St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

TRAPEZOLO RX 2.0CM

Facility

$730.28

Hospital Charge Code	64905332
Hospital Revenue Code	270
Min. Negotiated Rate	$255.60
Max. Negotiated Rate	$584.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$401.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$365.14
Rate for Payer: Aetna Government	$365.14
Rate for Payer: Brighton Health Commercial	$547.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$584.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$496.59
Rate for Payer: Group Health Inc Commercial	$365.14
Rate for Payer: Group Health Inc Medicare	$255.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$365.14
Rate for Payer: Hamaspik Choice Inc Medicare	$365.14

TRAP MUCOUS SPECIMEN

Facility

$2.83

Hospital Charge Code	64901235
Hospital Revenue Code	270
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Brighton Health Commercial	$2.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.92
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42

TRAP POLYP SUCTION

Facility

$252.00

Hospital Charge Code	40200818
Hospital Revenue Code	270
Min. Negotiated Rate	$88.20
Max. Negotiated Rate	$201.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$138.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$126.00
Rate for Payer: Aetna Government	$126.00
Rate for Payer: Brighton Health Commercial	$189.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$201.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$171.36
Rate for Payer: Group Health Inc Commercial	$126.00
Rate for Payer: Group Health Inc Medicare	$88.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$126.00
Rate for Payer: Hamaspik Choice Inc Medicare	$126.00

TRAP POLYP SUCTION BRACCO

Facility

$24.39

Hospital Charge Code	64903120
Hospital Revenue Code	270
Min. Negotiated Rate	$8.54
Max. Negotiated Rate	$19.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.20
Rate for Payer: Aetna Government	$12.20
Rate for Payer: Brighton Health Commercial	$18.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.51
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.59
Rate for Payer: Group Health Inc Commercial	$12.20
Rate for Payer: Group Health Inc Medicare	$8.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.20
Rate for Payer: Hamaspik Choice Inc Medicare	$12.20

TRAP TISSUE SAFETOUCH

Facility

$20.84

Hospital Charge Code	64903125
Hospital Revenue Code	270
Min. Negotiated Rate	$7.29
Max. Negotiated Rate	$16.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.42
Rate for Payer: Aetna Government	$10.42
Rate for Payer: Brighton Health Commercial	$15.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.17
Rate for Payer: Group Health Inc Commercial	$10.42
Rate for Payer: Group Health Inc Medicare	$7.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.42
Rate for Payer: Hamaspik Choice Inc Medicare	$10.42

TRAP TISSUE SAFETOUCH

Facility

$180.00

Hospital Charge Code	40200823
Hospital Revenue Code	270
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$144.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$99.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$90.00
Rate for Payer: Aetna Government	$90.00
Rate for Payer: Brighton Health Commercial	$135.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$144.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$122.40
Rate for Payer: Group Health Inc Commercial	$90.00
Rate for Payer: Group Health Inc Medicare	$63.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$90.00
Rate for Payer: Hamaspik Choice Inc Medicare	$90.00

TRAP WATER AQUA KNOT II

Facility

$48.75

Hospital Charge Code	64903298
Hospital Revenue Code	270
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$39.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.38
Rate for Payer: Aetna Government	$24.38
Rate for Payer: Brighton Health Commercial	$36.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.15
Rate for Payer: Group Health Inc Commercial	$24.38
Rate for Payer: Group Health Inc Medicare	$17.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.38
Rate for Payer: Hamaspik Choice Inc Medicare	$24.38

TRASTUZUMAB 150MG INJECTION

Facility

$244.83

Service Code	HCPCS J9355
Hospital Charge Code	41647808
Hospital Revenue Code	636
Min. Negotiated Rate	$64.37
Max. Negotiated Rate	$159.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.46
Rate for Payer: Aetna Government	$80.46
Rate for Payer: Brighton Health Commercial	$146.90
Rate for Payer: Cash Price	$80.47
Rate for Payer: Cash Price	$80.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$80.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.78
Rate for Payer: Elderplan Medicare Advantage	$80.46
Rate for Payer: EmblemHealth Commercial	$80.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80.46
Rate for Payer: Fidelis Essential Plan Aliesa	$80.46
Rate for Payer: Fidelis Essential Plan QHP	$84.49
Rate for Payer: Fidelis Medicare Advantage	$80.46
Rate for Payer: Fidelis Qualified Health Plan	$84.49
Rate for Payer: Group Health Inc Commercial	$80.46
Rate for Payer: Group Health Inc Medicare	$80.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.42
Rate for Payer: Hamaspik Choice Inc Medicare	$122.42
Rate for Payer: Healthfirst Medicare Advantage	$68.40
Rate for Payer: Healthfirst QHP	$80.46
Rate for Payer: Senior Whole Health Medicare Advantage	$80.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.85
Rate for Payer: SOMOS Essential	$84.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.37
Rate for Payer: Wellcare Medicare	$76.44

