Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

Facility

$13.13

Service Code	NDC 55150-165-05
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$8.27
Max. Negotiated Rate	$11.82
Rate for Payer: Aetna Commercial	$11.16
Rate for Payer: Aetna New Business (MI Preferred)	$8.53
Rate for Payer: Cash Price	$10.50
Rate for Payer: Cofinity Commercial	$11.29
Rate for Payer: Cofinity Commercial	$9.19
Rate for Payer: Healthscope Commercial	$11.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.16
Rate for Payer: PHP Commercial	$11.16
Rate for Payer: Priority Health Cigna Priority Health	$9.19
Rate for Payer: Priority Health SBD	$8.27

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

Facility

$12.94

Service Code	NDC 0409-4282-01
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$11.65
Rate for Payer: Aetna Commercial	$11.00
Rate for Payer: Aetna New Business (MI Preferred)	$8.41
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cofinity Commercial	$11.13
Rate for Payer: Cofinity Commercial	$9.06
Rate for Payer: Healthscope Commercial	$11.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.00
Rate for Payer: PHP Commercial	$11.00
Rate for Payer: Priority Health Cigna Priority Health	$9.06
Rate for Payer: Priority Health SBD	$8.15

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

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

Facility

$27.99

Service Code	NDC 0409-4282-12
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$25.19
Rate for Payer: Aetna Commercial	$23.79
Rate for Payer: Aetna New Business (MI Preferred)	$18.19
Rate for Payer: Cash Price	$22.39
Rate for Payer: Cofinity Commercial	$19.59
Rate for Payer: Cofinity Commercial	$24.07
Rate for Payer: Healthscope Commercial	$25.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.79
Rate for Payer: PHP Commercial	$23.79
Rate for Payer: Priority Health Cigna Priority Health	$19.59
Rate for Payer: Priority Health SBD	$17.63

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

Facility

$14.87

Service Code	NDC 70756-643-25
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$13.38
Rate for Payer: Aetna Commercial	$12.64
Rate for Payer: Aetna New Business (MI Preferred)	$9.67
Rate for Payer: Cash Price	$11.90
Rate for Payer: Cofinity Commercial	$10.41
Rate for Payer: Cofinity Commercial	$12.79
Rate for Payer: Healthscope Commercial	$13.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.64
Rate for Payer: PHP Commercial	$12.64
Rate for Payer: Priority Health Cigna Priority Health	$10.41
Rate for Payer: Priority Health SBD	$9.37

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

Facility

$27.99

Service Code	NDC 0409-4282-02
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$17.63
Max. Negotiated Rate	$25.19
Rate for Payer: Aetna Commercial	$23.79
Rate for Payer: Aetna New Business (MI Preferred)	$18.19
Rate for Payer: Cash Price	$22.39
Rate for Payer: Cofinity Commercial	$19.59
Rate for Payer: Cofinity Commercial	$24.07
Rate for Payer: Healthscope Commercial	$25.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.79
Rate for Payer: PHP Commercial	$23.79
Rate for Payer: Priority Health Cigna Priority Health	$19.59
Rate for Payer: Priority Health SBD	$17.63

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

Facility

$28.66

Service Code	NDC 63323-496-97
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$25.79
Rate for Payer: Aetna Commercial	$24.36
Rate for Payer: Aetna New Business (MI Preferred)	$18.63
Rate for Payer: Cash Price	$22.93
Rate for Payer: Cofinity Commercial	$20.06
Rate for Payer: Cofinity Commercial	$24.65
Rate for Payer: Healthscope Commercial	$25.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.36
Rate for Payer: PHP Commercial	$24.36
Rate for Payer: Priority Health Cigna Priority Health	$20.06
Rate for Payer: Priority Health SBD	$18.06

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

Facility

$12.94

Service Code	NDC 0409-4282-11
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$8.15
Max. Negotiated Rate	$11.65
Rate for Payer: Aetna Commercial	$11.00
Rate for Payer: Aetna New Business (MI Preferred)	$8.41
Rate for Payer: Cash Price	$10.35
Rate for Payer: Cofinity Commercial	$11.13
Rate for Payer: Cofinity Commercial	$9.06
Rate for Payer: Healthscope Commercial	$11.65
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.00
Rate for Payer: PHP Commercial	$11.00
Rate for Payer: Priority Health Cigna Priority Health	$9.06
Rate for Payer: Priority Health SBD	$8.15

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

Facility

$28.66

Service Code	NDC 63323-496-03
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$18.06
Max. Negotiated Rate	$25.79
Rate for Payer: Aetna Commercial	$24.36
Rate for Payer: Aetna New Business (MI Preferred)	$18.63
Rate for Payer: Cash Price	$22.93
Rate for Payer: Cofinity Commercial	$20.06
Rate for Payer: Cofinity Commercial	$24.65
Rate for Payer: Healthscope Commercial	$25.79
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.36
Rate for Payer: PHP Commercial	$24.36
Rate for Payer: Priority Health Cigna Priority Health	$20.06
Rate for Payer: Priority Health SBD	$18.06

