St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BEVACIZUMAB-AWWB 100 MG/4ML IV SOLN

Facility

$209.32

Service Code	HCPCS Q5107
Hospital Charge Code	5551320601
Hospital Revenue Code	258
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$167.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.86
Rate for Payer: Aetna Government	$27.86
Rate for Payer: Affinity Essential Plan 1&2	$19.50
Rate for Payer: Affinity Essential Plan 3&4	$19.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$19.50
Rate for Payer: Brighton Health Commercial	$156.99
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.34
Rate for Payer: Elderplan Medicare Advantage	$27.86
Rate for Payer: EmblemHealth Commercial	$27.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25.07
Rate for Payer: Fidelis Essential Plan Aliesa	$23.68
Rate for Payer: Fidelis Essential Plan QHP	$24.80
Rate for Payer: Fidelis Medicare Advantage	$27.86
Rate for Payer: Fidelis Qualified Health Plan	$24.80
Rate for Payer: Group Health Inc Commercial	$27.86
Rate for Payer: Group Health Inc Medicare	$27.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.86
Rate for Payer: Hamaspik Choice Inc Medicare	$27.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.86
Rate for Payer: Healthfirst Medicare Advantage	$23.68
Rate for Payer: Healthfirst QHP	$27.86
Rate for Payer: Humana Medicare	$28.42
Rate for Payer: Senior Whole Health Medicare Advantage	$27.86
Rate for Payer: United Healthcare Medicare Advantage	$27.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$136.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.47
Rate for Payer: Wellcare Medicare	$26.47

BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN

Facility

$209.32

Service Code	HCPCS Q5107
Hospital Charge Code	5551320701
Hospital Revenue Code	258
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$167.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$115.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$27.86
Rate for Payer: Aetna Government	$27.86
Rate for Payer: Affinity Essential Plan 1&2	$19.50
Rate for Payer: Affinity Essential Plan 3&4	$19.50
Rate for Payer: Affinity Medicaid/CHP/HARP	$19.50
Rate for Payer: Brighton Health Commercial	$156.99
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$27.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$167.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$142.34
Rate for Payer: Elderplan Medicare Advantage	$27.86
Rate for Payer: EmblemHealth Commercial	$27.86
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25.07
Rate for Payer: Fidelis Essential Plan Aliesa	$23.68
Rate for Payer: Fidelis Essential Plan QHP	$24.80
Rate for Payer: Fidelis Medicare Advantage	$27.86
Rate for Payer: Fidelis Qualified Health Plan	$24.80
Rate for Payer: Group Health Inc Commercial	$27.86
Rate for Payer: Group Health Inc Medicare	$27.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$27.86
Rate for Payer: Hamaspik Choice Inc Medicare	$27.86
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27.86
Rate for Payer: Healthfirst Medicare Advantage	$23.68
Rate for Payer: Healthfirst QHP	$27.86
Rate for Payer: Humana Medicare	$28.42
Rate for Payer: Senior Whole Health Medicare Advantage	$27.86
Rate for Payer: United Healthcare Medicare Advantage	$27.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$136.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$26.47
Rate for Payer: Wellcare Medicare	$26.47

BEVACIZUMAB-AWWB 400 MG/16ML IV SOLN

Facility

$209.32

Service Code	HCPCS Q5107
Hospital Charge Code	5551320701
Hospital Revenue Code	258
Min. Negotiated Rate	$104.66
Max. Negotiated Rate	$104.66
Rate for Payer: Hamaspik Choice Inc Medicaid	$104.66

BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN

Facility

$184.02

Service Code	HCPCS Q5118
Hospital Charge Code	0069031501
Hospital Revenue Code	258
Min. Negotiated Rate	$92.01
Max. Negotiated Rate	$92.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.01

