St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

LIDOCAINE 2% VISCOUS SOLN 100 ML

Facility

$4.00

Hospital Charge Code	41640428
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

LIDOCAINE 2% VISCOUS SOLN 20 ML

Facility

$2.00

Hospital Charge Code	41650366
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

LIDOCAINE 2% VISCOUS SOLN 20 ML

Facility

$2.00

Hospital Charge Code	41640366
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

LIDOCAINE 4% INJ 5 ML

Facility

$9.00

Service Code	HCPCS J2001
Hospital Charge Code	41652106
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.03
Rate for Payer: SOMOS Essential	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

LIDOCAINE 4% INJ 5 ML

Facility

$9.00

Service Code	HCPCS J2001
Hospital Charge Code	41652106
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

LIDOCAINE 4% INJ 5 ML

Facility

$9.00

Service Code	HCPCS J2001
Hospital Charge Code	41642106
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$0.03
Rate for Payer: SOMOS Essential	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

LIDOCAINE 4% INJ 5 ML

Facility

$9.00

Service Code	HCPCS J2001
Hospital Charge Code	41642106
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

LIDOCAINE 4% TOPICAL LARYNG-O-JET

Facility

$6.94

Hospital Charge Code	41642471
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$5.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.47
Rate for Payer: Aetna Government	$3.47
Rate for Payer: Brighton Health Commercial	$5.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.72
Rate for Payer: Group Health Inc Commercial	$3.47
Rate for Payer: Group Health Inc Medicare	$2.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.47
Rate for Payer: Hamaspik Choice Inc Medicare	$3.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.51

LIDOCAINE 4% TOPICAL LARYNG-O-JET

Facility

$6.94

Hospital Charge Code	41652471
Hospital Revenue Code	250
Min. Negotiated Rate	$2.43
Max. Negotiated Rate	$5.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.47
Rate for Payer: Aetna Government	$3.47
Rate for Payer: Brighton Health Commercial	$5.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.72
Rate for Payer: Group Health Inc Commercial	$3.47
Rate for Payer: Group Health Inc Medicare	$2.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.47
Rate for Payer: Hamaspik Choice Inc Medicare	$3.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.51

LIDOCAINE 5% CREAM

Facility

$69.00

Hospital Charge Code	41658004
Hospital Revenue Code	250
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$55.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.50
Rate for Payer: Aetna Government	$34.50
Rate for Payer: Brighton Health Commercial	$51.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.92
Rate for Payer: Group Health Inc Commercial	$34.50
Rate for Payer: Group Health Inc Medicare	$24.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.50
Rate for Payer: Hamaspik Choice Inc Medicare	$34.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.85

LIDOCAINE 5% CREAM

Facility

$69.00

Hospital Charge Code	41648004
Hospital Revenue Code	250
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$55.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$37.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$34.50
Rate for Payer: Aetna Government	$34.50
Rate for Payer: Brighton Health Commercial	$51.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$55.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$46.92
Rate for Payer: Group Health Inc Commercial	$34.50
Rate for Payer: Group Health Inc Medicare	$24.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$34.50
Rate for Payer: Hamaspik Choice Inc Medicare	$34.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$44.85

LIDOCAINE 5 % EX OINT [41831]

Facility

$8.94

Service Code	NDC 68462041820
Hospital Charge Code	68462041820
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

LIDOCAINE 5 % EX OINT [41831]

Facility

$8.94

Service Code	NDC 70752011303
Hospital Charge Code	70752011303
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

LIDOCAINE 5 % EX OINT [41831]

Facility

$8.94

Service Code	NDC 51672302009
Hospital Charge Code	51672302009
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

LIDOCAINE 5 % EX PTCH [28203]

Facility

$9.36

Service Code	NDC 00591352511
Hospital Charge Code	00591352511
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$7.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.68
Rate for Payer: Aetna Government	$4.68
Rate for Payer: Brighton Health Commercial	$7.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.36
Rate for Payer: Group Health Inc Commercial	$4.68
Rate for Payer: Group Health Inc Medicare	$3.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.08

