St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TETRACAINE HCL 0.5 % OP SOLN [7795]

Facility

$3.07

Service Code	NDC 50090236400
Hospital Charge Code	50090236400
Hospital Revenue Code	250
Min. Negotiated Rate	$1.07
Max. Negotiated Rate	$2.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.53
Rate for Payer: Aetna Government	$1.53
Rate for Payer: Brighton Health Commercial	$2.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.09
Rate for Payer: Group Health Inc Commercial	$1.53
Rate for Payer: Group Health Inc Medicare	$1.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.53
Rate for Payer: Hamaspik Choice Inc Medicare	$1.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.99

TETRACAINE HCL 0.5 % OP SOLN [7795]

Facility

$3.97

Service Code	NDC 00065074114
Hospital Charge Code	00065074114
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$3.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.98
Rate for Payer: Aetna Government	$1.98
Rate for Payer: Brighton Health Commercial	$2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.58

TETRACAINE HCL 0.5% OPTH SOLN 4ML

Facility

$10.45

Hospital Charge Code	41646651
Hospital Revenue Code	250
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$8.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.22
Rate for Payer: Aetna Government	$5.22
Rate for Payer: Brighton Health Commercial	$7.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.11
Rate for Payer: Group Health Inc Commercial	$5.22
Rate for Payer: Group Health Inc Medicare	$3.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.22
Rate for Payer: Hamaspik Choice Inc Medicare	$5.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.79

TETRACAINE HCL 1 % IJ SOLN [11517]

Facility

$45.52

Service Code	NDC 54288012710
Hospital Charge Code	54288012710
Hospital Revenue Code	250
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$36.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.76
Rate for Payer: Aetna Government	$22.76
Rate for Payer: Brighton Health Commercial	$34.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.95
Rate for Payer: Group Health Inc Commercial	$22.76
Rate for Payer: Group Health Inc Medicare	$15.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.76
Rate for Payer: Hamaspik Choice Inc Medicare	$22.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.58

TETRACAINE HCL 1 % IJ SOLN [11517]

Facility

$45.52

Service Code	NDC 42494043710
Hospital Charge Code	42494043710
Hospital Revenue Code	250
Min. Negotiated Rate	$15.93
Max. Negotiated Rate	$36.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$25.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.76
Rate for Payer: Aetna Government	$22.76
Rate for Payer: Brighton Health Commercial	$34.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$36.41
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.95
Rate for Payer: Group Health Inc Commercial	$22.76
Rate for Payer: Group Health Inc Medicare	$15.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.76
Rate for Payer: Hamaspik Choice Inc Medicare	$22.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$29.58

TETRACYCLINE 250 MG CAP

Facility

$1.00

Hospital Charge Code	41640699
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

TETRACYCLINE 250 MG CAP

Facility

$1.00

Hospital Charge Code	41650699
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

TETRACYCLINE 500 MG CAP

Facility

$1.00

Hospital Charge Code	41640822
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

TETRACYCLINE 500 MG CAP

Facility

$1.00

Hospital Charge Code	41650822
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

TETRACYCLINE HCL 250 MG PO CAPS [7796]

Facility

$7.88

Service Code	NDC 60219152201
Hospital Charge Code	60219152201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$6.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.94
Rate for Payer: Aetna Government	$3.94
Rate for Payer: Brighton Health Commercial	$5.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.36
Rate for Payer: Group Health Inc Commercial	$3.94
Rate for Payer: Group Health Inc Medicare	$2.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.94
Rate for Payer: Hamaspik Choice Inc Medicare	$3.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.12

TETRACYCLINE HCL 500 MG PO CAPS [7797]

Facility

$15.75

Service Code	NDC 69238152301
Hospital Charge Code	69238152301
Hospital Revenue Code	250
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$12.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.88
Rate for Payer: Aetna Government	$7.88
Rate for Payer: Brighton Health Commercial	$11.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.71
Rate for Payer: Group Health Inc Commercial	$7.88
Rate for Payer: Group Health Inc Medicare	$5.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.88
Rate for Payer: Hamaspik Choice Inc Medicare	$7.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.24

TETRACYCLINE HCL 500 MG PO CAPS [7797]