TRASTUZUMAB 150MG INJECTION

Facility

$244.83

Service Code	HCPCS J9355
Hospital Charge Code	41657808
Hospital Revenue Code	636
Min. Negotiated Rate	$122.42
Max. Negotiated Rate	$122.42
Rate for Payer: Cash Price	$80.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.42
Rate for Payer: Hamaspik Choice Inc Medicare	$122.42

TRASTUZUMAB 150MG INJECTION

Facility

$244.83

Service Code	HCPCS J9355
Hospital Charge Code	41647808
Hospital Revenue Code	636
Min. Negotiated Rate	$122.42
Max. Negotiated Rate	$122.42
Rate for Payer: Cash Price	$80.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.42
Rate for Payer: Hamaspik Choice Inc Medicare	$122.42

TRASTUZUMAB 150MG INJECTION

Facility

$244.83

Service Code	HCPCS J9355
Hospital Charge Code	41657808
Hospital Revenue Code	636
Min. Negotiated Rate	$64.37
Max. Negotiated Rate	$159.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$134.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.46
Rate for Payer: Aetna Government	$80.46
Rate for Payer: Brighton Health Commercial	$146.90
Rate for Payer: Cash Price	$80.47
Rate for Payer: Cash Price	$80.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$80.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$122.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$140.78
Rate for Payer: Elderplan Medicare Advantage	$80.46
Rate for Payer: EmblemHealth Commercial	$80.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80.46
Rate for Payer: Fidelis Essential Plan Aliesa	$80.46
Rate for Payer: Fidelis Essential Plan QHP	$84.49
Rate for Payer: Fidelis Medicare Advantage	$80.46
Rate for Payer: Fidelis Qualified Health Plan	$84.49
Rate for Payer: Group Health Inc Commercial	$80.46
Rate for Payer: Group Health Inc Medicare	$80.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$122.42
Rate for Payer: Hamaspik Choice Inc Medicare	$122.42
Rate for Payer: Healthfirst Medicare Advantage	$68.40
Rate for Payer: Healthfirst QHP	$80.46
Rate for Payer: Senior Whole Health Medicare Advantage	$80.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.85
Rate for Payer: SOMOS Essential	$84.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$159.14
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.37
Rate for Payer: Wellcare Medicare	$76.44

TRASTUZUMAB 150 MG IV SOLR [138974]

Facility

$1,870.10

Service Code	HCPCS J9355
Hospital Charge Code	50242013201
Hospital Revenue Code	278
Min. Negotiated Rate	$64.37
Max. Negotiated Rate	$1,215.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,028.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.46
Rate for Payer: Aetna Government	$80.46
Rate for Payer: Brighton Health Commercial	$1,122.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$80.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$935.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,075.31
Rate for Payer: Elderplan Medicare Advantage	$80.46
Rate for Payer: EmblemHealth Commercial	$935.05
Rate for Payer: Fidelis Medicare Advantage	$80.46
Rate for Payer: Group Health Inc Commercial	$80.46
Rate for Payer: Group Health Inc Medicare	$80.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$935.05
Rate for Payer: Hamaspik Choice Inc Medicare	$935.05
Rate for Payer: Healthfirst Medicare Advantage	$68.40
Rate for Payer: Healthfirst QHP	$80.46
Rate for Payer: Senior Whole Health Medicare Advantage	$80.46
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,215.56
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.37

TRASTUZUMAB 150 MG IV SOLR [138974]

Facility

$1,870.10

Service Code	HCPCS J9355
Hospital Charge Code	50242013201
Hospital Revenue Code	278
Min. Negotiated Rate	$935.05
Max. Negotiated Rate	$935.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$935.05
Rate for Payer: Hamaspik Choice Inc Medicare	$935.05

TRASTUZUMAB 440 MG INJ

Facility

$86.60

Service Code	HCPCS J9355
Hospital Charge Code	41643239
Hospital Revenue Code	636
Min. Negotiated Rate	$43.30
Max. Negotiated Rate	$43.30
Rate for Payer: Cash Price	$80.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.30
Rate for Payer: Hamaspik Choice Inc Medicare	$43.30

