St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

BENIGN-RMVL SKN LESION .5 OR LESS

Facility

$1,847.58

Service Code	HCPCS 11400
Hospital Charge Code	30300172
Hospital Revenue Code	510
Rate for Payer: Cash Price	$813.63

BENIGN-RMVL SKN LESION .5 OR LESS

Facility

$1,847.58

Service Code	HCPCS 11400
Hospital Charge Code	30300172
Hospital Revenue Code	510
Min. Negotiated Rate	$222.00
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2,134.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$813.63
Rate for Payer: Aetna Government	$813.63
Rate for Payer: Affinity Essential Plan 1&2	$569.54
Rate for Payer: Affinity Essential Plan 3&4	$569.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$569.54
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Cash Price	$813.63
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$813.63
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	$813.63
Rate for Payer: Fidelis Essential Plan Aliesa	$691.59
Rate for Payer: Fidelis Essential Plan QHP	$724.13
Rate for Payer: Fidelis Medicare Advantage	$813.63
Rate for Payer: Fidelis Qualified Health Plan	$724.13
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	$923.79
Rate for Payer: Hamaspik Choice Inc Medicare	$813.63
Rate for Payer: Healthfirst Medicare Advantage	$691.59
Rate for Payer: Healthfirst QHP	$813.63
Rate for Payer: Humana Medicare	$829.90
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$813.63
Rate for Payer: Senior Whole Health Medicare Advantage	$813.63
Rate for Payer: United Healthcare Commercial	$222.00
Rate for Payer: United Healthcare Medicare Advantage	$813.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$813.63
Rate for Payer: Wellcare CHP/FHP/Medicaid	$650.90
Rate for Payer: Wellcare Medicare	$772.95

BENJON SPRAY (CAN)

Facility

$18.78

Hospital Charge Code	40200607
Hospital Revenue Code	270
Min. Negotiated Rate	$6.57
Max. Negotiated Rate	$15.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.39
Rate for Payer: Aetna Government	$9.39
Rate for Payer: Brighton Health Commercial	$14.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.77
Rate for Payer: Group Health Inc Commercial	$9.39
Rate for Payer: Group Health Inc Medicare	$6.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.39
Rate for Payer: Hamaspik Choice Inc Medicare	$9.39

BENRALIZUMAB

Facility

$432.92

Service Code	HCPCS J0517
Hospital Charge Code	41650238
Hospital Revenue Code	636
Min. Negotiated Rate	$118.65
Max. Negotiated Rate	$281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.50
Rate for Payer: Aetna Government	$169.50
Rate for Payer: Affinity Essential Plan 1&2	$118.65
Rate for Payer: Affinity Essential Plan 3&4	$118.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$118.65
Rate for Payer: Brighton Health Commercial	$259.75
Rate for Payer: Cash Price	$169.50
Rate for Payer: Cash Price	$169.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$169.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.93
Rate for Payer: Elderplan Medicare Advantage	$169.50
Rate for Payer: EmblemHealth Commercial	$169.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$169.50
Rate for Payer: Fidelis Essential Plan Aliesa	$169.50
Rate for Payer: Fidelis Essential Plan QHP	$177.98
Rate for Payer: Fidelis Medicare Advantage	$169.50
Rate for Payer: Fidelis Qualified Health Plan	$177.98
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.46
Rate for Payer: Hamaspik Choice Inc Medicare	$216.46
Rate for Payer: Healthfirst Medicare Advantage	$144.08
Rate for Payer: Healthfirst QHP	$169.50
Rate for Payer: Humana Medicare	$172.89
Rate for Payer: Senior Whole Health Medicare Advantage	$169.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.16
Rate for Payer: SOMOS Essential	$175.16
Rate for Payer: United Healthcare Commercial	$168.25
Rate for Payer: United Healthcare Medicare Advantage	$169.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$135.60
Rate for Payer: Wellcare Medicare	$161.03

