St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

INJ PACLITAXEL, 1MG

Facility

$15.72

Service Code	HCPCS J9267
Hospital Charge Code	41652883
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$7.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.86
Rate for Payer: Hamaspik Choice Inc Medicare	$7.86

INJ PACLITAXEL, 1MG

Facility

$8.45

Service Code	HCPCS J9267
Hospital Charge Code	41642970
Hospital Revenue Code	636
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22

INJ PACLITAXEL, 1MG

Facility

$15.72

Service Code	HCPCS J9267
Hospital Charge Code	41642883
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$10.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$9.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.04
Rate for Payer: Group Health Inc Commercial	$7.86
Rate for Payer: Group Health Inc Medicare	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.86
Rate for Payer: Hamaspik Choice Inc Medicare	$7.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.11
Rate for Payer: SOMOS Essential	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.22

INJ PACLITAXEL, 1MG

Facility

$9.73

Service Code	HCPCS J9267
Hospital Charge Code	41652882
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$6.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$5.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.59
Rate for Payer: Group Health Inc Commercial	$4.86
Rate for Payer: Group Health Inc Medicare	$3.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.86
Rate for Payer: Hamaspik Choice Inc Medicare	$4.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.11
Rate for Payer: SOMOS Essential	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.32

INJ PACLITAXEL, 1MG

Facility

$8.45

Service Code	HCPCS J9267
Hospital Charge Code	41652970
Hospital Revenue Code	636
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22

INJ PACLITAXEL, 1MG

Facility

$15.72

Service Code	HCPCS J9267
Hospital Charge Code	41652883
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$10.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$9.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.04
Rate for Payer: Group Health Inc Commercial	$7.86
Rate for Payer: Group Health Inc Medicare	$5.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.86
Rate for Payer: Hamaspik Choice Inc Medicare	$7.86
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.11
Rate for Payer: SOMOS Essential	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.22

INJ PACLITAXEL, 1MG

Facility

$8.45

Service Code	HCPCS J9267
Hospital Charge Code	41642970
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$5.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$5.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.86
Rate for Payer: Group Health Inc Commercial	$4.22
Rate for Payer: Group Health Inc Medicare	$2.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.11
Rate for Payer: SOMOS Essential	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.49

INJ PACLITAXEL, 1MG

Facility

$8.45

Service Code	HCPCS J9267
Hospital Charge Code	41652970
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$5.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$5.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.86
Rate for Payer: Group Health Inc Commercial	$4.22
Rate for Payer: Group Health Inc Medicare	$2.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.11
Rate for Payer: SOMOS Essential	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.49

INJ PACLITAXEL, 1MG

Facility

$15.72

Service Code	HCPCS J9267
Hospital Charge Code	41642883
Hospital Revenue Code	636
Min. Negotiated Rate	$7.86
Max. Negotiated Rate	$7.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.86
Rate for Payer: Hamaspik Choice Inc Medicare	$7.86

INJ PACLITAXEL, 1MG

Facility

$9.73

Service Code	HCPCS J9267
Hospital Charge Code	41652882
Hospital Revenue Code	636
Min. Negotiated Rate	$4.86
Max. Negotiated Rate	$4.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.86
Rate for Payer: Hamaspik Choice Inc Medicare	$4.86

INJ PARAVERTEBRAL C/T

Facility

$2,459.50

Service Code	HCPCS 64490
Hospital Charge Code	40004378
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,054.06

INJ PARAVERTEBRAL C/T

Facility

$2,459.50

Service Code	HCPCS 64490
Hospital Charge Code	40004378
Hospital Revenue Code	360
Min. Negotiated Rate	$737.84
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Affinity Essential Plan 1&2	$737.84
Rate for Payer: Affinity Essential Plan 3&4	$737.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$737.84
Rate for Payer: Brighton Health Commercial	$1,844.62
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
Rate for Payer: Group Health Inc Commercial	$1,054.06
Rate for Payer: Group Health Inc Medicare	$1,054.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Humana Medicare	$1,075.14
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: United Healthcare Commercial	$1,188.00
Rate for Payer: United Healthcare Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