Facility

$15.75

Service Code	NDC 23155076701
Hospital Charge Code	23155076701
Hospital Revenue Code	250
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$12.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.88
Rate for Payer: Aetna Government	$7.88
Rate for Payer: Brighton Health Commercial	$11.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.71
Rate for Payer: Group Health Inc Commercial	$7.88
Rate for Payer: Group Health Inc Medicare	$5.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.88
Rate for Payer: Hamaspik Choice Inc Medicare	$7.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.24

TETRAHYDROZOLINE 0.05% OPHTHALMIC SOLN

Facility

$3.00

Hospital Charge Code	41640728
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

TETRAHYDROZOLINE 0.05% OPHTHALMIC SOLN

Facility

$3.00

Hospital Charge Code	41650728
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

TETRAHYDROZOLINE HCL 0.05 % OP SOLN [7800]

Facility

$0.13

Service Code	NDC 00536121794
Hospital Charge Code	00536121794
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
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	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

TEXAS CATHETER

Facility

$17.01

Hospital Charge Code	40206004
Hospital Revenue Code	270
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$13.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.50
Rate for Payer: Aetna Government	$8.50
Rate for Payer: Brighton Health Commercial	$12.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.57
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

TEZEPELUMAB-EKKO 210MG

Facility

$43.25

Service Code	HCPCS J2356
Hospital Charge Code	41650386
Hospital Revenue Code	636
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$21.62
Rate for Payer: Cash Price	$18.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.62
Rate for Payer: Hamaspik Choice Inc Medicare	$21.62

TEZEPELUMAB-EKKO 210MG

Facility

$43.25

Service Code	HCPCS J2356
Hospital Charge Code	41640386
Hospital Revenue Code	636
Min. Negotiated Rate	$21.62
Max. Negotiated Rate	$21.62
Rate for Payer: Cash Price	$18.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.62
Rate for Payer: Hamaspik Choice Inc Medicare	$21.62

TEZEPELUMAB-EKKO 210MG

Facility

$43.25

Service Code	HCPCS J2356
Hospital Charge Code	41650386
Hospital Revenue Code	636
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$28.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.59
Rate for Payer: Aetna Government	$18.59
Rate for Payer: Brighton Health Commercial	$25.95
Rate for Payer: Cash Price	$18.59
Rate for Payer: Cash Price	$18.59
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.87
Rate for Payer: Elderplan Medicare Advantage	$18.59
Rate for Payer: EmblemHealth Commercial	$18.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.59
Rate for Payer: Fidelis Essential Plan Aliesa	$18.59
Rate for Payer: Fidelis Essential Plan QHP	$19.52
Rate for Payer: Fidelis Medicare Advantage	$18.59
Rate for Payer: Fidelis Qualified Health Plan	$19.52
Rate for Payer: Group Health Inc Commercial	$18.59
Rate for Payer: Group Health Inc Medicare	$18.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.62
Rate for Payer: Hamaspik Choice Inc Medicare	$21.62
Rate for Payer: Healthfirst Medicare Advantage	$15.80
Rate for Payer: Healthfirst QHP	$18.59
Rate for Payer: Senior Whole Health Medicare Advantage	$18.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.87
Rate for Payer: SOMOS Essential	$18.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.87
Rate for Payer: Wellcare Medicare	$17.66

TEZEPELUMAB-EKKO 210MG

Facility

$43.25

Service Code	HCPCS J2356
Hospital Charge Code	41640386
Hospital Revenue Code	636
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$28.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$23.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.59
Rate for Payer: Aetna Government	$18.59
Rate for Payer: Brighton Health Commercial	$25.95
Rate for Payer: Cash Price	$18.59
Rate for Payer: Cash Price	$18.59
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.87
Rate for Payer: Elderplan Medicare Advantage	$18.59
Rate for Payer: EmblemHealth Commercial	$18.59
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18.59
Rate for Payer: Fidelis Essential Plan Aliesa	$18.59
Rate for Payer: Fidelis Essential Plan QHP	$19.52
Rate for Payer: Fidelis Medicare Advantage	$18.59
Rate for Payer: Fidelis Qualified Health Plan	$19.52
Rate for Payer: Group Health Inc Commercial	$18.59
Rate for Payer: Group Health Inc Medicare	$18.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$21.62
Rate for Payer: Hamaspik Choice Inc Medicare	$21.62
Rate for Payer: Healthfirst Medicare Advantage	$15.80
Rate for Payer: Healthfirst QHP	$18.59
Rate for Payer: Senior Whole Health Medicare Advantage	$18.59
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18.87
Rate for Payer: SOMOS Essential	$18.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.11
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.87
Rate for Payer: Wellcare Medicare	$17.66