TRASTUZUMAB 440 MG INJ

Facility

$86.60

Service Code	HCPCS J9355
Hospital Charge Code	41653239
Hospital Revenue Code	636
Min. Negotiated Rate	$43.30
Max. Negotiated Rate	$43.30
Rate for Payer: Cash Price	$80.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.30
Rate for Payer: Hamaspik Choice Inc Medicare	$43.30

TRASTUZUMAB 440 MG INJ

Facility

$86.60

Service Code	HCPCS J9355
Hospital Charge Code	41653239
Hospital Revenue Code	636
Min. Negotiated Rate	$43.30
Max. Negotiated Rate	$84.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.46
Rate for Payer: Aetna Government	$80.46
Rate for Payer: Brighton Health Commercial	$51.96
Rate for Payer: Cash Price	$80.47
Rate for Payer: Cash Price	$80.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$80.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.80
Rate for Payer: Elderplan Medicare Advantage	$80.46
Rate for Payer: EmblemHealth Commercial	$80.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80.46
Rate for Payer: Fidelis Essential Plan Aliesa	$80.46
Rate for Payer: Fidelis Essential Plan QHP	$84.49
Rate for Payer: Fidelis Medicare Advantage	$80.46
Rate for Payer: Fidelis Qualified Health Plan	$84.49
Rate for Payer: Group Health Inc Commercial	$80.46
Rate for Payer: Group Health Inc Medicare	$80.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.30
Rate for Payer: Hamaspik Choice Inc Medicare	$43.30
Rate for Payer: Healthfirst Medicare Advantage	$68.40
Rate for Payer: Healthfirst QHP	$80.46
Rate for Payer: Senior Whole Health Medicare Advantage	$80.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.85
Rate for Payer: SOMOS Essential	$84.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.37
Rate for Payer: Wellcare Medicare	$76.44

TRASTUZUMAB 440 MG INJ

Facility

$86.60

Service Code	HCPCS J9355
Hospital Charge Code	41643239
Hospital Revenue Code	636
Min. Negotiated Rate	$43.30
Max. Negotiated Rate	$84.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$47.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.46
Rate for Payer: Aetna Government	$80.46
Rate for Payer: Brighton Health Commercial	$51.96
Rate for Payer: Cash Price	$80.47
Rate for Payer: Cash Price	$80.47
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$80.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$43.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.80
Rate for Payer: Elderplan Medicare Advantage	$80.46
Rate for Payer: EmblemHealth Commercial	$80.46
Rate for Payer: Fidelis CHP/HARP/Medicaid	$80.46
Rate for Payer: Fidelis Essential Plan Aliesa	$80.46
Rate for Payer: Fidelis Essential Plan QHP	$84.49
Rate for Payer: Fidelis Medicare Advantage	$80.46
Rate for Payer: Fidelis Qualified Health Plan	$84.49
Rate for Payer: Group Health Inc Commercial	$80.46
Rate for Payer: Group Health Inc Medicare	$80.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.30
Rate for Payer: Hamaspik Choice Inc Medicare	$43.30
Rate for Payer: Healthfirst Medicare Advantage	$68.40
Rate for Payer: Healthfirst QHP	$80.46
Rate for Payer: Senior Whole Health Medicare Advantage	$80.46
Rate for Payer: SOMOS CHP/HARP/Medicaid	$84.85
Rate for Payer: SOMOS Essential	$84.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$56.29
Rate for Payer: Wellcare CHP/FHP/Medicaid	$64.37
Rate for Payer: Wellcare Medicare	$76.44

TRASTUZUMAB-ANNS 150 MG IV SOLR [170301]

Facility

$1,632.08

Service Code	HCPCS Q5117
Hospital Charge Code	55513014101
Hospital Revenue Code	278
Min. Negotiated Rate	$816.04
Max. Negotiated Rate	$816.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$816.04
Rate for Payer: Hamaspik Choice Inc Medicare	$816.04

TRASTUZUMAB-ANNS 150 MG IV SOLR [170301]

Facility

$1,632.08

Service Code	HCPCS Q5117
Hospital Charge Code	55513014101
Hospital Revenue Code	278
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$1,060.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$897.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.32
Rate for Payer: Aetna Government	$16.32
Rate for Payer: Brighton Health Commercial	$979.25
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$816.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$938.45
Rate for Payer: Elderplan Medicare Advantage	$16.32
Rate for Payer: EmblemHealth Commercial	$816.04
Rate for Payer: Fidelis Medicare Advantage	$16.32
Rate for Payer: Group Health Inc Commercial	$16.32
Rate for Payer: Group Health Inc Medicare	$16.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$816.04
Rate for Payer: Hamaspik Choice Inc Medicare	$816.04
Rate for Payer: Healthfirst Medicare Advantage	$13.87
Rate for Payer: Healthfirst QHP	$16.32
Rate for Payer: Senior Whole Health Medicare Advantage	$16.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,060.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.06

