St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TENDOR REPAIR ACHILLES

Facility

$18,117.83

Service Code	HCPCS 27650
Hospital Charge Code	40023202
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
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	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

TENDOR REPAIR ACHILLES

Facility

$18,117.83

Service Code	HCPCS 27650
Hospital Charge Code	40023202
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

TENDOR REPAIR ACHILLES SECONDARY

Facility

$18,117.83

Service Code	HCPCS 27654
Hospital Charge Code	40029696
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

TENDOR REPAIR ACHILLES SECONDARY

Facility

$18,117.83

Service Code	HCPCS 27654
Hospital Charge Code	40029696
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
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	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

TENDRIL 1688TC 46CM LEAD

Facility

$1,200.00

Hospital Charge Code	40205170
Hospital Revenue Code	270
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$960.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$600.00
Rate for Payer: Aetna Government	$600.00
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$816.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

TENDRIL 1788TC/52CM LEAD

Facility

$1,200.00

Hospital Charge Code	40205169
Hospital Revenue Code	270
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$960.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$600.00
Rate for Payer: Aetna Government	$600.00
Rate for Payer: Brighton Health Commercial	$900.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$960.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$816.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

TENDRIL 1888TC/58CM V LEAD

Facility

$1,200.00

Service Code	HCPCS C1896
Hospital Charge Code	40205180
Hospital Revenue Code	278
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$600.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00

TENDRIL 1888TC/58CM V LEAD

Facility

$1,200.00

Service Code	HCPCS C1896
Hospital Charge Code	40205180
Hospital Revenue Code	278
Min. Negotiated Rate	$420.00
Max. Negotiated Rate	$3,139.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$660.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,139.11
Rate for Payer: Aetna Government	$3,139.11
Rate for Payer: Brighton Health Commercial	$720.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$600.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$690.00
Rate for Payer: EmblemHealth Commercial	$600.00
Rate for Payer: Fidelis Medicare Advantage	$1,260.00
Rate for Payer: Group Health Inc Commercial	$600.00
Rate for Payer: Group Health Inc Medicare	$420.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$600.00
Rate for Payer: Hamaspik Choice Inc Medicare	$600.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$780.00

TENECTEPLASE 50 MG/10 ML IV (WET SOLR VIAL) [43028530]

Facility

$9,119.53

Service Code	HCPCS J3101
Hospital Charge Code	50242012047
Hospital Revenue Code	278
Min. Negotiated Rate	$122.49
Max. Negotiated Rate	$5,927.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,015.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.11
Rate for Payer: Aetna Government	$153.11
Rate for Payer: Brighton Health Commercial	$5,471.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$153.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,559.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,243.73
Rate for Payer: Elderplan Medicare Advantage	$153.11
Rate for Payer: EmblemHealth Commercial	$4,559.76
Rate for Payer: Fidelis Medicare Advantage	$153.11
Rate for Payer: Group Health Inc Commercial	$153.11
Rate for Payer: Group Health Inc Medicare	$153.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,559.76
Rate for Payer: Healthfirst Medicare Advantage	$130.15
Rate for Payer: Healthfirst QHP	$153.11
Rate for Payer: Senior Whole Health Medicare Advantage	$153.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,927.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.49

TENECTEPLASE 50 MG/10 ML IV (WET SOLR VIAL) [43028530]

Facility

$9,119.53

Service Code	HCPCS J3101
Hospital Charge Code	50242012047
Hospital Revenue Code	278
Min. Negotiated Rate	$4,559.76
Max. Negotiated Rate	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,559.76

TENECTEPLASE 50 MG INJ

Facility

$82.18

Service Code	HCPCS J3101
Hospital Charge Code	41654220
Hospital Revenue Code	636
Min. Negotiated Rate	$41.09
Max. Negotiated Rate	$41.09
Rate for Payer: Cash Price	$153.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.09
Rate for Payer: Hamaspik Choice Inc Medicare	$41.09

TENECTEPLASE 50 MG INJ

Facility

$82.18

Service Code	HCPCS J3101
Hospital Charge Code	41644220
Hospital Revenue Code	636
Min. Negotiated Rate	$41.09
Max. Negotiated Rate	$41.09
Rate for Payer: Cash Price	$153.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.09
Rate for Payer: Hamaspik Choice Inc Medicare	$41.09