INJ PARAVERTEBRAL C/T ADD LEVEL

Facility

$1,229.75

Service Code	HCPCS 64491
Hospital Charge Code	40009439
Hospital Revenue Code	360
Min. Negotiated Rate	$68.68
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.68
Rate for Payer: Aetna Government	$68.68
Rate for Payer: Brighton Health Commercial	$922.31
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$614.88
Rate for Payer: Group Health Inc Medicare	$430.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.88
Rate for Payer: Hamaspik Choice Inc Medicare	$614.88
Rate for Payer: United Healthcare Commercial	$1,113.00

INJ PARAVERT F JNT C/T 1 LEV

Facility

$2,459.50

Service Code	HCPCS 64490
Hospital Charge Code	30302498
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Affinity Essential Plan 1&2	$737.84
Rate for Payer: Affinity Essential Plan 3&4	$737.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$737.84
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
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	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Humana Medicare	$1,075.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

INJ PARAVERT F JNT C/T 1 LEV

Facility

$2,459.50

Service Code	HCPCS 64490
Hospital Charge Code	30302498
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,054.06

INJ PARAVERT F JNT C/T 2 LEV

Facility

$1,229.75

Service Code	HCPCS 64491
Hospital Charge Code	30302499
Hospital Revenue Code	510
Min. Negotiated Rate	$68.68
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$68.68
Rate for Payer: Aetna Government	$68.68
Rate for Payer: Brighton Health Commercial	$233.00
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: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.88
Rate for Payer: Hamaspik Choice Inc Medicare	$614.88
Rate for Payer: United Healthcare Commercial	$222.00

INJ PARAVERT F JNT C/T 3 LEV

Facility

$1,229.75

Service Code	HCPCS 64492
Hospital Charge Code	30305011
Hospital Revenue Code	510
Min. Negotiated Rate	$69.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.50
Rate for Payer: Aetna Government	$69.50
Rate for Payer: Brighton Health Commercial	$233.00
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: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.88
Rate for Payer: Hamaspik Choice Inc Medicare	$614.88
Rate for Payer: United Healthcare Commercial	$222.00

INJ PARAVERT F JNT C/T 3 LEVEL

Facility

$1,229.75

Service Code	HCPCS 64492
Hospital Charge Code	40005001
Hospital Revenue Code	360
Min. Negotiated Rate	$69.50
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$69.50
Rate for Payer: Aetna Government	$69.50
Rate for Payer: Brighton Health Commercial	$922.31
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$614.88
Rate for Payer: Group Health Inc Medicare	$430.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.88
Rate for Payer: Hamaspik Choice Inc Medicare	$614.88
Rate for Payer: United Healthcare Commercial	$1,113.00

INJ PARAVERT F JNT L/S 1 LEV

Facility

$2,459.50

Service Code	HCPCS 64493
Hospital Charge Code	30305012
Hospital Revenue Code	510
Rate for Payer: Cash Price	$1,054.06

INJ PARAVERT F JNT L/S 1 LEV

Facility

$2,459.50

Service Code	HCPCS 64493
Hospital Charge Code	30305012
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,054.06
Rate for Payer: Aetna Government	$1,054.06
Rate for Payer: Affinity Essential Plan 1&2	$737.84
Rate for Payer: Affinity Essential Plan 3&4	$737.84
Rate for Payer: Affinity Medicaid/CHP/HARP	$737.84
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Cash Price	$1,054.06
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1,054.06
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	$1,054.06
Rate for Payer: Fidelis Essential Plan Aliesa	$895.95
Rate for Payer: Fidelis Essential Plan QHP	$938.11
Rate for Payer: Fidelis Medicare Advantage	$1,054.06
Rate for Payer: Fidelis Qualified Health Plan	$938.11
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	$1,229.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1,054.06
Rate for Payer: Healthfirst Medicare Advantage	$895.95
Rate for Payer: Healthfirst QHP	$1,054.06
Rate for Payer: Humana Medicare	$1,075.14
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1,054.06
Rate for Payer: Senior Whole Health Medicare Advantage	$1,054.06
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$1,054.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,054.06
Rate for Payer: Wellcare CHP/FHP/Medicaid	$843.25
Rate for Payer: Wellcare Medicare	$1,001.36