BEVACIZUMAB-BVZR 100 MG/4ML IV SOLN

Facility

$184.02

Service Code	HCPCS Q5118
Hospital Charge Code	0069031501
Hospital Revenue Code	258
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$147.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.77
Rate for Payer: Aetna Government	$25.77
Rate for Payer: Affinity Essential Plan 1&2	$18.04
Rate for Payer: Affinity Essential Plan 3&4	$18.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.04
Rate for Payer: Brighton Health Commercial	$138.01
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.13
Rate for Payer: Elderplan Medicare Advantage	$25.77
Rate for Payer: EmblemHealth Commercial	$25.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23.19
Rate for Payer: Fidelis Essential Plan Aliesa	$21.90
Rate for Payer: Fidelis Essential Plan QHP	$22.94
Rate for Payer: Fidelis Medicare Advantage	$25.77
Rate for Payer: Fidelis Qualified Health Plan	$22.94
Rate for Payer: Group Health Inc Commercial	$25.77
Rate for Payer: Group Health Inc Medicare	$25.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.77
Rate for Payer: Hamaspik Choice Inc Medicare	$25.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.77
Rate for Payer: Healthfirst Medicare Advantage	$21.90
Rate for Payer: Healthfirst QHP	$25.77
Rate for Payer: Humana Medicare	$26.29
Rate for Payer: Senior Whole Health Medicare Advantage	$25.77
Rate for Payer: United Healthcare Medicare Advantage	$25.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.48
Rate for Payer: Wellcare Medicare	$24.48

BEVACIZUMAB-BVZR 400 MG/16ML IV SOLN

Facility

$184.02

Service Code	HCPCS Q5118
Hospital Charge Code	0069034201
Hospital Revenue Code	258
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$147.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$101.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.77
Rate for Payer: Aetna Government	$25.77
Rate for Payer: Affinity Essential Plan 1&2	$18.04
Rate for Payer: Affinity Essential Plan 3&4	$18.04
Rate for Payer: Affinity Medicaid/CHP/HARP	$18.04
Rate for Payer: Brighton Health Commercial	$138.01
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$147.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$125.13
Rate for Payer: Elderplan Medicare Advantage	$25.77
Rate for Payer: EmblemHealth Commercial	$25.77
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23.19
Rate for Payer: Fidelis Essential Plan Aliesa	$21.90
Rate for Payer: Fidelis Essential Plan QHP	$22.94
Rate for Payer: Fidelis Medicare Advantage	$25.77
Rate for Payer: Fidelis Qualified Health Plan	$22.94
Rate for Payer: Group Health Inc Commercial	$25.77
Rate for Payer: Group Health Inc Medicare	$25.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.77
Rate for Payer: Hamaspik Choice Inc Medicare	$25.77
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.77
Rate for Payer: Healthfirst Medicare Advantage	$21.90
Rate for Payer: Healthfirst QHP	$25.77
Rate for Payer: Humana Medicare	$26.29
Rate for Payer: Senior Whole Health Medicare Advantage	$25.77
Rate for Payer: United Healthcare Medicare Advantage	$25.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$119.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24.48
Rate for Payer: Wellcare Medicare	$24.48

BEVACIZUMAB-BVZR 400 MG/16ML IV SOLN

Facility

$184.02

Service Code	HCPCS Q5118
Hospital Charge Code	0069034201
Hospital Revenue Code	258
Min. Negotiated Rate	$92.01
Max. Negotiated Rate	$92.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$92.01

BEVACIZUMAB-MALY 100 MG/4ML IV SOLN

Facility

$215.58

Service Code	NDC 7012117541
Hospital Charge Code	7012117541
Hospital Revenue Code	258
Min. Negotiated Rate	$107.79
Max. Negotiated Rate	$107.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.79

BEVACIZUMAB-MALY 100 MG/4ML IV SOLN

Facility

$215.58

Service Code	NDC 7012117541
Hospital Charge Code	7012117541
Hospital Revenue Code	258
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$172.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.79
Rate for Payer: Aetna Government	$107.79
Rate for Payer: Brighton Health Commercial	$161.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.59
Rate for Payer: EmblemHealth Commercial	$107.79
Rate for Payer: Group Health Inc Commercial	$107.79
Rate for Payer: Group Health Inc Medicare	$75.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.79
Rate for Payer: Hamaspik Choice Inc Medicare	$107.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$140.13

