Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION

Facility

$71.40

Service Code	NDC 52565-009-50
Hospital Charge Code	4450
Hospital Revenue Code	637
Min. Negotiated Rate	$44.98
Max. Negotiated Rate	$64.26
Rate for Payer: Aetna Commercial	$60.69
Rate for Payer: Aetna New Business (MI Preferred)	$46.41
Rate for Payer: Cash Price	$57.12
Rate for Payer: Cofinity Commercial	$49.98
Rate for Payer: Cofinity Commercial	$61.40
Rate for Payer: Healthscope Commercial	$64.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.69
Rate for Payer: PHP Commercial	$60.69
Rate for Payer: Priority Health Cigna Priority Health	$49.98
Rate for Payer: Priority Health SBD	$44.98

LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION

Facility

$104.13

Service Code	NDC 60432-465-51
Hospital Charge Code	4450
Hospital Revenue Code	637
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$93.72
Rate for Payer: Aetna Commercial	$88.51
Rate for Payer: Aetna New Business (MI Preferred)	$67.68
Rate for Payer: Cash Price	$83.30
Rate for Payer: Cofinity Commercial	$72.89
Rate for Payer: Cofinity Commercial	$89.55
Rate for Payer: Healthscope Commercial	$93.72
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$88.51
Rate for Payer: PHP Commercial	$88.51
Rate for Payer: Priority Health Cigna Priority Health	$72.89
Rate for Payer: Priority Health SBD	$65.60

LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION

Facility

$133.00

Service Code	NDC 0054-3505-47
Hospital Charge Code	4450
Hospital Revenue Code	637
Min. Negotiated Rate	$83.79
Max. Negotiated Rate	$119.70
Rate for Payer: Aetna Commercial	$113.05
Rate for Payer: Aetna New Business (MI Preferred)	$86.45
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cofinity Commercial	$114.38
Rate for Payer: Cofinity Commercial	$93.10
Rate for Payer: Healthscope Commercial	$119.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$113.05
Rate for Payer: PHP Commercial	$113.05
Rate for Payer: Priority Health Cigna Priority Health	$93.10
Rate for Payer: Priority Health SBD	$83.79

LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION

Facility

$94.56

Service Code	NDC 76329-6300-5
Hospital Charge Code	43717
Hospital Revenue Code	637
Min. Negotiated Rate	$59.57
Max. Negotiated Rate	$85.10
Rate for Payer: Aetna Commercial	$80.38
Rate for Payer: Aetna New Business (MI Preferred)	$61.46
Rate for Payer: Cash Price	$75.65
Rate for Payer: Cofinity Commercial	$81.32
Rate for Payer: Cofinity Commercial	$66.19
Rate for Payer: Healthscope Commercial	$85.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$80.38
Rate for Payer: PHP Commercial	$80.38
Rate for Payer: Priority Health Cigna Priority Health	$66.19
Rate for Payer: Priority Health SBD	$59.57

LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)

Facility

$35.60

Service Code	HCPCS J2001
Hospital Charge Code	163705
Hospital Revenue Code	636
Min. Negotiated Rate	$22.43
Max. Negotiated Rate	$32.04
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna New Business (MI Preferred)	$23.14
Rate for Payer: Cash Price	$28.48
Rate for Payer: Cofinity Commercial	$24.92
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Healthscope Commercial	$32.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$30.26
Rate for Payer: PHP Commercial	$30.26
Rate for Payer: Priority Health Cigna Priority Health	$24.92
Rate for Payer: Priority Health SBD	$22.43

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE

Facility

$19.12

Service Code	NDC 0409-4903-34
Hospital Charge Code	4459
Hospital Revenue Code	250
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$17.21
Rate for Payer: Aetna Commercial	$16.25
Rate for Payer: Aetna New Business (MI Preferred)	$12.43
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cofinity Commercial	$13.38
Rate for Payer: Cofinity Commercial	$16.44
Rate for Payer: Healthscope Commercial	$17.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.25
Rate for Payer: PHP Commercial	$16.25
Rate for Payer: Priority Health Cigna Priority Health	$13.38
Rate for Payer: Priority Health SBD	$12.05