INJ PARAVERT F JNT L/S 2 LEV

Facility

$1,229.75

Service Code	HCPCS 64494
Hospital Charge Code	40011761
Hospital Revenue Code	360
Min. Negotiated Rate	$59.29
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$59.29
Rate for Payer: Aetna Government	$59.29
Rate for Payer: Brighton Health Commercial	$922.31
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: EmblemHealth Commercial	$1,505.00
Rate for Payer: Group Health Inc Commercial	$614.88
Rate for Payer: Group Health Inc Medicare	$430.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$614.88
Rate for Payer: Hamaspik Choice Inc Medicare	$614.88
Rate for Payer: United Healthcare Commercial	$1,113.00

INJ PARAVERT F JNT L/S 3 LEV

Facility

$259.90

Service Code	HCPCS 64495
Hospital Charge Code	30305013
Hospital Revenue Code	510
Min. Negotiated Rate	$60.11
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$60.11
Rate for Payer: Aetna Government	$60.11
Rate for Payer: Brighton Health Commercial	$233.00
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: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$129.95
Rate for Payer: Hamaspik Choice Inc Medicare	$129.95
Rate for Payer: United Healthcare Commercial	$222.00

INJ PERTUZUMAB, 10MG

Facility

$19.06

Service Code	HCPCS J9306
Hospital Charge Code	41657791
Hospital Revenue Code	636
Min. Negotiated Rate	$9.53
Max. Negotiated Rate	$9.53
Rate for Payer: Cash Price	$15.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.53
Rate for Payer: Hamaspik Choice Inc Medicare	$9.53

INJ PERTUZUMAB, 10MG

Facility

$19.06

Service Code	HCPCS J9306
Hospital Charge Code	41657791
Hospital Revenue Code	636
Min. Negotiated Rate	$9.53
Max. Negotiated Rate	$1,032.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.43
Rate for Payer: Aetna Government	$15.43
Rate for Payer: Affinity Essential Plan 1&2	$23.22
Rate for Payer: Affinity Essential Plan 3&4	$23.22
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.32
Rate for Payer: Amida Care Medicaid	$10.32
Rate for Payer: Brighton Health Commercial	$11.44
Rate for Payer: Cash Price	$15.43
Rate for Payer: Cash Price	$15.43
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.96
Rate for Payer: Elderplan Medicare Advantage	$15.43
Rate for Payer: EmblemHealth Commercial	$15.43
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1,032.00
Rate for Payer: Fidelis Essential Plan Aliesa	$10.32
Rate for Payer: Fidelis Essential Plan QHP	$10.32
Rate for Payer: Fidelis Medicare Advantage	$15.43
Rate for Payer: Fidelis Qualified Health Plan	$10.84
Rate for Payer: Group Health Inc Commercial	$15.43
Rate for Payer: Group Health Inc Medicare	$15.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.32
Rate for Payer: Hamaspik Choice Inc Medicare	$9.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$10.32
Rate for Payer: Healthfirst Essential Plan	$23.22
Rate for Payer: Healthfirst Medicare Advantage	$13.11
Rate for Payer: Healthfirst QHP	$10.32
Rate for Payer: Humana Medicare	$15.74
Rate for Payer: Senior Whole Health Medicare Advantage	$15.43
Rate for Payer: SOMOS CHP/HARP/Medicaid	$10.32
Rate for Payer: SOMOS Essential	$10.32
Rate for Payer: United Healthcare Commercial	$14.41
Rate for Payer: United Healthcare Essential Plan 1&2	$23.22
Rate for Payer: United Healthcare Essential Plan 3&4	$11.35
Rate for Payer: United Healthcare Medicaid	$10.32
Rate for Payer: United Healthcare Medicare Advantage	$15.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.34
Rate for Payer: Wellcare Medicare	$14.66

INJ PERTUZUMAB, 10MG

Facility

$19.06

Service Code	HCPCS J9306
Hospital Charge Code	41647791
Hospital Revenue Code	636
Min. Negotiated Rate	$9.53
Max. Negotiated Rate	$9.53
Rate for Payer: Cash Price	$15.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.53
Rate for Payer: Hamaspik Choice Inc Medicare	$9.53

Know your out-of-pocket cost for care.

All Charges