St. Barnabas Hospital

All Charges

Charge

Type

Price

BENZTROPINE 2 MG TAB

Facility OP

$1.00

Hospital Charge Code	41650545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BENZYLPENICILLOYL POLYLYSINE INJ

Facility OP

$33.00

Hospital Charge Code	41645419
Hospital Revenue Code	250
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$26.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.50
Rate for Payer: Aetna Government	$16.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.44
Rate for Payer: Group Health Inc Commercial	$16.50
Rate for Payer: Group Health Inc Medicare	$11.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.50
Rate for Payer: Hamaspik Choice Inc Medicare	$16.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.45

BENZYLPENICILLOYL POLYLYSINE INJ

Facility OP

$33.00

Hospital Charge Code	41655419
Hospital Revenue Code	250
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$26.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.50
Rate for Payer: Aetna Government	$16.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.44
Rate for Payer: Group Health Inc Commercial	$16.50
Rate for Payer: Group Health Inc Medicare	$11.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.50
Rate for Payer: Hamaspik Choice Inc Medicare	$16.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.45

BERACTANT 25 MG/ML INTRATRACHEAL

Facility OP

$510.58

Hospital Charge Code	41652282
Hospital Revenue Code	250
Min. Negotiated Rate	$178.70
Max. Negotiated Rate	$408.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$255.29
Rate for Payer: Aetna Government	$255.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$408.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$347.19
Rate for Payer: Group Health Inc Commercial	$255.29
Rate for Payer: Group Health Inc Medicare	$178.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.29
Rate for Payer: Hamaspik Choice Inc Medicare	$255.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$331.88

BERACTANT 25 MG/ML INTRATRACHEAL

Facility OP

$510.58

Hospital Charge Code	41642282
Hospital Revenue Code	250
Min. Negotiated Rate	$178.70
Max. Negotiated Rate	$408.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$280.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$255.29
Rate for Payer: Aetna Government	$255.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$408.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$347.19
Rate for Payer: Group Health Inc Commercial	$255.29
Rate for Payer: Group Health Inc Medicare	$178.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$255.29
Rate for Payer: Hamaspik Choice Inc Medicare	$255.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$331.88

BETA-2 GLYCOPROTEIN I AB, IGG

Facility OP

$63.63

Service Code	HCPCS 86146
Hospital Charge Code	40729325
Hospital Revenue Code	300
Min. Negotiated Rate	$20.36
Max. Negotiated Rate	$40.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.45
Rate for Payer: Aetna Government	$25.45
Rate for Payer: Cash Price	$25.45
Rate for Payer: Cash Price	$25.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.21
Rate for Payer: Elderplan Medicare Advantage	$25.45
Rate for Payer: EmblemHealth Commercial	$25.45
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22.90
Rate for Payer: Fidelis Essential Plan Aliesa	$21.63
Rate for Payer: Fidelis Essential Plan QHP	$22.65
Rate for Payer: Fidelis Medicare Advantage	$25.45
Rate for Payer: Fidelis Qualified Health Plan	$22.65
Rate for Payer: Group Health Inc Commercial	$25.45
Rate for Payer: Group Health Inc Medicare	$25.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.82
Rate for Payer: Hamaspik Choice Inc Medicare	$25.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25.45
Rate for Payer: Healthfirst Medicare Advantage	$25.45
Rate for Payer: Healthfirst QHP	$25.45
Rate for Payer: Senior Whole Health Medicare Advantage	$25.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.36
Rate for Payer: Wellcare Medicare	$22.90

BETA-2 MICROGLOBULIN, SERUM

Facility OP

$40.45

Service Code	HCPCS 82232
Hospital Charge Code	40609045
Hospital Revenue Code	300
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$25.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.18
Rate for Payer: Aetna Government	$16.18
Rate for Payer: Cash Price	$16.18
Rate for Payer: Cash Price	$16.18
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$16.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.75
Rate for Payer: Elderplan Medicare Advantage	$16.18
Rate for Payer: EmblemHealth Commercial	$16.18
Rate for Payer: Fidelis CHP/HARP/Medicaid	$14.56
Rate for Payer: Fidelis Essential Plan Aliesa	$13.75
Rate for Payer: Fidelis Essential Plan QHP	$14.40
Rate for Payer: Fidelis Medicare Advantage	$16.18
Rate for Payer: Fidelis Qualified Health Plan	$14.40
Rate for Payer: Group Health Inc Commercial	$16.18
Rate for Payer: Group Health Inc Medicare	$16.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.22
Rate for Payer: Hamaspik Choice Inc Medicare	$16.18
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$16.18
Rate for Payer: Healthfirst Medicare Advantage	$16.18
Rate for Payer: Healthfirst QHP	$16.18
Rate for Payer: Senior Whole Health Medicare Advantage	$16.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.18
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.94
Rate for Payer: Wellcare Medicare	$14.56

