Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LIDOCAINE 4 % TOPICAL PATCH

Facility

$16.52

Service Code	NDC 96295-13458
Hospital Charge Code	108212
Hospital Revenue Code	637
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$14.87
Rate for Payer: Aetna Commercial	$14.04
Rate for Payer: Aetna New Business (MI Preferred)	$10.74
Rate for Payer: Cash Price	$13.22
Rate for Payer: Cofinity Commercial	$11.56
Rate for Payer: Cofinity Commercial	$14.21
Rate for Payer: Healthscope Commercial	$14.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.04
Rate for Payer: PHP Commercial	$14.04
Rate for Payer: Priority Health Cigna Priority Health	$11.56
Rate for Payer: Priority Health SBD	$10.41

LIDOCAINE 4 % TOPICAL PATCH

Facility

$27.17

Service Code	NDC 0536-1202-15
Hospital Charge Code	108212
Hospital Revenue Code	637
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$24.45
Rate for Payer: Aetna Commercial	$23.09
Rate for Payer: Aetna New Business (MI Preferred)	$17.66
Rate for Payer: Cash Price	$21.74
Rate for Payer: Cofinity Commercial	$19.02
Rate for Payer: Cofinity Commercial	$23.37
Rate for Payer: Healthscope Commercial	$24.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.09
Rate for Payer: PHP Commercial	$23.09
Rate for Payer: Priority Health Cigna Priority Health	$19.02
Rate for Payer: Priority Health SBD	$17.12

LIDOCAINE 4 % TOPICAL PATCH

Facility

$18.72

Service Code	NDC 70000-0366-1
Hospital Charge Code	108212
Hospital Revenue Code	637
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$16.85
Rate for Payer: Aetna Commercial	$15.91
Rate for Payer: Aetna New Business (MI Preferred)	$12.17
Rate for Payer: Cash Price	$14.98
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$16.10
Rate for Payer: Healthscope Commercial	$16.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$15.91
Rate for Payer: PHP Commercial	$15.91
Rate for Payer: Priority Health Cigna Priority Health	$13.10
Rate for Payer: Priority Health SBD	$11.79

LIDOCAINE 4 % WITH EPINEPHRINE TOPICAL SOLUTION

Facility

$599.82

Service Code	NDC 9900-0002-11
Hospital Charge Code	155018
Hospital Revenue Code	250
Min. Negotiated Rate	$377.89
Max. Negotiated Rate	$539.84
Rate for Payer: Aetna Commercial	$509.85
Rate for Payer: Aetna New Business (MI Preferred)	$389.88
Rate for Payer: Cash Price	$479.86
Rate for Payer: Cofinity Commercial	$419.87
Rate for Payer: Cofinity Commercial	$515.85
Rate for Payer: Healthscope Commercial	$539.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$509.85
Rate for Payer: PHP Commercial	$509.85
Rate for Payer: Priority Health Cigna Priority Health	$419.87
Rate for Payer: Priority Health SBD	$377.89

LIDOCAINE 5 % TOPICAL OINTMENT

Facility

$89.69

Service Code	NDC 68462-418-20
Hospital Charge Code	159107
Hospital Revenue Code	637
Min. Negotiated Rate	$56.50
Max. Negotiated Rate	$80.72
Rate for Payer: Aetna Commercial	$76.24
Rate for Payer: Aetna New Business (MI Preferred)	$58.30
Rate for Payer: Cash Price	$71.75
Rate for Payer: Cofinity Commercial	$62.78
Rate for Payer: Cofinity Commercial	$77.13
Rate for Payer: Healthscope Commercial	$80.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.24
Rate for Payer: PHP Commercial	$76.24
Rate for Payer: Priority Health Cigna Priority Health	$62.78
Rate for Payer: Priority Health SBD	$56.50

LIDOCAINE 5 % TOPICAL OINTMENT

Facility

$781.21

Service Code	NDC 0168-0204-37
Hospital Charge Code	159107
Hospital Revenue Code	637
Min. Negotiated Rate	$492.16
Max. Negotiated Rate	$703.09
Rate for Payer: Aetna Commercial	$664.03
Rate for Payer: Aetna New Business (MI Preferred)	$507.79
Rate for Payer: Cash Price	$624.97
Rate for Payer: Cofinity Commercial	$546.85
Rate for Payer: Cofinity Commercial	$671.84
Rate for Payer: Healthscope Commercial	$703.09
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$664.03
Rate for Payer: PHP Commercial	$664.03
Rate for Payer: Priority Health Cigna Priority Health	$546.85
Rate for Payer: Priority Health SBD	$492.16