TRASTUZUMAB-ANNS 420 MG IV SOLR [168930]

Facility

$4,569.82

Service Code	HCPCS Q5117
Hospital Charge Code	55513016401
Hospital Revenue Code	278
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$2,970.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,513.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.32
Rate for Payer: Aetna Government	$16.32
Rate for Payer: Brighton Health Commercial	$2,741.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,284.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,627.65
Rate for Payer: Elderplan Medicare Advantage	$16.32
Rate for Payer: EmblemHealth Commercial	$2,284.91
Rate for Payer: Fidelis Medicare Advantage	$16.32
Rate for Payer: Group Health Inc Commercial	$16.32
Rate for Payer: Group Health Inc Medicare	$16.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,284.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2,284.91
Rate for Payer: Healthfirst Medicare Advantage	$13.87
Rate for Payer: Healthfirst QHP	$16.32
Rate for Payer: Senior Whole Health Medicare Advantage	$16.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,970.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.06

TRASTUZUMAB-ANNS 420 MG IV SOLR [168930]

Facility

$4,569.82

Service Code	HCPCS Q5117
Hospital Charge Code	55513016401
Hospital Revenue Code	278
Min. Negotiated Rate	$2,284.91
Max. Negotiated Rate	$2,284.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,284.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2,284.91

TRASTUZUMAB-ANNS 420 MG IV SOLR [168930]

Facility

$4,569.82

Service Code	HCPCS Q5117
Hospital Charge Code	55513013201
Hospital Revenue Code	278
Min. Negotiated Rate	$2,284.91
Max. Negotiated Rate	$2,284.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,284.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2,284.91

TRASTUZUMAB-ANNS 420 MG IV SOLR [168930]

Facility

$4,569.82

Service Code	HCPCS Q5117
Hospital Charge Code	55513013201
Hospital Revenue Code	278
Min. Negotiated Rate	$13.06
Max. Negotiated Rate	$2,970.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,513.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.32
Rate for Payer: Aetna Government	$16.32
Rate for Payer: Brighton Health Commercial	$2,741.89
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,284.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,627.65
Rate for Payer: Elderplan Medicare Advantage	$16.32
Rate for Payer: EmblemHealth Commercial	$2,284.91
Rate for Payer: Fidelis Medicare Advantage	$16.32
Rate for Payer: Group Health Inc Commercial	$16.32
Rate for Payer: Group Health Inc Medicare	$16.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,284.91
Rate for Payer: Hamaspik Choice Inc Medicare	$2,284.91
Rate for Payer: Healthfirst Medicare Advantage	$13.87
Rate for Payer: Healthfirst QHP	$16.32
Rate for Payer: Senior Whole Health Medicare Advantage	$16.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2,970.38
Rate for Payer: Wellcare CHP/FHP/Medicaid	$13.06

TRASTUZUMAB-DKST 150 MG IV SOLR [170123]

Facility

$1,128.61

Service Code	HCPCS Q5114
Hospital Charge Code	67457099115
Hospital Revenue Code	278
Min. Negotiated Rate	$564.30
Max. Negotiated Rate	$564.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$564.30
Rate for Payer: Hamaspik Choice Inc Medicare	$564.30

TRASTUZUMAB-DKST 150 MG IV SOLR [170123]

Facility

$1,128.61

Service Code	HCPCS Q5114
Hospital Charge Code	67457099115
Hospital Revenue Code	278
Min. Negotiated Rate	$35.54
Max. Negotiated Rate	$733.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$620.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$44.43
Rate for Payer: Aetna Government	$44.43
Rate for Payer: Brighton Health Commercial	$677.17
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$44.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$564.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$648.95
Rate for Payer: Elderplan Medicare Advantage	$44.43
Rate for Payer: EmblemHealth Commercial	$564.30
Rate for Payer: Fidelis Medicare Advantage	$44.43
Rate for Payer: Group Health Inc Commercial	$44.43
Rate for Payer: Group Health Inc Medicare	$44.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$564.30
Rate for Payer: Hamaspik Choice Inc Medicare	$564.30
Rate for Payer: Healthfirst Medicare Advantage	$37.76
Rate for Payer: Healthfirst QHP	$44.43
Rate for Payer: Senior Whole Health Medicare Advantage	$44.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$733.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35.54

Know your out-of-pocket cost for care.

All Charges