BETA CAP CLAMP

Facility OP

$11.70

Hospital Charge Code	42905255
Hospital Revenue Code	801
Min. Negotiated Rate	$4.10
Max. Negotiated Rate	$9.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.85
Rate for Payer: Aetna Government	$5.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.96
Rate for Payer: Group Health Inc Commercial	$5.85
Rate for Payer: Group Health Inc Medicare	$4.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.85
Rate for Payer: Hamaspik Choice Inc Medicare	$5.85

BETA-HYDROXYBUTYRATE

Facility OP

$20.43

Service Code	HCPCS 82010
Hospital Charge Code	40609031
Hospital Revenue Code	300
Min. Negotiated Rate	$6.54
Max. Negotiated Rate	$13.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.17
Rate for Payer: Aetna Government	$8.17
Rate for Payer: Cash Price	$8.17
Rate for Payer: Cash Price	$8.17
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.00
Rate for Payer: Elderplan Medicare Advantage	$8.17
Rate for Payer: EmblemHealth Commercial	$8.17
Rate for Payer: Fidelis CHP/HARP/Medicaid	$7.35
Rate for Payer: Fidelis Essential Plan Aliesa	$6.94
Rate for Payer: Fidelis Essential Plan QHP	$7.27
Rate for Payer: Fidelis Medicare Advantage	$8.17
Rate for Payer: Fidelis Qualified Health Plan	$7.27
Rate for Payer: Group Health Inc Commercial	$8.17
Rate for Payer: Group Health Inc Medicare	$8.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.22
Rate for Payer: Hamaspik Choice Inc Medicare	$8.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$8.17
Rate for Payer: Healthfirst Medicare Advantage	$8.17
Rate for Payer: Healthfirst QHP	$8.17
Rate for Payer: Senior Whole Health Medicare Advantage	$8.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.17
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.54
Rate for Payer: Wellcare Medicare	$7.35

BETAMETHASONE DIPROPIONATE 0.05% CREAM -

Facility OP

$2.00

Hospital Charge Code	41650047
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: 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

BETAMETHASONE DIPROPIONATE 0.05% CREAM -

Facility OP

$2.00

Hospital Charge Code	41640047
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: 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

BETAMETHASONE DIPROPROPIONATE 0.05% OINT

Facility OP

$3.00

Hospital Charge Code	41640897
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BETAMETHASONE DIPROPROPIONATE 0.05% OINT

Facility OP

$3.00

Hospital Charge Code	41650897
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BETAMETHASONE SOD PHOS-ACETATE 6 MG/ML I

Facility OP

$27.35

Service Code	HCPCS J0702
Hospital Charge Code	41651885
Hospital Revenue Code	636
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$17.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.04
Rate for Payer: Aetna Government	$8.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.26
Rate for Payer: Group Health Inc Commercial	$13.68
Rate for Payer: Group Health Inc Medicare	$9.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.68
Rate for Payer: Hamaspik Choice Inc Medicare	$13.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.30
Rate for Payer: SOMOS Essential	$7.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.78

BETAMETHASONE SOD PHOS-ACETATE 6 MG/ML I

Facility IP

$27.35

Service Code	HCPCS J0702
Hospital Charge Code	41651885
Hospital Revenue Code	636
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$13.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.68
Rate for Payer: Hamaspik Choice Inc Medicare	$13.68

BETAMETHASONE SOD PHOS-ACETATE 6 MG/ML I

Facility OP

$27.35

Service Code	HCPCS J0702
Hospital Charge Code	41641885
Hospital Revenue Code	636
Min. Negotiated Rate	$6.26
Max. Negotiated Rate	$17.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.04
Rate for Payer: Aetna Government	$8.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.26
Rate for Payer: Group Health Inc Commercial	$13.68
Rate for Payer: Group Health Inc Medicare	$9.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.68
Rate for Payer: Hamaspik Choice Inc Medicare	$13.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.96
Rate for Payer: SOMOS CHP/HARP/Medicaid	$7.30
Rate for Payer: SOMOS Essential	$7.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.78