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE

Facility

$19.12

Service Code	NDC 0409-4903-11
Hospital Charge Code	4459
Hospital Revenue Code	250
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$17.21
Rate for Payer: Aetna Commercial	$16.25
Rate for Payer: Aetna New Business (MI Preferred)	$12.43
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cofinity Commercial	$13.38
Rate for Payer: Cofinity Commercial	$16.44
Rate for Payer: Healthscope Commercial	$17.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.25
Rate for Payer: PHP Commercial	$16.25
Rate for Payer: Priority Health Cigna Priority Health	$13.38
Rate for Payer: Priority Health SBD	$12.05

LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE

Facility

$19.99

Service Code	NDC 0409-1323-05
Hospital Charge Code	4459
Hospital Revenue Code	250
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$17.99
Rate for Payer: Aetna Commercial	$16.99
Rate for Payer: Aetna New Business (MI Preferred)	$12.99
Rate for Payer: Cash Price	$15.99
Rate for Payer: Cofinity Commercial	$13.99
Rate for Payer: Cofinity Commercial	$17.19
Rate for Payer: Healthscope Commercial	$17.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.99
Rate for Payer: PHP Commercial	$16.99
Rate for Payer: Priority Health Cigna Priority Health	$13.99
Rate for Payer: Priority Health SBD	$12.59

LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)

Facility

$19.99

Service Code	NDC 0409-1323-05
Hospital Charge Code	163704
Hospital Revenue Code	250
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$17.99
Rate for Payer: Aetna Commercial	$16.99
Rate for Payer: Aetna New Business (MI Preferred)	$12.99
Rate for Payer: Cash Price	$15.99
Rate for Payer: Cofinity Commercial	$13.99
Rate for Payer: Cofinity Commercial	$17.19
Rate for Payer: Healthscope Commercial	$17.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.99
Rate for Payer: PHP Commercial	$16.99
Rate for Payer: Priority Health Cigna Priority Health	$13.99
Rate for Payer: Priority Health SBD	$12.59

LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)

Facility

$19.12

Service Code	NDC 0409-4903-11
Hospital Charge Code	163704
Hospital Revenue Code	250
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$17.21
Rate for Payer: Aetna Commercial	$16.25
Rate for Payer: Aetna New Business (MI Preferred)	$12.43
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cofinity Commercial	$13.38
Rate for Payer: Cofinity Commercial	$16.44
Rate for Payer: Healthscope Commercial	$17.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.25
Rate for Payer: PHP Commercial	$16.25
Rate for Payer: Priority Health Cigna Priority Health	$13.38
Rate for Payer: Priority Health SBD	$12.05

LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)

Facility

$19.12

Service Code	NDC 0409-4903-34
Hospital Charge Code	163704
Hospital Revenue Code	250
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$17.21
Rate for Payer: Aetna Commercial	$16.25
Rate for Payer: Aetna New Business (MI Preferred)	$12.43
Rate for Payer: Cash Price	$15.30
Rate for Payer: Cofinity Commercial	$13.38
Rate for Payer: Cofinity Commercial	$16.44
Rate for Payer: Healthscope Commercial	$17.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.25
Rate for Payer: PHP Commercial	$16.25
Rate for Payer: Priority Health Cigna Priority Health	$13.38
Rate for Payer: Priority Health SBD	$12.05

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

Facility

$17.40

Service Code	NDC 55150-163-30
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$10.96
Max. Negotiated Rate	$15.66
Rate for Payer: Aetna Commercial	$14.79
Rate for Payer: Aetna New Business (MI Preferred)	$11.31
Rate for Payer: Cash Price	$13.92
Rate for Payer: Cofinity Commercial	$12.18
Rate for Payer: Cofinity Commercial	$14.96
Rate for Payer: Healthscope Commercial	$15.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.79
Rate for Payer: PHP Commercial	$14.79
Rate for Payer: Priority Health Cigna Priority Health	$12.18
Rate for Payer: Priority Health SBD	$10.96