TENECTEPLASE 50 MG INJ

Facility

$82.18

Service Code	HCPCS J3101
Hospital Charge Code	41644220
Hospital Revenue Code	636
Min. Negotiated Rate	$41.09
Max. Negotiated Rate	$162.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.11
Rate for Payer: Aetna Government	$153.11
Rate for Payer: Brighton Health Commercial	$49.31
Rate for Payer: Cash Price	$153.11
Rate for Payer: Cash Price	$153.11
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$153.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.25
Rate for Payer: Elderplan Medicare Advantage	$153.11
Rate for Payer: EmblemHealth Commercial	$153.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$153.11
Rate for Payer: Fidelis Essential Plan Aliesa	$153.11
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$153.11
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$153.11
Rate for Payer: Group Health Inc Medicare	$153.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.09
Rate for Payer: Hamaspik Choice Inc Medicare	$41.09
Rate for Payer: Healthfirst Medicare Advantage	$130.15
Rate for Payer: Healthfirst QHP	$153.11
Rate for Payer: Senior Whole Health Medicare Advantage	$153.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$162.30
Rate for Payer: SOMOS Essential	$162.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.49
Rate for Payer: Wellcare Medicare	$145.46

TENECTEPLASE 50 MG INJ

Facility

$82.18

Service Code	HCPCS J3101
Hospital Charge Code	41654220
Hospital Revenue Code	636
Min. Negotiated Rate	$41.09
Max. Negotiated Rate	$162.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.11
Rate for Payer: Aetna Government	$153.11
Rate for Payer: Brighton Health Commercial	$49.31
Rate for Payer: Cash Price	$153.11
Rate for Payer: Cash Price	$153.11
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$153.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$41.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$47.25
Rate for Payer: Elderplan Medicare Advantage	$153.11
Rate for Payer: EmblemHealth Commercial	$153.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$153.11
Rate for Payer: Fidelis Essential Plan Aliesa	$153.11
Rate for Payer: Fidelis Essential Plan QHP	$160.77
Rate for Payer: Fidelis Medicare Advantage	$153.11
Rate for Payer: Fidelis Qualified Health Plan	$160.77
Rate for Payer: Group Health Inc Commercial	$153.11
Rate for Payer: Group Health Inc Medicare	$153.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.09
Rate for Payer: Hamaspik Choice Inc Medicare	$41.09
Rate for Payer: Healthfirst Medicare Advantage	$130.15
Rate for Payer: Healthfirst QHP	$153.11
Rate for Payer: Senior Whole Health Medicare Advantage	$153.11
Rate for Payer: SOMOS CHP/HARP/Medicaid	$162.30
Rate for Payer: SOMOS Essential	$162.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.42
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.49
Rate for Payer: Wellcare Medicare	$145.46

TENECTEPLASE 50 MG IV KIT [28530]

Facility

$9,119.53

Service Code	HCPCS J3101
Hospital Charge Code	50242012047
Hospital Revenue Code	278
Min. Negotiated Rate	$4,559.76
Max. Negotiated Rate	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,559.76

TENECTEPLASE 50 MG IV KIT [28530]

Facility

$9,119.53

Service Code	HCPCS J3101
Hospital Charge Code	50242012047
Hospital Revenue Code	278
Min. Negotiated Rate	$122.49
Max. Negotiated Rate	$5,927.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,015.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.11
Rate for Payer: Aetna Government	$153.11
Rate for Payer: Brighton Health Commercial	$5,471.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$153.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,559.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,243.73
Rate for Payer: Elderplan Medicare Advantage	$153.11
Rate for Payer: EmblemHealth Commercial	$4,559.76
Rate for Payer: Fidelis Medicare Advantage	$153.11
Rate for Payer: Group Health Inc Commercial	$153.11
Rate for Payer: Group Health Inc Medicare	$153.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,559.76
Rate for Payer: Healthfirst Medicare Advantage	$130.15
Rate for Payer: Healthfirst QHP	$153.11
Rate for Payer: Senior Whole Health Medicare Advantage	$153.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,927.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.49

TENECTEPLASE 50 MG IV KIT (STEMI/PE) [2853002]

Facility

$9,119.53

Service Code	HCPCS J3101
Hospital Charge Code	50242012047
Hospital Revenue Code	278
Min. Negotiated Rate	$4,559.76
Max. Negotiated Rate	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,559.76