LIDOCAINE 5 % TOPICAL OINTMENT

Facility

$34.36

Service Code	NDC 52565-008-14
Hospital Charge Code	159107
Hospital Revenue Code	637
Min. Negotiated Rate	$21.65
Max. Negotiated Rate	$30.92
Rate for Payer: Aetna Commercial	$29.21
Rate for Payer: Aetna New Business (MI Preferred)	$22.33
Rate for Payer: Cash Price	$27.49
Rate for Payer: Cofinity Commercial	$24.05
Rate for Payer: Cofinity Commercial	$29.55
Rate for Payer: Healthscope Commercial	$30.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.21
Rate for Payer: PHP Commercial	$29.21
Rate for Payer: Priority Health Cigna Priority Health	$24.05
Rate for Payer: Priority Health SBD	$21.65

LIDOCAINE 5 % TOPICAL OINTMENT

Facility

$372.54

Service Code	NDC 51672-3020-2
Hospital Charge Code	159107
Hospital Revenue Code	637
Min. Negotiated Rate	$234.70
Max. Negotiated Rate	$335.29
Rate for Payer: Aetna Commercial	$316.66
Rate for Payer: Aetna New Business (MI Preferred)	$242.15
Rate for Payer: Cash Price	$298.03
Rate for Payer: Cofinity Commercial	$260.78
Rate for Payer: Cofinity Commercial	$320.38
Rate for Payer: Healthscope Commercial	$335.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$316.66
Rate for Payer: PHP Commercial	$316.66
Rate for Payer: Priority Health Cigna Priority Health	$260.78
Rate for Payer: Priority Health SBD	$234.70

LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION

Facility

$16.28

Service Code	NDC 0409-3177-16
Hospital Charge Code	14870
Hospital Revenue Code	250
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$14.65
Rate for Payer: Aetna Commercial	$13.84
Rate for Payer: Aetna New Business (MI Preferred)	$10.58
Rate for Payer: Cash Price	$13.02
Rate for Payer: Cofinity Commercial	$11.40
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Healthscope Commercial	$14.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.84
Rate for Payer: PHP Commercial	$13.84
Rate for Payer: Priority Health Cigna Priority Health	$11.40
Rate for Payer: Priority Health SBD	$10.26

LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION

Facility

$28.93

Service Code	NDC 63323-481-57
Hospital Charge Code	14870
Hospital Revenue Code	250
Min. Negotiated Rate	$18.23
Max. Negotiated Rate	$26.04
Rate for Payer: Aetna Commercial	$24.59
Rate for Payer: Aetna New Business (MI Preferred)	$18.80
Rate for Payer: Cash Price	$23.14
Rate for Payer: Cofinity Commercial	$20.25
Rate for Payer: Cofinity Commercial	$24.88
Rate for Payer: Healthscope Commercial	$26.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.59
Rate for Payer: PHP Commercial	$24.59
Rate for Payer: Priority Health Cigna Priority Health	$20.25
Rate for Payer: Priority Health SBD	$18.23

LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION

Facility

$16.28

Service Code	NDC 0409-3177-01
Hospital Charge Code	14870
Hospital Revenue Code	250
Min. Negotiated Rate	$10.26
Max. Negotiated Rate	$14.65
Rate for Payer: Aetna Commercial	$13.84
Rate for Payer: Aetna New Business (MI Preferred)	$10.58
Rate for Payer: Cash Price	$13.02
Rate for Payer: Cofinity Commercial	$11.40
Rate for Payer: Cofinity Commercial	$14.00
Rate for Payer: Healthscope Commercial	$14.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.84
Rate for Payer: PHP Commercial	$13.84
Rate for Payer: Priority Health Cigna Priority Health	$11.40
Rate for Payer: Priority Health SBD	$10.26

LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION

Facility

$48.87

Service Code	NDC 63323-487-37
Hospital Charge Code	15985
Hospital Revenue Code	250
Min. Negotiated Rate	$30.79
Max. Negotiated Rate	$43.98
Rate for Payer: Aetna Commercial	$41.54
Rate for Payer: Aetna New Business (MI Preferred)	$31.77
Rate for Payer: Cash Price	$39.10
Rate for Payer: Cofinity Commercial	$34.21
Rate for Payer: Cofinity Commercial	$42.03
Rate for Payer: Healthscope Commercial	$43.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$41.54
Rate for Payer: PHP Commercial	$41.54
Rate for Payer: Priority Health Cigna Priority Health	$34.21
Rate for Payer: Priority Health SBD	$30.79

LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION

Facility

$35.07

Service Code	NDC 63323-487-17
Hospital Charge Code	15985
Hospital Revenue Code	250
Min. Negotiated Rate	$22.09
Max. Negotiated Rate	$31.56
Rate for Payer: Aetna Commercial	$29.81
Rate for Payer: Aetna New Business (MI Preferred)	$22.80
Rate for Payer: Cash Price	$28.06
Rate for Payer: Cofinity Commercial	$24.55
Rate for Payer: Cofinity Commercial	$30.16
Rate for Payer: Healthscope Commercial	$31.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$29.81
Rate for Payer: PHP Commercial	$29.81
Rate for Payer: Priority Health Cigna Priority Health	$24.55
Rate for Payer: Priority Health SBD	$22.09

LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION

Facility

$39.79

Service Code	NDC 63323-487-31
Hospital Charge Code	15985
Hospital Revenue Code	250
Min. Negotiated Rate	$25.07
Max. Negotiated Rate	$35.81
Rate for Payer: Aetna Commercial	$33.82
Rate for Payer: Aetna New Business (MI Preferred)	$25.86
Rate for Payer: Cash Price	$31.83
Rate for Payer: Cofinity Commercial	$27.85
Rate for Payer: Cofinity Commercial	$34.22
Rate for Payer: Healthscope Commercial	$35.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.82
Rate for Payer: PHP Commercial	$33.82
Rate for Payer: Priority Health Cigna Priority Health	$27.85
Rate for Payer: Priority Health SBD	$25.07

LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION SOLUTION

Facility

$39.57

Service Code	NDC 63323-488-17
Hospital Charge Code	15956
Hospital Revenue Code	250
Min. Negotiated Rate	$24.93
Max. Negotiated Rate	$35.61
Rate for Payer: Aetna Commercial	$33.63
Rate for Payer: Aetna New Business (MI Preferred)	$25.72
Rate for Payer: Cash Price	$31.66
Rate for Payer: Cofinity Commercial	$27.70
Rate for Payer: Cofinity Commercial	$34.03
Rate for Payer: Healthscope Commercial	$35.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.63
Rate for Payer: PHP Commercial	$33.63
Rate for Payer: Priority Health Cigna Priority Health	$27.70
Rate for Payer: Priority Health SBD	$24.93

LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION

Facility

$74.76

Service Code	NDC 63323-489-27
Hospital Charge Code	10431
Hospital Revenue Code	250
Min. Negotiated Rate	$47.10
Max. Negotiated Rate	$67.28
Rate for Payer: Aetna Commercial	$63.55
Rate for Payer: Aetna New Business (MI Preferred)	$48.59
Rate for Payer: Cash Price	$59.81
Rate for Payer: Cofinity Commercial	$52.33
Rate for Payer: Cofinity Commercial	$64.29
Rate for Payer: Healthscope Commercial	$67.28
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$63.55
Rate for Payer: PHP Commercial	$63.55
Rate for Payer: Priority Health Cigna Priority Health	$52.33
Rate for Payer: Priority Health SBD	$47.10

LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION

Facility

$39.52

Service Code	NDC 63323-489-21
Hospital Charge Code	10431
Hospital Revenue Code	250
Min. Negotiated Rate	$24.90
Max. Negotiated Rate	$35.57
Rate for Payer: Aetna Commercial	$33.59
Rate for Payer: Aetna New Business (MI Preferred)	$25.69
Rate for Payer: Cash Price	$31.62
Rate for Payer: Cofinity Commercial	$27.66
Rate for Payer: Cofinity Commercial	$33.99
Rate for Payer: Healthscope Commercial	$35.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.59
Rate for Payer: PHP Commercial	$33.59
Rate for Payer: Priority Health Cigna Priority Health	$27.66
Rate for Payer: Priority Health SBD	$24.90

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$24.36

Service Code	NDC 63323-485-27
Hospital Charge Code	4452
Hospital Revenue Code	250
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$21.92
Rate for Payer: Aetna Commercial	$20.71
Rate for Payer: Aetna New Business (MI Preferred)	$15.83
Rate for Payer: Cash Price	$19.49
Rate for Payer: Cofinity Commercial	$17.05
Rate for Payer: Cofinity Commercial	$20.95
Rate for Payer: Healthscope Commercial	$21.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.71
Rate for Payer: PHP Commercial	$20.71
Rate for Payer: Priority Health Cigna Priority Health	$17.05
Rate for Payer: Priority Health SBD	$15.35