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

Facility

$15.23

Service Code	NDC 55150-162-05
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$13.71
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna New Business (MI Preferred)	$9.90
Rate for Payer: Cash Price	$12.18
Rate for Payer: Cofinity Commercial	$10.66
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Healthscope Commercial	$13.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.95
Rate for Payer: PHP Commercial	$12.95
Rate for Payer: Priority Health Cigna Priority Health	$10.66
Rate for Payer: Priority Health SBD	$9.59

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

Facility

$22.62

Service Code	NDC 0409-4279-02
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$20.36
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: Aetna New Business (MI Preferred)	$14.70
Rate for Payer: BCBS Complete	$9.05
Rate for Payer: Cash Price	$18.10
Rate for Payer: Cofinity Commercial	$15.83
Rate for Payer: Cofinity Commercial	$19.45
Rate for Payer: Healthscope Commercial	$20.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.23
Rate for Payer: PHP Commercial	$19.23
Rate for Payer: Priority Health Cigna Priority Health	$15.83
Rate for Payer: Priority Health SBD	$14.25

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

Facility

$27.05

Service Code	NDC 63323-492-57
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$24.34
Rate for Payer: Aetna Commercial	$22.99
Rate for Payer: Aetna New Business (MI Preferred)	$17.58
Rate for Payer: Cash Price	$21.64
Rate for Payer: Cofinity Commercial	$18.94
Rate for Payer: Cofinity Commercial	$23.26
Rate for Payer: Healthscope Commercial	$24.34
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.99
Rate for Payer: PHP Commercial	$22.99
Rate for Payer: Priority Health Cigna Priority Health	$18.94
Rate for Payer: Priority Health SBD	$17.04

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

Facility

$22.62

Service Code	NDC 0409-4279-02
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$20.36
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: Aetna New Business (MI Preferred)	$14.70
Rate for Payer: Cash Price	$18.10
Rate for Payer: Cofinity Commercial	$15.83
Rate for Payer: Cofinity Commercial	$19.45
Rate for Payer: Healthscope Commercial	$20.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.23
Rate for Payer: PHP Commercial	$19.23
Rate for Payer: Priority Health Cigna Priority Health	$15.83
Rate for Payer: Priority Health SBD	$14.25

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

Facility

$22.62

Service Code	NDC 0409-4279-16
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$14.25
Max. Negotiated Rate	$20.36
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: Aetna New Business (MI Preferred)	$14.70
Rate for Payer: Cash Price	$18.10
Rate for Payer: Cofinity Commercial	$15.83
Rate for Payer: Cofinity Commercial	$19.45
Rate for Payer: Healthscope Commercial	$20.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.23
Rate for Payer: PHP Commercial	$19.23
Rate for Payer: Priority Health Cigna Priority Health	$15.83
Rate for Payer: Priority Health SBD	$14.25

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

Facility

$20.23

Service Code	NDC 73293-0001-2
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$18.21
Rate for Payer: Aetna Commercial	$17.20
Rate for Payer: Aetna New Business (MI Preferred)	$13.15
Rate for Payer: Cash Price	$16.18
Rate for Payer: Cofinity Commercial	$14.16
Rate for Payer: Cofinity Commercial	$17.40
Rate for Payer: Healthscope Commercial	$18.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.20
Rate for Payer: PHP Commercial	$17.20
Rate for Payer: Priority Health Cigna Priority Health	$14.16
Rate for Payer: Priority Health SBD	$12.74

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

Facility

$25.35

Service Code	NDC 63323-492-27
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$15.97
Max. Negotiated Rate	$22.82
Rate for Payer: Aetna Commercial	$21.55
Rate for Payer: Aetna New Business (MI Preferred)	$16.48
Rate for Payer: Cash Price	$20.28
Rate for Payer: Cofinity Commercial	$17.74
Rate for Payer: Cofinity Commercial	$21.80
Rate for Payer: Healthscope Commercial	$22.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.55
Rate for Payer: PHP Commercial	$21.55
Rate for Payer: Priority Health Cigna Priority Health	$17.74
Rate for Payer: Priority Health SBD	$15.97