BENRALIZUMAB

Facility

$432.92

Service Code	HCPCS J0517
Hospital Charge Code	41640238
Hospital Revenue Code	636
Min. Negotiated Rate	$118.65
Max. Negotiated Rate	$281.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$238.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.50
Rate for Payer: Aetna Government	$169.50
Rate for Payer: Affinity Essential Plan 1&2	$118.65
Rate for Payer: Affinity Essential Plan 3&4	$118.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$118.65
Rate for Payer: Brighton Health Commercial	$259.75
Rate for Payer: Cash Price	$169.50
Rate for Payer: Cash Price	$169.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$169.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$216.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$248.93
Rate for Payer: Elderplan Medicare Advantage	$169.50
Rate for Payer: EmblemHealth Commercial	$169.50
Rate for Payer: Fidelis CHP/HARP/Medicaid	$169.50
Rate for Payer: Fidelis Essential Plan Aliesa	$169.50
Rate for Payer: Fidelis Essential Plan QHP	$177.98
Rate for Payer: Fidelis Medicare Advantage	$169.50
Rate for Payer: Fidelis Qualified Health Plan	$177.98
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.46
Rate for Payer: Hamaspik Choice Inc Medicare	$216.46
Rate for Payer: Healthfirst Medicare Advantage	$144.08
Rate for Payer: Healthfirst QHP	$169.50
Rate for Payer: Humana Medicare	$172.89
Rate for Payer: Senior Whole Health Medicare Advantage	$169.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$175.16
Rate for Payer: SOMOS Essential	$175.16
Rate for Payer: United Healthcare Commercial	$168.25
Rate for Payer: United Healthcare Medicare Advantage	$169.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$281.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$135.60
Rate for Payer: Wellcare Medicare	$161.03

BENRALIZUMAB

Facility

$432.92

Service Code	HCPCS J0517
Hospital Charge Code	41640238
Hospital Revenue Code	636
Min. Negotiated Rate	$216.46
Max. Negotiated Rate	$216.46
Rate for Payer: Cash Price	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.46
Rate for Payer: Hamaspik Choice Inc Medicare	$216.46

BENRALIZUMAB

Facility

$432.92

Service Code	HCPCS J0517
Hospital Charge Code	41650238
Hospital Revenue Code	636
Min. Negotiated Rate	$216.46
Max. Negotiated Rate	$216.46
Rate for Payer: Cash Price	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$216.46
Rate for Payer: Hamaspik Choice Inc Medicare	$216.46

BENRALIZUMAB 30 MG/ML SC SOSY [150888]

Facility

$6,812.10

Service Code	HCPCS J0517
Hospital Charge Code	00310173030
Hospital Revenue Code	250
Min. Negotiated Rate	$118.65
Max. Negotiated Rate	$5,449.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,746.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$169.50
Rate for Payer: Aetna Government	$169.50
Rate for Payer: Affinity Essential Plan 1&2	$118.65
Rate for Payer: Affinity Essential Plan 3&4	$118.65
Rate for Payer: Affinity Medicaid/CHP/HARP	$118.65
Rate for Payer: Brighton Health Commercial	$5,109.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$169.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5,449.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$4,632.23
Rate for Payer: Elderplan Medicare Advantage	$169.50
Rate for Payer: EmblemHealth Commercial	$169.50
Rate for Payer: Fidelis Essential Plan Aliesa	$144.08
Rate for Payer: Fidelis Essential Plan QHP	$150.86
Rate for Payer: Fidelis Medicare Advantage	$169.50
Rate for Payer: Fidelis Qualified Health Plan	$150.86
Rate for Payer: Group Health Inc Commercial	$169.50
Rate for Payer: Group Health Inc Medicare	$169.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3,406.05
Rate for Payer: Hamaspik Choice Inc Medicare	$169.50
Rate for Payer: Healthfirst Medicare Advantage	$144.08
Rate for Payer: Healthfirst QHP	$169.50
Rate for Payer: Humana Medicare	$172.89
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$165.25
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$175.16
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$175.16
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$175.16
Rate for Payer: Senior Whole Health Medicare Advantage	$169.50
Rate for Payer: United Healthcare Medicare Advantage	$169.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4,427.86
Rate for Payer: Wellcare CHP/FHP/Medicaid	$135.60
Rate for Payer: Wellcare Medicare	$161.03

BENTSON WIRE 180CM

Facility

$37.88

Hospital Charge Code	64905210
Hospital Revenue Code	270
Min. Negotiated Rate	$13.26
Max. Negotiated Rate	$30.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.94
Rate for Payer: Aetna Government	$18.94
Rate for Payer: Brighton Health Commercial	$28.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$30.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.76
Rate for Payer: Group Health Inc Commercial	$18.94
Rate for Payer: Group Health Inc Medicare	$13.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.94
Rate for Payer: Hamaspik Choice Inc Medicare	$18.94

BENZOCAINE + BUTAMBEN + TETRACAINE TOPIC

Facility

$44.24

Hospital Charge Code	41654258
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$35.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.12
Rate for Payer: Aetna Government	$22.12
Rate for Payer: Brighton Health Commercial	$33.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.08
Rate for Payer: Group Health Inc Commercial	$22.12
Rate for Payer: Group Health Inc Medicare	$15.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.12
Rate for Payer: Hamaspik Choice Inc Medicare	$22.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.76