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$15.37

Service Code	NDC 55150-251-10
Hospital Charge Code	4452
Hospital Revenue Code	250
Min. Negotiated Rate	$9.68
Max. Negotiated Rate	$13.83
Rate for Payer: Aetna Commercial	$13.06
Rate for Payer: Aetna New Business (MI Preferred)	$9.99
Rate for Payer: Cash Price	$12.30
Rate for Payer: Cofinity Commercial	$10.76
Rate for Payer: Cofinity Commercial	$13.22
Rate for Payer: Healthscope Commercial	$13.83
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.06
Rate for Payer: PHP Commercial	$13.06
Rate for Payer: Priority Health Cigna Priority Health	$10.76
Rate for Payer: Priority Health SBD	$9.68

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$19.00

Service Code	NDC 63323-201-10
Hospital Charge Code	4452
Hospital Revenue Code	250
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna Commercial	$16.15
Rate for Payer: Aetna New Business (MI Preferred)	$12.35
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cofinity Commercial	$13.30
Rate for Payer: Cofinity Commercial	$16.34
Rate for Payer: Healthscope Commercial	$17.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.15
Rate for Payer: PHP Commercial	$16.15
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: Priority Health SBD	$11.97

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$24.36

Service Code	NDC 63323-485-01
Hospital Charge Code	4452
Hospital Revenue Code	250
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$21.92
Rate for Payer: Aetna Commercial	$20.71
Rate for Payer: Aetna New Business (MI Preferred)	$15.83
Rate for Payer: Cash Price	$19.49
Rate for Payer: Cofinity Commercial	$17.05
Rate for Payer: Cofinity Commercial	$20.95
Rate for Payer: Healthscope Commercial	$21.92
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.71
Rate for Payer: PHP Commercial	$20.71
Rate for Payer: Priority Health Cigna Priority Health	$17.05
Rate for Payer: Priority Health SBD	$15.35

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$12.47

Service Code	NDC 0409-4276-01
Hospital Charge Code	4452
Hospital Revenue Code	250
Min. Negotiated Rate	$4.99
Max. Negotiated Rate	$11.22
Rate for Payer: Aetna Commercial	$10.60
Rate for Payer: Aetna New Business (MI Preferred)	$8.11
Rate for Payer: BCBS Complete	$4.99
Rate for Payer: Cash Price	$9.98
Rate for Payer: Cofinity Commercial	$10.72
Rate for Payer: Cofinity Commercial	$8.73
Rate for Payer: Healthscope Commercial	$11.22
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.60
Rate for Payer: PHP Commercial	$10.60
Rate for Payer: Priority Health Cigna Priority Health	$8.73
Rate for Payer: Priority Health SBD	$7.86

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$28.12

Service Code	NDC 0143-9577-10
Hospital Charge Code	4452
Hospital Revenue Code	250
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$25.31
Rate for Payer: Aetna Commercial	$23.90
Rate for Payer: Aetna New Business (MI Preferred)	$18.28
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cofinity Commercial	$19.68
Rate for Payer: Cofinity Commercial	$24.18
Rate for Payer: Healthscope Commercial	$25.31
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.90
Rate for Payer: PHP Commercial	$23.90
Rate for Payer: Priority Health Cigna Priority Health	$19.68
Rate for Payer: Priority Health SBD	$17.72

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$19.00

Service Code	NDC 63323-201-03
Hospital Charge Code	4452
Hospital Revenue Code	250
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna Commercial	$16.15
Rate for Payer: Aetna New Business (MI Preferred)	$12.35
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cofinity Commercial	$13.30
Rate for Payer: Cofinity Commercial	$16.34
Rate for Payer: Healthscope Commercial	$17.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.15
Rate for Payer: PHP Commercial	$16.15
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: Priority Health SBD	$11.97

LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION

Facility

$19.00

Service Code	NDC 63323-201-10
Hospital Charge Code	4452
Hospital Revenue Code	250
Min. Negotiated Rate	$11.97
Max. Negotiated Rate	$17.10
Rate for Payer: Aetna Commercial	$16.15
Rate for Payer: Aetna New Business (MI Preferred)	$12.35
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cofinity Commercial	$13.30
Rate for Payer: Cofinity Commercial	$16.34
Rate for Payer: Healthscope Commercial	$17.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.15
Rate for Payer: PHP Commercial	$16.15
Rate for Payer: Priority Health Cigna Priority Health	$13.30
Rate for Payer: Priority Health SBD	$11.97

Know your out-of-pocket cost for care.

All Charges