LIDOCAINE 5 % EX PTCH [28203]

Facility

$9.36

Service Code	NDC 00591352530
Hospital Charge Code	00591352530
Hospital Revenue Code	250
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$7.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.68
Rate for Payer: Aetna Government	$4.68
Rate for Payer: Brighton Health Commercial	$7.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.36
Rate for Payer: Group Health Inc Commercial	$4.68
Rate for Payer: Group Health Inc Medicare	$3.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.68
Rate for Payer: Hamaspik Choice Inc Medicare	$4.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.08

LIDOCAINE 5 % EX PTCH [28203]

Facility

$10.28

Service Code	NDC 00378905593
Hospital Charge Code	00378905593
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68

LIDOCAINE 5 % EX PTCH [28203]

Facility

$3.42

Service Code	NDC 82347050505
Hospital Charge Code	82347050505
Hospital Revenue Code	250
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.71
Rate for Payer: Aetna Government	$1.71
Rate for Payer: Brighton Health Commercial	$2.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.33
Rate for Payer: Group Health Inc Commercial	$1.71
Rate for Payer: Group Health Inc Medicare	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.71
Rate for Payer: Hamaspik Choice Inc Medicare	$1.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.22

LIDOCAINE 5 % EX PTCH [28203]

Facility

$10.28

Service Code	NDC 00378905516
Hospital Charge Code	00378905516
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68

LIDOCAINE 5 % EX PTCH [28203]

Facility

$10.28

Service Code	NDC 00603188016
Hospital Charge Code	00603188016
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.14
Rate for Payer: Aetna Government	$5.14
Rate for Payer: Brighton Health Commercial	$7.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.99
Rate for Payer: Group Health Inc Commercial	$5.14
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.14
Rate for Payer: Hamaspik Choice Inc Medicare	$5.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.68

LIDOCAINE 5 % EX PTCH [28203]

Facility

$31.81

Service Code	NDC 63481068706
Hospital Charge Code	63481068706
Hospital Revenue Code	250
Min. Negotiated Rate	$11.13
Max. Negotiated Rate	$25.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.90
Rate for Payer: Aetna Government	$15.90
Rate for Payer: Brighton Health Commercial	$23.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.63
Rate for Payer: Group Health Inc Commercial	$15.90
Rate for Payer: Group Health Inc Medicare	$11.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.90
Rate for Payer: Hamaspik Choice Inc Medicare	$15.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.68

LIDOCAINE 5% TOPICAL OINT 37.5 GRAMS

Facility

$34.00

Hospital Charge Code	41650525
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$27.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.00
Rate for Payer: Aetna Government	$17.00
Rate for Payer: Brighton Health Commercial	$25.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.12
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

LIDOCAINE 5% TOPICAL OINT 37.5 GRAMS

Facility

$34.00

Hospital Charge Code	41640525
Hospital Revenue Code	250
Min. Negotiated Rate	$11.90
Max. Negotiated Rate	$27.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$17.00
Rate for Payer: Aetna Government	$17.00
Rate for Payer: Brighton Health Commercial	$25.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.12
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

LIDOCAINE 5% TOPICAL PATCH

Facility

$13.96

Hospital Charge Code	41653007
Hospital Revenue Code	250
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$11.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.98
Rate for Payer: Aetna Government	$6.98
Rate for Payer: Brighton Health Commercial	$10.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.49
Rate for Payer: Group Health Inc Commercial	$6.98
Rate for Payer: Group Health Inc Medicare	$4.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.98
Rate for Payer: Hamaspik Choice Inc Medicare	$6.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.07

LIDOCAINE 5% TOPICAL PATCH

Facility

$13.96

Hospital Charge Code	41643007
Hospital Revenue Code	250
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$11.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.98
Rate for Payer: Aetna Government	$6.98
Rate for Payer: Brighton Health Commercial	$10.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.49
Rate for Payer: Group Health Inc Commercial	$6.98
Rate for Payer: Group Health Inc Medicare	$4.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.98
Rate for Payer: Hamaspik Choice Inc Medicare	$6.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.07

Know your out-of-pocket cost for care.

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