|
BENZOYL PEROXIDE 10% GEL 45 GRAMS
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
41640584
|
|
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
|
|
|
BENZOYL PEROXIDE 5 % EX GEL [991]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 00536105556
|
| Hospital Charge Code |
00536105556
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.10
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| 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
|
|
|
BENZOYL PEROXIDE 5% GEL 45 GRAMS
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
41640387
|
|
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
|
|
|
BENZOYL PEROXIDE 5% GEL 45 GRAMS
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
41650387
|
|
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
|
|
|
BENZTROPINE 0.5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41643515
|
|
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
|
|
|
BENZTROPINE 0.5 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41653515
|
|
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
|
|
|
BENZTROPINE 1 MG/ML INJ
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
41644393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$21.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.86
|
|
|
BENZTROPINE 1 MG/ML INJ
|
Facility
|
OP
|
$43.73
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
41644393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.51
|
| Rate for Payer: Aetna Government |
$19.51
|
| Rate for Payer: Brighton Health Commercial |
$26.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.14
|
| Rate for Payer: Group Health Inc Commercial |
$21.86
|
| Rate for Payer: Group Health Inc Medicare |
$15.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.43
|
| Rate for Payer: SOMOS Essential |
$17.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.42
|
|
|
BENZTROPINE 1 MG/ML INJ
|
Facility
|
IP
|
$43.73
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
41654393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.86 |
| Max. Negotiated Rate |
$21.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.86
|
|
|
BENZTROPINE 1 MG/ML INJ
|
Facility
|
OP
|
$43.73
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
41654393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$28.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.51
|
| Rate for Payer: Aetna Government |
$19.51
|
| Rate for Payer: Brighton Health Commercial |
$26.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.86
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.14
|
| Rate for Payer: Group Health Inc Commercial |
$21.86
|
| Rate for Payer: Group Health Inc Medicare |
$15.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.86
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$17.43
|
| Rate for Payer: SOMOS Essential |
$17.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.42
|
|
|
BENZTROPINE 1 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41643516
|
|
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
|
|
|
BENZTROPINE 1 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41653516
|
|
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
|
|
|
BENZTROPINE 2 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640545
|
|
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
|
|
|
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: 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
|
|
|
BENZTROPINE MESYLATE 0.5 MG PO TABS [998]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 00603243732
|
| Hospital Charge Code |
00603243732
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
BENZTROPINE MESYLATE 0.5 MG PO TABS [998]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 00904678861
|
| Hospital Charge Code |
00904678861
|
|
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: Brighton Health Commercial |
$0.40
|
| 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 |
$0.35
|
|
|
BENZTROPINE MESYLATE 1 MG/ML IJ SOLN [9259]
|
Facility
|
OP
|
$29.38
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
68382086002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.51
|
| Rate for Payer: Aetna Government |
$19.51
|
| Rate for Payer: Brighton Health Commercial |
$22.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.98
|
| Rate for Payer: Group Health Inc Commercial |
$14.69
|
| Rate for Payer: Group Health Inc Medicare |
$10.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.09
|
|
|
BENZTROPINE MESYLATE 1 MG/ML IJ SOLN [9259]
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
00143923301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.51
|
| Rate for Payer: Aetna Government |
$19.51
|
| Rate for Payer: Brighton Health Commercial |
$20.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$18.36
|
| Rate for Payer: Group Health Inc Commercial |
$13.50
|
| Rate for Payer: Group Health Inc Medicare |
$9.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.50
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$17.55
|
|
|
BENZTROPINE MESYLATE 1 MG/ML IJ SOLN [9259]
|
Facility
|
OP
|
$29.38
|
|
|
Service Code
|
HCPCS J0515
|
| Hospital Charge Code |
68382086010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.28 |
| Max. Negotiated Rate |
$23.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$19.51
|
| Rate for Payer: Aetna Government |
$19.51
|
| Rate for Payer: Brighton Health Commercial |
$22.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.98
|
| Rate for Payer: Group Health Inc Commercial |
$14.69
|
| Rate for Payer: Group Health Inc Medicare |
$10.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.69
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$16.45
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$17.43
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$17.43
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$17.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.09
|
|
|
BENZTROPINE MESYLATE 1 MG PO TABS [999]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 00904679061
|
| Hospital Charge Code |
00904679061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.29
|
| Rate for Payer: Aetna Government |
$0.29
|
| Rate for Payer: Brighton Health Commercial |
$0.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.29
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.38
|
|
|
BENZTROPINE MESYLATE 1 MG PO TABS [999]
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 00603243832
|
| Hospital Charge Code |
00603243832
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.19
|
| Rate for Payer: Aetna Government |
$0.19
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
BENZTROPINE MESYLATE 1 MG PO TABS [999]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 69315013701
|
| Hospital Charge Code |
69315013701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
BENZTROPINE MESYLATE 1 MG PO TABS [999]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 68084038811
|
| Hospital Charge Code |
68084038811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Brighton Health Commercial |
$0.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.40
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.38
|
|
|
BENZTROPINE MESYLATE 1 MG PO TABS [999]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 00603243821
|
| Hospital Charge Code |
00603243821
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
BENZTROPINE MESYLATE 2 MG PO TABS [1000]
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
NDC 69097083207
|
| Hospital Charge Code |
69097083207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
