St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TOCILIZUMAB 80MG/4ML

Facility

$14.22

Service Code	HCPCS J3262
Hospital Charge Code	41640246
Hospital Revenue Code	636
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$7.11
Rate for Payer: Cash Price	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.11
Rate for Payer: Hamaspik Choice Inc Medicare	$7.11

TOCILIZUMAB 80MG/4ML

Facility

$14.22

Service Code	HCPCS J3262
Hospital Charge Code	41650246
Hospital Revenue Code	636
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$9.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.12
Rate for Payer: Aetna Government	$6.12
Rate for Payer: Affinity Essential Plan 1&2	$4.28
Rate for Payer: Affinity Essential Plan 3&4	$4.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.28
Rate for Payer: Brighton Health Commercial	$8.53
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cash Price	$6.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.18
Rate for Payer: Elderplan Medicare Advantage	$6.12
Rate for Payer: EmblemHealth Commercial	$6.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.12
Rate for Payer: Fidelis Essential Plan Aliesa	$6.12
Rate for Payer: Fidelis Essential Plan QHP	$6.43
Rate for Payer: Fidelis Medicare Advantage	$6.12
Rate for Payer: Fidelis Qualified Health Plan	$6.43
Rate for Payer: Group Health Inc Commercial	$6.12
Rate for Payer: Group Health Inc Medicare	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.11
Rate for Payer: Hamaspik Choice Inc Medicare	$7.11
Rate for Payer: Healthfirst Medicare Advantage	$5.20
Rate for Payer: Healthfirst QHP	$6.12
Rate for Payer: Humana Medicare	$6.24
Rate for Payer: Senior Whole Health Medicare Advantage	$6.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.40
Rate for Payer: SOMOS Essential	$6.40
Rate for Payer: United Healthcare Commercial	$5.99
Rate for Payer: United Healthcare Medicare Advantage	$6.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.90
Rate for Payer: Wellcare Medicare	$5.81

TOCILIZUMAB 80MG/4ML

Facility

$14.22

Service Code	HCPCS J3262
Hospital Charge Code	41650246
Hospital Revenue Code	636
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$7.11
Rate for Payer: Cash Price	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.11
Rate for Payer: Hamaspik Choice Inc Medicare	$7.11

TOCILIZUMAB 80MG/4ML

Facility

$14.22

Service Code	HCPCS J3262
Hospital Charge Code	41640246
Hospital Revenue Code	636
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$9.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.12
Rate for Payer: Aetna Government	$6.12
Rate for Payer: Affinity Essential Plan 1&2	$4.28
Rate for Payer: Affinity Essential Plan 3&4	$4.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.28
Rate for Payer: Brighton Health Commercial	$8.53
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cash Price	$6.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.18
Rate for Payer: Elderplan Medicare Advantage	$6.12
Rate for Payer: EmblemHealth Commercial	$6.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.12
Rate for Payer: Fidelis Essential Plan Aliesa	$6.12
Rate for Payer: Fidelis Essential Plan QHP	$6.43
Rate for Payer: Fidelis Medicare Advantage	$6.12
Rate for Payer: Fidelis Qualified Health Plan	$6.43
Rate for Payer: Group Health Inc Commercial	$6.12
Rate for Payer: Group Health Inc Medicare	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.11
Rate for Payer: Hamaspik Choice Inc Medicare	$7.11
Rate for Payer: Healthfirst Medicare Advantage	$5.20
Rate for Payer: Healthfirst QHP	$6.12
Rate for Payer: Humana Medicare	$6.24
Rate for Payer: Senior Whole Health Medicare Advantage	$6.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.40
Rate for Payer: SOMOS Essential	$6.40
Rate for Payer: United Healthcare Commercial	$5.99
Rate for Payer: United Healthcare Medicare Advantage	$6.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.24
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.90
Rate for Payer: Wellcare Medicare	$5.81

TOCILIZUMAB 80 MG/4ML IV SOLN [108061]

Facility

$159.35

Service Code	HCPCS J3262
Hospital Charge Code	50242013501
Hospital Revenue Code	278
Min. Negotiated Rate	$79.67
Max. Negotiated Rate	$79.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.67
Rate for Payer: Hamaspik Choice Inc Medicare	$79.67

TOCILIZUMAB 80 MG/4ML IV SOLN [108061]

