St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TENOFOVIR ALAFENAMIDE 25MG

Facility

$38.75

Hospital Charge Code	41640358
Hospital Revenue Code	250
Min. Negotiated Rate	$13.56
Max. Negotiated Rate	$31.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.38
Rate for Payer: Aetna Government	$19.38
Rate for Payer: Brighton Health Commercial	$29.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.35
Rate for Payer: Group Health Inc Commercial	$19.38
Rate for Payer: Group Health Inc Medicare	$13.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.38
Rate for Payer: Hamaspik Choice Inc Medicare	$19.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.19

TENOFOVIR ALAFENAMIDE 25MG

Facility

$38.75

Hospital Charge Code	41650358
Hospital Revenue Code	250
Min. Negotiated Rate	$13.56
Max. Negotiated Rate	$31.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.38
Rate for Payer: Aetna Government	$19.38
Rate for Payer: Brighton Health Commercial	$29.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.35
Rate for Payer: Group Health Inc Commercial	$19.38
Rate for Payer: Group Health Inc Medicare	$13.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.38
Rate for Payer: Hamaspik Choice Inc Medicare	$19.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.19

TENOFOVIR ALAFENAMIDE FUMARATE 25 MG PO TABS [135195]

Facility

$57.66

Service Code	NDC 61958230101
Hospital Charge Code	61958230101
Hospital Revenue Code	250
Min. Negotiated Rate	$20.18
Max. Negotiated Rate	$46.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.83
Rate for Payer: Aetna Government	$28.83
Rate for Payer: Brighton Health Commercial	$43.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.13
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.21
Rate for Payer: Group Health Inc Commercial	$28.83
Rate for Payer: Group Health Inc Medicare	$20.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.83
Rate for Payer: Hamaspik Choice Inc Medicare	$28.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.48

TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS [31684]

Facility

$40.53

Service Code	NDC 64380071404
Hospital Charge Code	64380071404
Hospital Revenue Code	250
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$32.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.27
Rate for Payer: Aetna Government	$20.27
Rate for Payer: Brighton Health Commercial	$30.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.56
Rate for Payer: Group Health Inc Commercial	$20.27
Rate for Payer: Group Health Inc Medicare	$14.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.27
Rate for Payer: Hamaspik Choice Inc Medicare	$20.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.35

TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS [31684]

Facility

$5.66

Service Code	NDC 00904682104
Hospital Charge Code	00904682104
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$4.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.83
Rate for Payer: Aetna Government	$2.83
Rate for Payer: Brighton Health Commercial	$4.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.85
Rate for Payer: Group Health Inc Commercial	$2.83
Rate for Payer: Group Health Inc Medicare	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.83
Rate for Payer: Hamaspik Choice Inc Medicare	$2.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.68

TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS [31684]

Facility

$5.57

Service Code	NDC 69097053302
Hospital Charge Code	69097053302
Hospital Revenue Code	250
Min. Negotiated Rate	$1.95
Max. Negotiated Rate	$4.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.79
Rate for Payer: Aetna Government	$2.79
Rate for Payer: Brighton Health Commercial	$4.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.79
Rate for Payer: Group Health Inc Commercial	$2.79
Rate for Payer: Group Health Inc Medicare	$1.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.79
Rate for Payer: Hamaspik Choice Inc Medicare	$2.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.62

TENOFOVIR DISOPROXIL FUMARATE 300 MG PO TABS [31684]

Facility

$40.53

Service Code	NDC 33342009607
Hospital Charge Code	33342009607
Hospital Revenue Code	250
Min. Negotiated Rate	$14.19
Max. Negotiated Rate	$32.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.27
Rate for Payer: Aetna Government	$20.27
Rate for Payer: Brighton Health Commercial	$30.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.56
Rate for Payer: Group Health Inc Commercial	$20.27
Rate for Payer: Group Health Inc Medicare	$14.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.27
Rate for Payer: Hamaspik Choice Inc Medicare	$20.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.35