TENECTEPLASE 50 MG IV KIT (STEMI/PE) [2853002]

Facility

$9,119.53

Service Code	HCPCS J3101
Hospital Charge Code	50242012047
Hospital Revenue Code	278
Min. Negotiated Rate	$122.49
Max. Negotiated Rate	$5,927.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5,015.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$153.11
Rate for Payer: Aetna Government	$153.11
Rate for Payer: Brighton Health Commercial	$5,471.72
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$153.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,559.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$5,243.73
Rate for Payer: Elderplan Medicare Advantage	$153.11
Rate for Payer: EmblemHealth Commercial	$4,559.76
Rate for Payer: Fidelis Medicare Advantage	$153.11
Rate for Payer: Group Health Inc Commercial	$153.11
Rate for Payer: Group Health Inc Medicare	$153.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$4,559.76
Rate for Payer: Hamaspik Choice Inc Medicare	$4,559.76
Rate for Payer: Healthfirst Medicare Advantage	$130.15
Rate for Payer: Healthfirst QHP	$153.11
Rate for Payer: Senior Whole Health Medicare Advantage	$153.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5,927.69
Rate for Payer: Wellcare CHP/FHP/Medicaid	$122.49

TENIVAC ADULT INJ 5-2 LF UNITS

Facility

$36.84

Service Code	HCPCS 90714
Hospital Charge Code	41656086
Hospital Revenue Code	636
Min. Negotiated Rate	$18.42
Max. Negotiated Rate	$18.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.42
Rate for Payer: Hamaspik Choice Inc Medicare	$18.42

TENIVAC ADULT INJ 5-2 LF UNITS

Facility

$36.84

Service Code	HCPCS 90714
Hospital Charge Code	41646086
Hospital Revenue Code	636
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$22.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.18
Rate for Payer: Group Health Inc Commercial	$18.42
Rate for Payer: Group Health Inc Medicare	$12.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.42
Rate for Payer: Hamaspik Choice Inc Medicare	$18.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.95

TENIVAC ADULT INJ 5-2 LF UNITS

Facility

$36.84

Service Code	HCPCS 90714
Hospital Charge Code	41646086
Hospital Revenue Code	636
Min. Negotiated Rate	$18.42
Max. Negotiated Rate	$18.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.42
Rate for Payer: Hamaspik Choice Inc Medicare	$18.42

TENIVAC ADULT INJ 5-2 LF UNITS

Facility

$36.84

Service Code	HCPCS 90714
Hospital Charge Code	41656086
Hospital Revenue Code	636
Min. Negotiated Rate	$12.89
Max. Negotiated Rate	$26.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.22
Rate for Payer: Aetna Government	$26.22
Rate for Payer: Brighton Health Commercial	$22.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.18
Rate for Payer: Group Health Inc Commercial	$18.42
Rate for Payer: Group Health Inc Medicare	$12.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.42
Rate for Payer: Hamaspik Choice Inc Medicare	$18.42
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.96
Rate for Payer: SOMOS Essential	$19.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.95

Tenodesis of long tendon of biceps

Facility

$8,273.12

Service Code	CPT 23430
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$8,273.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
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	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

TENOFOVIR 300 MG TAB

Facility

$48.08

Hospital Charge Code	41652728
Hospital Revenue Code	250
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$38.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.04
Rate for Payer: Aetna Government	$24.04
Rate for Payer: Brighton Health Commercial	$36.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.69
Rate for Payer: Group Health Inc Commercial	$24.04
Rate for Payer: Group Health Inc Medicare	$16.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.04
Rate for Payer: Hamaspik Choice Inc Medicare	$24.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.25

TENOFOVIR 300 MG TAB

Facility

$48.08

Hospital Charge Code	41642728
Hospital Revenue Code	250
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$38.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.04
Rate for Payer: Aetna Government	$24.04
Rate for Payer: Brighton Health Commercial	$36.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$38.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$32.69
Rate for Payer: Group Health Inc Commercial	$24.04
Rate for Payer: Group Health Inc Medicare	$16.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.04
Rate for Payer: Hamaspik Choice Inc Medicare	$24.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.25

Know your out-of-pocket cost for care.

All Charges