BENZOCAINE + BUTAMBEN + TETRACAINE TOPIC

Facility

$44.24

Hospital Charge Code	41644258
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$35.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.12
Rate for Payer: Aetna Government	$22.12
Rate for Payer: Brighton Health Commercial	$33.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$35.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$30.08
Rate for Payer: Group Health Inc Commercial	$22.12
Rate for Payer: Group Health Inc Medicare	$15.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.12
Rate for Payer: Hamaspik Choice Inc Medicare	$22.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.76

BENZOCAINE-MENTHOL 15-2.6 MG MT LOZG [111183]

Facility

$0.18

Service Code	NDC 63824073216
Hospital Charge Code	63824073216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

BENZOCAINE-MENTHOL 15-3.6MG LOZ

Facility

$0.14

Hospital Charge Code	41657045
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

BENZOCAINE-MENTHOL 15-3.6MG LOZ

Facility

$0.14

Hospital Charge Code	41647045
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG [94141]

Facility

$0.18

Service Code	NDC 63824071516
Hospital Charge Code	63824071516
Hospital Revenue Code	250
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.09
Rate for Payer: Aetna Government	$0.09
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.12
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

BENZOCAINE-MENTHOL 15-3.6 MG MT LOZG [94141]

Facility

$0.19

Service Code	NDC 00904625549
Hospital Charge Code	00904625549
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.13
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.12

BENZOCAINE MENTHOL LOZENGE 15/4

Facility

$1.00

Hospital Charge Code	41656042
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: Brighton Health Commercial	$0.75
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

BENZOCAINE MENTHOL LOZENGE 15MG

Facility

$1.00

Hospital Charge Code	41646042
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: Brighton Health Commercial	$0.75
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

BENZOCAINE TOPICAL SPRAY 20%

Facility

$5.02

Hospital Charge Code	41651419
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Brighton Health Commercial	$3.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.41
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.26

BENZOCAINE TOPICAL SPRAY 20%

Facility

$5.02

Hospital Charge Code	41641419
Hospital Revenue Code	250
Min. Negotiated Rate	$1.76
Max. Negotiated Rate	$4.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.51
Rate for Payer: Aetna Government	$2.51
Rate for Payer: Brighton Health Commercial	$3.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.41
Rate for Payer: Group Health Inc Commercial	$2.51
Rate for Payer: Group Health Inc Medicare	$1.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.51
Rate for Payer: Hamaspik Choice Inc Medicare	$2.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.26

BENZODIAZEPINES, 1-12

Facility

$33.95

Service Code	HCPCS 80346
Hospital Charge Code	40609728
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$27.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$25.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.09
Rate for Payer: Group Health Inc Commercial	$16.98
Rate for Payer: Group Health Inc Medicare	$11.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.98
Rate for Payer: Hamaspik Choice Inc Medicare	$16.98
Rate for Payer: United Healthcare Commercial	$24.25

BENZODIAZEPINES, 13 OR MORE

Facility

$37.35

Service Code	HCPCS 80347
Hospital Charge Code	40601022
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$29.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$28.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.40
Rate for Payer: Group Health Inc Commercial	$18.68
Rate for Payer: Group Health Inc Medicare	$13.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.68
Rate for Payer: Hamaspik Choice Inc Medicare	$18.68
Rate for Payer: United Healthcare Commercial	$24.25

BENZOIN COMPOUND TINCTURE 30 ML

Facility

$49.04

Hospital Charge Code	41655232
Hospital Revenue Code	250
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$39.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.52
Rate for Payer: Aetna Government	$24.52
Rate for Payer: Brighton Health Commercial	$36.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.35
Rate for Payer: Group Health Inc Commercial	$24.52
Rate for Payer: Group Health Inc Medicare	$17.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.52
Rate for Payer: Hamaspik Choice Inc Medicare	$24.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.88

BENZOIN COMPOUND TINCTURE 30 ML

Facility

$49.04

Hospital Charge Code	41645232
Hospital Revenue Code	250
Min. Negotiated Rate	$17.16
Max. Negotiated Rate	$39.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$26.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$24.52
Rate for Payer: Aetna Government	$24.52
Rate for Payer: Brighton Health Commercial	$36.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$39.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$33.35
Rate for Payer: Group Health Inc Commercial	$24.52
Rate for Payer: Group Health Inc Medicare	$17.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$24.52
Rate for Payer: Hamaspik Choice Inc Medicare	$24.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$31.88

BENZOYL PEROXIDE 10% GEL 45 GRAMS

Facility

$4.00

Hospital Charge Code	41650584
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

Know your out-of-pocket cost for care.

All Charges