Facility

$159.35

Service Code	HCPCS J3262
Hospital Charge Code	50242013501
Hospital Revenue Code	278
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$103.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.12
Rate for Payer: Aetna Government	$6.12
Rate for Payer: Brighton Health Commercial	$95.61
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$79.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$91.63
Rate for Payer: Elderplan Medicare Advantage	$6.12
Rate for Payer: EmblemHealth Commercial	$79.67
Rate for Payer: Fidelis Medicare Advantage	$6.12
Rate for Payer: Group Health Inc Commercial	$6.12
Rate for Payer: Group Health Inc Medicare	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.67
Rate for Payer: Hamaspik Choice Inc Medicare	$79.67
Rate for Payer: Healthfirst Medicare Advantage	$5.20
Rate for Payer: Healthfirst QHP	$6.12
Rate for Payer: Humana Medicare	$6.24
Rate for Payer: Senior Whole Health Medicare Advantage	$6.12
Rate for Payer: United Healthcare Medicare Advantage	$6.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.58
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.90

TOCILIZUMAB/PLACEBO (TRIAL)

Facility

$0.01

Service Code	HCPCS J3262
Hospital Charge Code	41640350
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TOCILIZUMAB/PLACEBO (TRIAL)

Facility

$0.01

Service Code	HCPCS J3262
Hospital Charge Code	41650350
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$6.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.12
Rate for Payer: Aetna Government	$6.12
Rate for Payer: Affinity Essential Plan 1&2	$4.28
Rate for Payer: Affinity Essential Plan 3&4	$4.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.28
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cash Price	$6.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Elderplan Medicare Advantage	$6.12
Rate for Payer: EmblemHealth Commercial	$6.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.12
Rate for Payer: Fidelis Essential Plan Aliesa	$6.12
Rate for Payer: Fidelis Essential Plan QHP	$6.43
Rate for Payer: Fidelis Medicare Advantage	$6.12
Rate for Payer: Fidelis Qualified Health Plan	$6.43
Rate for Payer: Group Health Inc Commercial	$6.12
Rate for Payer: Group Health Inc Medicare	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst Medicare Advantage	$5.20
Rate for Payer: Healthfirst QHP	$6.12
Rate for Payer: Humana Medicare	$6.24
Rate for Payer: Senior Whole Health Medicare Advantage	$6.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.40
Rate for Payer: SOMOS Essential	$6.40
Rate for Payer: United Healthcare Commercial	$5.99
Rate for Payer: United Healthcare Medicare Advantage	$6.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.90
Rate for Payer: Wellcare Medicare	$5.81

TOCILIZUMAB/PLACEBO (TRIAL)

Facility

$0.01

Service Code	HCPCS J3262
Hospital Charge Code	41650350
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Cash Price	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

TOCILIZUMAB/PLACEBO (TRIAL)

Facility

$0.01

Service Code	HCPCS J3262
Hospital Charge Code	41640350
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$6.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.12
Rate for Payer: Aetna Government	$6.12
Rate for Payer: Affinity Essential Plan 1&2	$4.28
Rate for Payer: Affinity Essential Plan 3&4	$4.28
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.28
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cash Price	$6.12
Rate for Payer: Cash Price	$6.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Elderplan Medicare Advantage	$6.12
Rate for Payer: EmblemHealth Commercial	$6.12
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.12
Rate for Payer: Fidelis Essential Plan Aliesa	$6.12
Rate for Payer: Fidelis Essential Plan QHP	$6.43
Rate for Payer: Fidelis Medicare Advantage	$6.12
Rate for Payer: Fidelis Qualified Health Plan	$6.43
Rate for Payer: Group Health Inc Commercial	$6.12
Rate for Payer: Group Health Inc Medicare	$6.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: Healthfirst Medicare Advantage	$5.20
Rate for Payer: Healthfirst QHP	$6.12
Rate for Payer: Humana Medicare	$6.24
Rate for Payer: Senior Whole Health Medicare Advantage	$6.12
Rate for Payer: SOMOS CHP/HARP/Medicaid	$6.40
Rate for Payer: SOMOS Essential	$6.40
Rate for Payer: United Healthcare Commercial	$5.99
Rate for Payer: United Healthcare Medicare Advantage	$6.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01
Rate for Payer: Wellcare CHP/FHP/Medicaid	$4.90
Rate for Payer: Wellcare Medicare	$5.81