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

Facility

$16.80

Service Code	NDC 55150-158-72
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$15.12
Rate for Payer: Aetna Commercial	$14.28
Rate for Payer: Aetna New Business (MI Preferred)	$10.92
Rate for Payer: Cash Price	$13.44
Rate for Payer: Cofinity Commercial	$11.76
Rate for Payer: Cofinity Commercial	$14.45
Rate for Payer: Healthscope Commercial	$15.12
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.28
Rate for Payer: PHP Commercial	$14.28
Rate for Payer: Priority Health Cigna Priority Health	$11.76
Rate for Payer: Priority Health SBD	$10.58

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

Facility

$16.05

Service Code	NDC 0409-4713-32
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$10.11
Max. Negotiated Rate	$14.44
Rate for Payer: Aetna Commercial	$13.64
Rate for Payer: Aetna New Business (MI Preferred)	$10.43
Rate for Payer: Cash Price	$12.84
Rate for Payer: Cofinity Commercial	$11.24
Rate for Payer: Cofinity Commercial	$13.80
Rate for Payer: Healthscope Commercial	$14.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.64
Rate for Payer: PHP Commercial	$13.64
Rate for Payer: Priority Health Cigna Priority Health	$11.24
Rate for Payer: Priority Health SBD	$10.11

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

Facility

$11.60

Service Code	NDC 0409-4713-02
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$10.44
Rate for Payer: Aetna Commercial	$9.86
Rate for Payer: Aetna New Business (MI Preferred)	$7.54
Rate for Payer: Cash Price	$9.28
Rate for Payer: Cofinity Commercial	$8.12
Rate for Payer: Cofinity Commercial	$9.98
Rate for Payer: Healthscope Commercial	$10.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9.86
Rate for Payer: PHP Commercial	$9.86
Rate for Payer: Priority Health Cigna Priority Health	$8.12
Rate for Payer: Priority Health SBD	$7.31

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

Facility

$22.62

Service Code	NDC 0409-4279-16
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$9.05
Max. Negotiated Rate	$20.36
Rate for Payer: Aetna Commercial	$19.23
Rate for Payer: Aetna New Business (MI Preferred)	$14.70
Rate for Payer: BCBS Complete	$9.05
Rate for Payer: Cash Price	$18.10
Rate for Payer: Cofinity Commercial	$15.83
Rate for Payer: Cofinity Commercial	$19.45
Rate for Payer: Healthscope Commercial	$20.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.23
Rate for Payer: PHP Commercial	$19.23
Rate for Payer: Priority Health Cigna Priority Health	$15.83
Rate for Payer: Priority Health SBD	$14.25

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

Facility

$20.23

Service Code	NDC 73293-0001-1
Hospital Charge Code	103888
Hospital Revenue Code	250
Min. Negotiated Rate	$12.74
Max. Negotiated Rate	$18.21
Rate for Payer: Aetna Commercial	$17.20
Rate for Payer: Aetna New Business (MI Preferred)	$13.15
Rate for Payer: Cash Price	$16.18
Rate for Payer: Cofinity Commercial	$14.16
Rate for Payer: Cofinity Commercial	$17.40
Rate for Payer: Healthscope Commercial	$18.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.20
Rate for Payer: PHP Commercial	$17.20
Rate for Payer: Priority Health Cigna Priority Health	$14.16
Rate for Payer: Priority Health SBD	$12.74

LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION

Facility

$21.39

Service Code	NDC 0143-9594-25
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$13.48
Max. Negotiated Rate	$19.25
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: Aetna New Business (MI Preferred)	$13.90
Rate for Payer: Cash Price	$17.11
Rate for Payer: Cofinity Commercial	$14.97
Rate for Payer: Cofinity Commercial	$18.40
Rate for Payer: Healthscope Commercial	$19.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.18
Rate for Payer: PHP Commercial	$18.18
Rate for Payer: Priority Health Cigna Priority Health	$14.97
Rate for Payer: Priority Health SBD	$13.48

Know your out-of-pocket cost for care.

All Charges