BEVACIZUMAB-MALY 100 MG/4ML IV SOLN

Facility

$215.58

Service Code	NDC 7012117547
Hospital Charge Code	7012117547
Hospital Revenue Code	258
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$172.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.79
Rate for Payer: Aetna Government	$107.79
Rate for Payer: Brighton Health Commercial	$161.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.59
Rate for Payer: EmblemHealth Commercial	$107.79
Rate for Payer: Group Health Inc Commercial	$107.79
Rate for Payer: Group Health Inc Medicare	$75.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.79
Rate for Payer: Hamaspik Choice Inc Medicare	$107.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$140.13

BEVACIZUMAB-MALY 100 MG/4ML IV SOLN

Facility

$215.58

Service Code	NDC 7012117547
Hospital Charge Code	7012117547
Hospital Revenue Code	258
Min. Negotiated Rate	$107.79
Max. Negotiated Rate	$107.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.79

BEVACIZUMAB-MALY 400 MG/16ML IV SOLN

Facility

$215.58

Service Code	NDC 7012117557
Hospital Charge Code	7012117557
Hospital Revenue Code	258
Min. Negotiated Rate	$107.79
Max. Negotiated Rate	$107.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.79

BEVACIZUMAB-MALY 400 MG/16ML IV SOLN

Facility

$215.58

Service Code	NDC 7012117557
Hospital Charge Code	7012117557
Hospital Revenue Code	258
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$172.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.79
Rate for Payer: Aetna Government	$107.79
Rate for Payer: Brighton Health Commercial	$161.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.59
Rate for Payer: EmblemHealth Commercial	$107.79
Rate for Payer: Group Health Inc Commercial	$107.79
Rate for Payer: Group Health Inc Medicare	$75.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.79
Rate for Payer: Hamaspik Choice Inc Medicare	$107.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$140.13

BEVACIZUMAB-MALY 400 MG/16ML IV SOLN

Facility

$215.58

Service Code	NDC 7012117551
Hospital Charge Code	7012117551
Hospital Revenue Code	258
Min. Negotiated Rate	$75.45
Max. Negotiated Rate	$172.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$118.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$107.79
Rate for Payer: Aetna Government	$107.79
Rate for Payer: Brighton Health Commercial	$161.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$172.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$146.59
Rate for Payer: EmblemHealth Commercial	$107.79
Rate for Payer: Group Health Inc Commercial	$107.79
Rate for Payer: Group Health Inc Medicare	$75.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.79
Rate for Payer: Hamaspik Choice Inc Medicare	$107.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$140.13

BEVACIZUMAB-MALY 400 MG/16ML IV SOLN

Facility

$215.58

Service Code	NDC 7012117551
Hospital Charge Code	7012117551
Hospital Revenue Code	258
Min. Negotiated Rate	$107.79
Max. Negotiated Rate	$107.79
Rate for Payer: Hamaspik Choice Inc Medicaid	$107.79

BEZLOTOXUMAB 1000 MG/40ML IV SOLN

Facility

$114.00

Service Code	HCPCS J0565
Hospital Charge Code	0006302500
Hospital Revenue Code	258
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$91.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$62.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.83
Rate for Payer: Aetna Government	$39.83
Rate for Payer: Affinity Essential Plan 1&2	$27.88
Rate for Payer: Affinity Essential Plan 3&4	$27.88
Rate for Payer: Affinity Medicaid/CHP/HARP	$27.88
Rate for Payer: Brighton Health Commercial	$85.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$39.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$91.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$77.52
Rate for Payer: Elderplan Medicare Advantage	$39.83
Rate for Payer: EmblemHealth Commercial	$39.83
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35.85
Rate for Payer: Fidelis Essential Plan Aliesa	$33.86
Rate for Payer: Fidelis Essential Plan QHP	$35.45
Rate for Payer: Fidelis Medicare Advantage	$39.83
Rate for Payer: Fidelis Qualified Health Plan	$35.45
Rate for Payer: Group Health Inc Commercial	$39.83
Rate for Payer: Group Health Inc Medicare	$39.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.83
Rate for Payer: Hamaspik Choice Inc Medicare	$39.83
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$39.83
Rate for Payer: Healthfirst Medicare Advantage	$33.86
Rate for Payer: Healthfirst QHP	$39.83
Rate for Payer: Humana Medicare	$40.63
Rate for Payer: Senior Whole Health Medicare Advantage	$39.83
Rate for Payer: United Healthcare Medicare Advantage	$39.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$74.10
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.84
Rate for Payer: Wellcare Medicare	$37.84

