min. Negotiated Rate	$10.98
Max. Negotiated Rate	$25.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.73
Rate for Payer: Aetna Government	$13.73
Rate for Payer: Brighton Health Commercial	$25.75
Rate for Payer: Cash Price	$13.73
Rate for Payer: Cash Price	$13.73
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$13.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.47
Rate for Payer: Elderplan Medicare Advantage	$13.73
Rate for Payer: EmblemHealth Commercial	$13.73
Rate for Payer: Fidelis Essential Plan Aliesa	$11.67
Rate for Payer: Fidelis Essential Plan QHP	$12.22
Rate for Payer: Fidelis Medicare Advantage	$13.73
Rate for Payer: Fidelis Qualified Health Plan	$12.22
Rate for Payer: Group Health Inc Commercial	$13.73
Rate for Payer: Group Health Inc Medicare	$13.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.16
Rate for Payer: Hamaspik Choice Inc Medicare	$13.73
Rate for Payer: Healthfirst Medicare Advantage	$13.73
Rate for Payer: Healthfirst QHP	$13.73
Rate for Payer: Senior Whole Health Medicare Advantage	$13.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$10.98
Rate for Payer: Wellcare Medicare	$12.36

TACROLIMUS (FK506), BLOOD

Facility

$34.33

Service Code	HCPCS 80197
Hospital Charge Code	40609005
Hospital Revenue Code	300
Rate for Payer: Cash Price	$13.73

TAILOR BUNIONECTOMY

Facility

$8,291.05

Service Code	HCPCS 28292
Hospital Charge Code	40082750
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$3,743.15
Rate for Payer: Brighton Health Commercial	$6,218.29
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Cash Price	$3,743.15
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$3,743.15
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: Elderplan Medicare Advantage	$3,743.15
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$3,181.68
Rate for Payer: Fidelis Essential Plan QHP	$3,331.40
Rate for Payer: Fidelis Medicare Advantage	$3,743.15
Rate for Payer: Fidelis Qualified Health Plan	$3,331.40
Rate for Payer: Group Health Inc Commercial	$3,743.15
Rate for Payer: Group Health Inc Medicare	$3,743.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,145.52
Rate for Payer: Hamaspik Choice Inc Medicare	$3,743.15
Rate for Payer: Healthfirst Medicare Advantage	$3,181.68
Rate for Payer: Healthfirst QHP	$3,743.15
Rate for Payer: Senior Whole Health Medicare Advantage	$3,743.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3,743.15
Rate for Payer: Wellcare CHP/FHP/Medicaid	$2,994.52
Rate for Payer: Wellcare Medicare	$3,555.99

TAILOR BUNIONECTOMY

Facility

$8,291.05

Service Code	HCPCS 28292
Hospital Charge Code	40082750
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

TAKING STATIN OR REC'D ORDER

Facility

$0.01

Service Code	HCPCS G9664
Hospital Charge Code	30307873
Hospital Revenue Code	510
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
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	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TALAR-FIT IMPLANT 11MM

Facility

$2,750.00

Hospital Charge Code	40200174
Hospital Revenue Code	272
Min. Negotiated Rate	$962.50
Max. Negotiated Rate	$2,200.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,512.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,375.00
Rate for Payer: Aetna Government	$1,375.00
Rate for Payer: Brighton Health Commercial	$2,062.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,870.00
Rate for Payer: Group Health Inc Commercial	$1,375.00
Rate for Payer: Group Health Inc Medicare	$962.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,375.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,375.00

TALC 4 G PL AERP [32569]

Facility

$4.20

Service Code	NDC 63256010030
Hospital Charge Code	63256010030
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$3.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.10
Rate for Payer: Aetna Government	$2.10
Rate for Payer: Brighton Health Commercial	$3.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.86
Rate for Payer: Group Health Inc Commercial	$2.10
Rate for Payer: Group Health Inc Medicare	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.10
Rate for Payer: Hamaspik Choice Inc Medicare	$2.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.73

TAMIFLU 6MG PER ML

Facility

$3.36

Hospital Charge Code	41648041
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.28
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

TAMIFLU 6MG PER ML

Facility

$3.36

Hospital Charge Code	41658041
Hospital Revenue Code	250
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$2.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.28
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

TAMOXIFEN 10 MGTAB

Facility

$0.28

Service Code	HCPCS J8999
Hospital Charge Code	41645106
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

TAMOXIFEN 10 MGTAB

Facility

$0.28

Service Code	HCPCS J8999
Hospital Charge Code	41655106
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

TAMOXIFEN 10 MGTAB

Facility

$0.28

Service Code	HCPCS J8999
Hospital Charge Code	41655106
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14

Know your out-of-pocket cost for care.

All Charges