TEZEPELUMAB-EKKO 210 MG/1.91ML SC SOAJ [189043]

Facility

$2,715.93

Service Code	NDC 55513012301
Hospital Charge Code	55513012301
Hospital Revenue Code	250
Min. Negotiated Rate	$950.57
Max. Negotiated Rate	$2,172.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,493.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,357.96
Rate for Payer: Aetna Government	$1,357.96
Rate for Payer: Brighton Health Commercial	$2,036.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,172.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,846.83
Rate for Payer: Group Health Inc Commercial	$1,357.96
Rate for Payer: Group Health Inc Medicare	$950.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,357.96
Rate for Payer: Hamaspik Choice Inc Medicare	$1,357.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,765.35

TEZEPELUMAB-EKKO 210 MG/1.91ML SC SOSY [183830]

Facility

$2,538.04

Service Code	HCPCS J2356
Hospital Charge Code	55513011201
Hospital Revenue Code	250
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$2,030.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,395.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.59
Rate for Payer: Aetna Government	$18.59
Rate for Payer: Brighton Health Commercial	$1,903.53
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$18.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,030.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,725.87
Rate for Payer: Elderplan Medicare Advantage	$18.59
Rate for Payer: EmblemHealth Commercial	$18.59
Rate for Payer: Fidelis Essential Plan Aliesa	$15.80
Rate for Payer: Fidelis Essential Plan QHP	$16.54
Rate for Payer: Fidelis Medicare Advantage	$18.59
Rate for Payer: Fidelis Qualified Health Plan	$16.54
Rate for Payer: Group Health Inc Commercial	$18.59
Rate for Payer: Group Health Inc Medicare	$18.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,269.02
Rate for Payer: Hamaspik Choice Inc Medicare	$18.59
Rate for Payer: Healthfirst Medicare Advantage	$15.80
Rate for Payer: Healthfirst QHP	$18.59
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$17.80
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$18.87
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$18.87
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$18.87
Rate for Payer: Senior Whole Health Medicare Advantage	$18.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,649.73
Rate for Payer: Wellcare CHP/FHP/Medicaid	$14.87
Rate for Payer: Wellcare Medicare	$17.66

TGAB+THYROGLOBULIN, IMA OR LCMS

Facility

$39.78

Service Code	HCPCS 86800
Hospital Charge Code	40609152
Hospital Revenue Code	300
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$29.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.91
Rate for Payer: Aetna Government	$15.91
Rate for Payer: Brighton Health Commercial	$29.84
Rate for Payer: Cash Price	$15.91
Rate for Payer: Cash Price	$15.91
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.40
Rate for Payer: Elderplan Medicare Advantage	$15.91
Rate for Payer: EmblemHealth Commercial	$15.91
Rate for Payer: Fidelis Essential Plan Aliesa	$13.52
Rate for Payer: Fidelis Essential Plan QHP	$14.16
Rate for Payer: Fidelis Medicare Advantage	$15.91
Rate for Payer: Fidelis Qualified Health Plan	$14.16
Rate for Payer: Group Health Inc Commercial	$15.91
Rate for Payer: Group Health Inc Medicare	$15.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.89
Rate for Payer: Hamaspik Choice Inc Medicare	$15.91
Rate for Payer: Healthfirst Medicare Advantage	$15.91
Rate for Payer: Healthfirst QHP	$15.91
Rate for Payer: Senior Whole Health Medicare Advantage	$15.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.91
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.73
Rate for Payer: Wellcare Medicare	$14.32

TGAB+THYROGLOBULIN, IMA OR LCMS

Facility

$39.78

Service Code	HCPCS 86800
Hospital Charge Code	40609152
Hospital Revenue Code	300
Rate for Payer: Cash Price	$15.91

TGAB+THYROGLOBULIN,IMA OR RIA

Facility

$39.78

Service Code	HCPCS 86800
Hospital Charge Code	40609151
Hospital Revenue Code	300
Rate for Payer: Cash Price	$15.91

Know your out-of-pocket cost for care.

All Charges