BETAMETHASONE SOD PHOS-ACETATE 6 MG/ML I

Facility IP

$27.35

Service Code	HCPCS J0702
Hospital Charge Code	41641885
Hospital Revenue Code	636
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$13.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.68
Rate for Payer: Hamaspik Choice Inc Medicare	$13.68

BETAXOLOL 0.5% OPHTHALMIC SOLN

Facility OP

$101.94

Hospital Charge Code	41642664
Hospital Revenue Code	250
Min. Negotiated Rate	$35.68
Max. Negotiated Rate	$81.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.97
Rate for Payer: Aetna Government	$50.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.32
Rate for Payer: Group Health Inc Commercial	$50.97
Rate for Payer: Group Health Inc Medicare	$35.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.97
Rate for Payer: Hamaspik Choice Inc Medicare	$50.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.26

BETAXOLOL 0.5% OPHTHALMIC SOLN

Facility OP

$101.94

Hospital Charge Code	41652664
Hospital Revenue Code	250
Min. Negotiated Rate	$35.68
Max. Negotiated Rate	$81.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$56.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$50.97
Rate for Payer: Aetna Government	$50.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$81.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$69.32
Rate for Payer: Group Health Inc Commercial	$50.97
Rate for Payer: Group Health Inc Medicare	$35.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$50.97
Rate for Payer: Hamaspik Choice Inc Medicare	$50.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$66.26

BETHANECHOL 25 MG TAB

Facility OP

$0.53

Hospital Charge Code	41643572
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

BETHANECHOL 25 MG TAB

Facility OP

$0.53

Hospital Charge Code	41653572
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.36
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

BETHANECHOL 5 MG TAB

Facility OP

$1.00

Hospital Charge Code	41653451
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BETHANECHOL 5 MG TAB

Facility OP

$1.00

Hospital Charge Code	41643451
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BEVACIZUMAB 100 MG/4 ML INJ

Facility OP

$199.22

Service Code	HCPCS J9035
Hospital Charge Code	41643654
Hospital Revenue Code	636
Min. Negotiated Rate	$59.26
Max. Negotiated Rate	$129.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$109.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$74.07
Rate for Payer: Aetna Government	$74.07
Rate for Payer: Cash Price	$74.07
Rate for Payer: Cash Price	$74.07
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$74.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$99.61
Rate for Payer: Cigna LocalPlus Benefit Plan	$114.55
Rate for Payer: Elderplan Medicare Advantage	$74.07
Rate for Payer: EmblemHealth Commercial	$74.07
Rate for Payer: Fidelis CHP/HARP/Medicaid	$74.07
Rate for Payer: Fidelis Essential Plan Aliesa	$74.07
Rate for Payer: Fidelis Essential Plan QHP	$77.78
Rate for Payer: Fidelis Medicare Advantage	$74.07
Rate for Payer: Fidelis Qualified Health Plan	$77.78
Rate for Payer: Group Health Inc Commercial	$74.07
Rate for Payer: Group Health Inc Medicare	$74.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.61
Rate for Payer: Hamaspik Choice Inc Medicare	$99.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$73.58
Rate for Payer: Healthfirst Medicare Advantage	$62.96
Rate for Payer: Healthfirst QHP	$74.07
Rate for Payer: Senior Whole Health Medicare Advantage	$74.07
Rate for Payer: SOMOS CHP/HARP/Medicaid	$78.61
Rate for Payer: SOMOS Essential	$78.61
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$129.49
Rate for Payer: Wellcare CHP/FHP/Medicaid	$59.26
Rate for Payer: Wellcare Medicare	$70.37

BEVACIZUMAB 100 MG/4 ML INJ

Facility IP

$199.22

Service Code	HCPCS J9035
Hospital Charge Code	41643654
Hospital Revenue Code	636
Min. Negotiated Rate	$99.61
Max. Negotiated Rate	$99.61
Rate for Payer: Cash Price	$74.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$99.61
Rate for Payer: Hamaspik Choice Inc Medicare	$99.61

Price Transparency.

All Charges