TOE IMPLANT, FLEX HINGED

Facility

$315.75

Hospital Charge Code	40202112
Hospital Revenue Code	270
Min. Negotiated Rate	$110.51
Max. Negotiated Rate	$252.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$173.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$157.88
Rate for Payer: Aetna Government	$157.88
Rate for Payer: Brighton Health Commercial	$236.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$252.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$214.71
Rate for Payer: Group Health Inc Commercial	$157.88
Rate for Payer: Group Health Inc Medicare	$110.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$157.88
Rate for Payer: Hamaspik Choice Inc Medicare	$157.88

TOE IMPLANT, GREAT

Facility

$282.44

Hospital Charge Code	40202122
Hospital Revenue Code	270
Min. Negotiated Rate	$98.85
Max. Negotiated Rate	$225.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$155.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$141.22
Rate for Payer: Aetna Government	$141.22
Rate for Payer: Brighton Health Commercial	$211.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$225.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$192.06
Rate for Payer: Group Health Inc Commercial	$141.22
Rate for Payer: Group Health Inc Medicare	$98.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.22
Rate for Payer: Hamaspik Choice Inc Medicare	$141.22

TOE M-P JNT MED20MM POROUS COTED

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Charge Code	40200807
Hospital Revenue Code	278
Min. Negotiated Rate	$1,075.00
Max. Negotiated Rate	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,075.00

TOE M-P JNT MED20MM POROUS COTED

Facility

$2,150.00

Service Code	HCPCS C1713
Hospital Charge Code	40200807
Hospital Revenue Code	278
Min. Negotiated Rate	$134.20
Max. Negotiated Rate	$2,257.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,182.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$134.20
Rate for Payer: Aetna Government	$134.20
Rate for Payer: Brighton Health Commercial	$1,290.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,075.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,236.25
Rate for Payer: EmblemHealth Commercial	$1,075.00
Rate for Payer: Fidelis Medicare Advantage	$2,257.50
Rate for Payer: Group Health Inc Commercial	$1,075.00
Rate for Payer: Group Health Inc Medicare	$752.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,075.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1,075.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,397.50

TOLVAPTAN 15 MG PO TABS [97893]

Facility

$561.78

Service Code	NDC 49884076854
Hospital Charge Code	49884076854
Hospital Revenue Code	250
Min. Negotiated Rate	$196.62
Max. Negotiated Rate	$449.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$308.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$280.89
Rate for Payer: Aetna Government	$280.89
Rate for Payer: Brighton Health Commercial	$421.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$449.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$382.01
Rate for Payer: Group Health Inc Commercial	$280.89
Rate for Payer: Group Health Inc Medicare	$196.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$280.89
Rate for Payer: Hamaspik Choice Inc Medicare	$280.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$365.16

TOLVAPTAN 15 MG PO TABS [97893]

Facility

$624.24

Service Code	NDC 59148002050
Hospital Charge Code	59148002050
Hospital Revenue Code	250
Min. Negotiated Rate	$218.48
Max. Negotiated Rate	$499.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$343.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$312.12
Rate for Payer: Aetna Government	$312.12
Rate for Payer: Brighton Health Commercial	$468.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$499.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$424.48
Rate for Payer: Group Health Inc Commercial	$312.12
Rate for Payer: Group Health Inc Medicare	$218.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$312.12
Rate for Payer: Hamaspik Choice Inc Medicare	$312.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$405.75

TOLVAPTAN 15 MG TAB

Facility

$535.31

Hospital Charge Code	41655592
Hospital Revenue Code	250
Min. Negotiated Rate	$187.36
Max. Negotiated Rate	$428.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$267.65
Rate for Payer: Aetna Government	$267.65
Rate for Payer: Brighton Health Commercial	$401.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$364.01
Rate for Payer: Group Health Inc Commercial	$267.65
Rate for Payer: Group Health Inc Medicare	$187.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.65
Rate for Payer: Hamaspik Choice Inc Medicare	$267.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$347.95

TOLVAPTAN 15 MG TAB

Facility

$535.31

Hospital Charge Code	41645592
Hospital Revenue Code	250
Min. Negotiated Rate	$187.36
Max. Negotiated Rate	$428.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$267.65
Rate for Payer: Aetna Government	$267.65
Rate for Payer: Brighton Health Commercial	$401.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$364.01
Rate for Payer: Group Health Inc Commercial	$267.65
Rate for Payer: Group Health Inc Medicare	$187.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.65
Rate for Payer: Hamaspik Choice Inc Medicare	$267.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$347.95

TOLVAPTAN 30 MG PO TABS [97894]