TENOFOVIR EMTRICIT 300/200MG

Facility

$76.49

Hospital Charge Code	41653747
Hospital Revenue Code	250
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$61.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.24
Rate for Payer: Aetna Government	$38.24
Rate for Payer: Brighton Health Commercial	$57.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.01
Rate for Payer: Group Health Inc Commercial	$38.24
Rate for Payer: Group Health Inc Medicare	$26.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.24
Rate for Payer: Hamaspik Choice Inc Medicare	$38.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.72

TENOFOVIR-EMTRICITABINE 300 MG-200 MG TA

Facility

$76.49

Hospital Charge Code	41643747
Hospital Revenue Code	250
Min. Negotiated Rate	$26.77
Max. Negotiated Rate	$61.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$42.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$38.24
Rate for Payer: Aetna Government	$38.24
Rate for Payer: Brighton Health Commercial	$57.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$61.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$52.01
Rate for Payer: Group Health Inc Commercial	$38.24
Rate for Payer: Group Health Inc Medicare	$26.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$38.24
Rate for Payer: Hamaspik Choice Inc Medicare	$38.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$49.72

Tenolysis, flexor tendon; palm AND finger, each tendon

Facility

$3,743.15

Service Code	CPT 26442
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$3,743.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3,743.15
Rate for Payer: Aetna Government	$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 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

Tenolysis, flexor tendon; palm OR finger, each tendon

Facility

$2,915.00

Service Code	CPT 26440
Hospital Revenue Code	360
Min. Negotiated Rate	$1,486.89
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,858.61
Rate for Payer: Aetna Government	$1,858.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,858.61
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	$1,858.61
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$1,579.82
Rate for Payer: Fidelis Essential Plan QHP	$1,654.16
Rate for Payer: Fidelis Medicare Advantage	$1,858.61
Rate for Payer: Fidelis Qualified Health Plan	$1,654.16
Rate for Payer: Group Health Inc Commercial	$1,858.61
Rate for Payer: Group Health Inc Medicare	$1,858.61
Rate for Payer: Hamaspik Choice Inc Medicare	$1,858.61
Rate for Payer: Healthfirst Medicare Advantage	$1,579.82
Rate for Payer: Healthfirst QHP	$1,858.61
Rate for Payer: Senior Whole Health Medicare Advantage	$1,858.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,858.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1,486.89
Rate for Payer: Wellcare Medicare	$1,765.68

TENOTOMY

Facility

$8,291.05

Service Code	HCPCS 27606
Hospital Charge Code	40082865
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,743.15

TENOTOMY

Facility

$8,291.05

Service Code	HCPCS 27606
Hospital Charge Code	40082865
Hospital Revenue Code	360
Min. Negotiated Rate	$1,412.00
Max. Negotiated Rate	$6,218.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
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

TENSILON TEST

Facility

$766.58

Service Code	HCPCS 95857
Hospital Charge Code	30301270
Hospital Revenue Code	920
Rate for Payer: Cash Price	$362.98

TENSILON TEST

Facility

$4,105.13

Service Code	HCPCS 95857
Hospital Charge Code	30301225
Hospital Revenue Code	510
Min. Negotiated Rate	$173.89
Max. Negotiated Rate	$2,257.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,257.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
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	$2,052.56
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$362.98
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

TENSILON TEST

Facility

$766.58

Service Code	HCPCS 95857
Hospital Charge Code	30301270
Hospital Revenue Code	920
Min. Negotiated Rate	$290.38
Max. Negotiated Rate	$613.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$421.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$362.98
Rate for Payer: Aetna Government	$362.98
Rate for Payer: Brighton Health Commercial	$574.94
Rate for Payer: Cash Price	$362.98
Rate for Payer: Cash Price	$362.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$362.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$613.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$521.27
Rate for Payer: Elderplan Medicare Advantage	$362.98
Rate for Payer: EmblemHealth Commercial	$362.98
Rate for Payer: Fidelis Essential Plan Aliesa	$308.53
Rate for Payer: Fidelis Essential Plan QHP	$323.05
Rate for Payer: Fidelis Medicare Advantage	$362.98
Rate for Payer: Fidelis Qualified Health Plan	$323.05
Rate for Payer: Group Health Inc Commercial	$362.98
Rate for Payer: Group Health Inc Medicare	$362.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$383.29
Rate for Payer: Hamaspik Choice Inc Medicare	$362.98
Rate for Payer: Healthfirst Medicare Advantage	$308.53
Rate for Payer: Healthfirst QHP	$362.98
Rate for Payer: Senior Whole Health Medicare Advantage	$362.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$362.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$290.38
Rate for Payer: Wellcare Medicare	$344.83