BEZLOTOXUMAB 1000 MG/40ML IV SOLN

Facility

$114.00

Service Code	HCPCS J0565
Hospital Charge Code	0006302500
Hospital Revenue Code	258
Min. Negotiated Rate	$57.00
Max. Negotiated Rate	$57.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.00

BICALUTAMIDE 50 MG PO TABS

Facility

$18.35

Service Code	NDC 1672902301
Hospital Charge Code	1672902301
Hospital Revenue Code	250
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$14.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.18
Rate for Payer: Aetna Government	$9.18
Rate for Payer: Brighton Health Commercial	$13.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.48
Rate for Payer: EmblemHealth Commercial	$9.18
Rate for Payer: Group Health Inc Commercial	$9.18
Rate for Payer: Group Health Inc Medicare	$6.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.18
Rate for Payer: Hamaspik Choice Inc Medicare	$9.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.93

BICALUTAMIDE 50 MG PO TABS

Facility

$18.35

Service Code	NDC 1672902301
Hospital Charge Code	1672902301
Hospital Revenue Code	250
Min. Negotiated Rate	$9.18
Max. Negotiated Rate	$9.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.18

BICALUTAMIDE 50 MG PO TABS

Facility

$18.25

Service Code	NDC 6255989030
Hospital Charge Code	6255989030
Hospital Revenue Code	250
Min. Negotiated Rate	$6.39
Max. Negotiated Rate	$14.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.13
Rate for Payer: Aetna Government	$9.13
Rate for Payer: Brighton Health Commercial	$13.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.41
Rate for Payer: EmblemHealth Commercial	$9.13
Rate for Payer: Group Health Inc Commercial	$9.13
Rate for Payer: Group Health Inc Medicare	$6.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.13
Rate for Payer: Hamaspik Choice Inc Medicare	$9.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.86

BICALUTAMIDE 50 MG PO TABS

Facility

$18.53

Service Code	NDC 4733548583
Hospital Charge Code	4733548583
Hospital Revenue Code	250
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$14.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.27
Rate for Payer: Aetna Government	$9.27
Rate for Payer: Brighton Health Commercial	$13.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.60
Rate for Payer: EmblemHealth Commercial	$9.27
Rate for Payer: Group Health Inc Commercial	$9.27
Rate for Payer: Group Health Inc Medicare	$6.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.27
Rate for Payer: Hamaspik Choice Inc Medicare	$9.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05

BICALUTAMIDE 50 MG PO TABS

Facility

$18.25

Service Code	NDC 6255989030
Hospital Charge Code	6255989030
Hospital Revenue Code	250
Min. Negotiated Rate	$9.13
Max. Negotiated Rate	$9.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.13

BICALUTAMIDE 50 MG PO TABS

Facility

$18.53

Service Code	NDC 4733548583
Hospital Charge Code	4733548583
Hospital Revenue Code	250
Min. Negotiated Rate	$9.27
Max. Negotiated Rate	$9.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.27

BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO TABS

Facility

$159.25

Service Code	NDC 6195825011
Hospital Charge Code	6195825011
Hospital Revenue Code	250
Min. Negotiated Rate	$79.62
Max. Negotiated Rate	$79.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.62

BICTEGRAVIR-EMTRICITAB-TENOFOV 50-200-25 MG PO TABS

Facility

$159.25

Service Code	NDC 6195825011
Hospital Charge Code	6195825011
Hospital Revenue Code	250
Min. Negotiated Rate	$55.74
Max. Negotiated Rate	$127.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.62
Rate for Payer: Aetna Government	$79.62
Rate for Payer: Brighton Health Commercial	$119.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$108.29
Rate for Payer: EmblemHealth Commercial	$79.62
Rate for Payer: Group Health Inc Commercial	$79.62
Rate for Payer: Group Health Inc Medicare	$55.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.62
Rate for Payer: Hamaspik Choice Inc Medicare	$79.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.51

Know your out-of-pocket cost for care.

All Charges