Facility

$647.57

Service Code	NDC 59148002150
Hospital Charge Code	59148002150
Hospital Revenue Code	250
Min. Negotiated Rate	$226.65
Max. Negotiated Rate	$518.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$356.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$323.79
Rate for Payer: Aetna Government	$323.79
Rate for Payer: Brighton Health Commercial	$485.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$518.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$440.35
Rate for Payer: Group Health Inc Commercial	$323.79
Rate for Payer: Group Health Inc Medicare	$226.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$323.79
Rate for Payer: Hamaspik Choice Inc Medicare	$323.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$420.92

TOLVAPTAN 30 MG PO TABS [97894]

Facility

$582.75

Service Code	NDC 31722086903
Hospital Charge Code	31722086903
Hospital Revenue Code	250
Min. Negotiated Rate	$203.96
Max. Negotiated Rate	$466.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$320.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$291.38
Rate for Payer: Aetna Government	$291.38
Rate for Payer: Brighton Health Commercial	$437.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$466.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$396.27
Rate for Payer: Group Health Inc Commercial	$291.38
Rate for Payer: Group Health Inc Medicare	$203.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$291.38
Rate for Payer: Hamaspik Choice Inc Medicare	$291.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$378.79

TOLVAPTAN 30 MG TAB

Facility

$535.31

Hospital Charge Code	41645593
Hospital Revenue Code	250
Min. Negotiated Rate	$187.36
Max. Negotiated Rate	$428.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$267.65
Rate for Payer: Aetna Government	$267.65
Rate for Payer: Brighton Health Commercial	$401.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$364.01
Rate for Payer: Group Health Inc Commercial	$267.65
Rate for Payer: Group Health Inc Medicare	$187.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.65
Rate for Payer: Hamaspik Choice Inc Medicare	$267.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$347.95

TOLVAPTAN 30 MG TAB

Facility

$535.31

Hospital Charge Code	41655593
Hospital Revenue Code	250
Min. Negotiated Rate	$187.36
Max. Negotiated Rate	$428.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$294.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$267.65
Rate for Payer: Aetna Government	$267.65
Rate for Payer: Brighton Health Commercial	$401.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$428.25
Rate for Payer: Cigna LocalPlus Benefit Plan	$364.01
Rate for Payer: Group Health Inc Commercial	$267.65
Rate for Payer: Group Health Inc Medicare	$187.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$267.65
Rate for Payer: Hamaspik Choice Inc Medicare	$267.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$347.95

TOMOGRAPHIC SURVEY

Facility

$732.85

Service Code	HCPCS D0322
Hospital Charge Code	42300180
Hospital Revenue Code	361
Min. Negotiated Rate	$89.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$403.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$127.14
Rate for Payer: Aetna Government	$127.14
Rate for Payer: Affinity Essential Plan 1&2	$89.00
Rate for Payer: Affinity Essential Plan 3&4	$89.00
Rate for Payer: Affinity Medicaid/CHP/HARP	$89.00
Rate for Payer: Brighton Health Commercial	$549.64
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Cash Price	$127.14
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$127.14
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	$127.14
Rate for Payer: EmblemHealth Commercial	$127.14
Rate for Payer: Fidelis Essential Plan Aliesa	$108.07
Rate for Payer: Fidelis Essential Plan QHP	$113.15
Rate for Payer: Fidelis Medicare Advantage	$127.14
Rate for Payer: Fidelis Qualified Health Plan	$113.15
Rate for Payer: Group Health Inc Commercial	$127.14
Rate for Payer: Group Health Inc Medicare	$127.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$366.43
Rate for Payer: Hamaspik Choice Inc Medicare	$127.14
Rate for Payer: Healthfirst Medicare Advantage	$108.07
Rate for Payer: Healthfirst QHP	$127.14
Rate for Payer: Humana Medicare	$129.68
Rate for Payer: Senior Whole Health Medicare Advantage	$127.14
Rate for Payer: United Healthcare Medicare Advantage	$127.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$127.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$101.71
Rate for Payer: Wellcare Medicare	$120.78

TOMOGRAPHIC SURVEY

Facility

$732.85

Service Code	HCPCS D0322
Hospital Charge Code	42300180
Hospital Revenue Code	361
Rate for Payer: Cash Price	$127.14

TONE DECAY

Facility

$101.25

Service Code	HCPCS 92563
Hospital Charge Code	42003100
Hospital Revenue Code	471
Rate for Payer: Cash Price	$46.38

Know your out-of-pocket cost for care.

All Charges