TENSILON TEST

Facility

$4,105.13

Service Code	HCPCS 95857
Hospital Charge Code	30301225
Hospital Revenue Code	510
Rate for Payer: Cash Price	$362.98

TERBINAFINE 250 MG TAB

Facility

$0.30

Hospital Charge Code	41642649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

TERBINAFINE 250 MG TAB

Facility

$0.30

Hospital Charge Code	41652649
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.15
Rate for Payer: Aetna Government	$0.15
Rate for Payer: Brighton Health Commercial	$0.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: Group Health Inc Commercial	$0.15
Rate for Payer: Group Health Inc Medicare	$0.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15
Rate for Payer: Hamaspik Choice Inc Medicare	$0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

TERBINAFINE HCL 250 MG PO TABS [12724]

Facility

$13.02

Service Code	NDC 69097073102
Hospital Charge Code	69097073102
Hospital Revenue Code	250
Min. Negotiated Rate	$4.56
Max. Negotiated Rate	$10.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.51
Rate for Payer: Aetna Government	$6.51
Rate for Payer: Brighton Health Commercial	$9.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.86
Rate for Payer: Group Health Inc Commercial	$6.51
Rate for Payer: Group Health Inc Medicare	$4.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.51
Rate for Payer: Hamaspik Choice Inc Medicare	$6.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.46

TERBINAFINE HCL 250 MG PO TABS [12724]

Facility

$12.79

Service Code	NDC 65862007930
Hospital Charge Code	65862007930
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$10.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.39
Rate for Payer: Aetna Government	$6.39
Rate for Payer: Brighton Health Commercial	$9.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.69
Rate for Payer: Group Health Inc Commercial	$6.39
Rate for Payer: Group Health Inc Medicare	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.39
Rate for Payer: Hamaspik Choice Inc Medicare	$6.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.31

TERBUTALINE 1 MG/ML INJ

Facility

$18.38

Service Code	HCPCS J3105
Hospital Charge Code	41653723
Hospital Revenue Code	636
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$9.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.19
Rate for Payer: Hamaspik Choice Inc Medicare	$9.19

TERBUTALINE 1 MG/ML INJ

Facility

$18.38

Service Code	HCPCS J3105
Hospital Charge Code	41643723
Hospital Revenue Code	636
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$11.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$11.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.57
Rate for Payer: Group Health Inc Commercial	$9.19
Rate for Payer: Group Health Inc Medicare	$6.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.19
Rate for Payer: Hamaspik Choice Inc Medicare	$9.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.45
Rate for Payer: SOMOS Essential	$6.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.95

TERBUTALINE 1 MG/ML INJ

Facility

$18.38

Service Code	HCPCS J3105
Hospital Charge Code	41643723
Hospital Revenue Code	636
Min. Negotiated Rate	$9.19
Max. Negotiated Rate	$9.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.19
Rate for Payer: Hamaspik Choice Inc Medicare	$9.19

TERBUTALINE 1 MG/ML INJ

Facility

$18.38

Service Code	HCPCS J3105
Hospital Charge Code	41653723
Hospital Revenue Code	636
Min. Negotiated Rate	$2.53
Max. Negotiated Rate	$11.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.53
Rate for Payer: Aetna Government	$2.53
Rate for Payer: Brighton Health Commercial	$11.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.19
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.57
Rate for Payer: Group Health Inc Commercial	$9.19
Rate for Payer: Group Health Inc Medicare	$6.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.19
Rate for Payer: Hamaspik Choice Inc Medicare	$9.19
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.45
Rate for Payer: SOMOS Essential	$6.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.95

Know your out-of-pocket cost for care.

All Charges