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

Facility

$21.39

Service Code	NDC 0143-9594-01
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

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

Facility

$28.42

Service Code	NDC 63323-495-07
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$17.90
Max. Negotiated Rate	$25.58
Rate for Payer: Aetna Commercial	$24.16
Rate for Payer: Aetna New Business (MI Preferred)	$18.47
Rate for Payer: Cash Price	$22.74
Rate for Payer: Cofinity Commercial	$19.89
Rate for Payer: Cofinity Commercial	$24.44
Rate for Payer: Healthscope Commercial	$25.58
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.16
Rate for Payer: PHP Commercial	$24.16
Rate for Payer: Priority Health Cigna Priority Health	$19.89
Rate for Payer: Priority Health SBD	$17.90

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

Facility

$14.87

Service Code	NDC 70756-643-85
Hospital Charge Code	103889
Hospital Revenue Code	250
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$13.38
Rate for Payer: Aetna Commercial	$12.64
Rate for Payer: Aetna New Business (MI Preferred)	$9.67
Rate for Payer: Cash Price	$11.90
Rate for Payer: Cofinity Commercial	$10.41
Rate for Payer: Cofinity Commercial	$12.79
Rate for Payer: Healthscope Commercial	$13.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.64
Rate for Payer: PHP Commercial	$12.64
Rate for Payer: Priority Health Cigna Priority Health	$10.41
Rate for Payer: Priority Health SBD	$9.37

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

Facility

$23.61

Service Code	HCPCS J2001
Hospital Charge Code	116451
Hospital Revenue Code	636
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$21.25
Rate for Payer: Aetna Commercial	$20.07
Rate for Payer: Aetna New Business (MI Preferred)	$15.35
Rate for Payer: Cash Price	$18.89
Rate for Payer: Cofinity Commercial	$16.53
Rate for Payer: Cofinity Commercial	$20.30
Rate for Payer: Healthscope Commercial	$21.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$20.07
Rate for Payer: PHP Commercial	$20.07
Rate for Payer: Priority Health Cigna Priority Health	$16.53
Rate for Payer: Priority Health SBD	$14.87

LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION

Facility

$20.95

Service Code	NDC 0409-4283-11
Hospital Charge Code	4455
Hospital Revenue Code	250
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.86
Rate for Payer: Aetna Commercial	$17.81
Rate for Payer: Aetna New Business (MI Preferred)	$13.62
Rate for Payer: Cash Price	$16.76
Rate for Payer: Cofinity Commercial	$14.66
Rate for Payer: Cofinity Commercial	$18.02
Rate for Payer: Healthscope Commercial	$18.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.81
Rate for Payer: PHP Commercial	$17.81
Rate for Payer: Priority Health Cigna Priority Health	$14.66
Rate for Payer: Priority Health SBD	$13.20

LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION

Facility

$20.95

Service Code	NDC 0409-4283-01
Hospital Charge Code	4455
Hospital Revenue Code	250
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.86
Rate for Payer: Aetna Commercial	$17.81
Rate for Payer: Aetna New Business (MI Preferred)	$13.62
Rate for Payer: Cash Price	$16.76
Rate for Payer: Cofinity Commercial	$14.66
Rate for Payer: Cofinity Commercial	$18.02
Rate for Payer: Healthscope Commercial	$18.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.81
Rate for Payer: PHP Commercial	$17.81
Rate for Payer: Priority Health Cigna Priority Health	$14.66
Rate for Payer: Priority Health SBD	$13.20

LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION

Facility

$20.95

Service Code	NDC 0409-4283-01
Hospital Charge Code	168979
Hospital Revenue Code	250
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$18.86
Rate for Payer: Aetna Commercial	$17.81
Rate for Payer: Aetna New Business (MI Preferred)	$13.62
Rate for Payer: Cash Price	$16.76
Rate for Payer: Cofinity Commercial	$14.66
Rate for Payer: Cofinity Commercial	$18.02
Rate for Payer: Healthscope Commercial	$18.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.81
Rate for Payer: PHP Commercial	$17.81
Rate for Payer: Priority Health Cigna Priority Health	$14.66
Rate for Payer: Priority Health SBD	$13.20

LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION

Facility

$22.20

Service Code	HCPCS J2001
Hospital Charge Code	14868
Hospital Revenue Code	636
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$19.98
Rate for Payer: Aetna Commercial	$18.87
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna New Business (MI Preferred)	$14.43
Rate for Payer: Aetna New Business (MI Preferred)	$23.14
Rate for Payer: Cash Price	$17.76
Rate for Payer: Cash Price	$28.48
Rate for Payer: Cofinity Commercial	$19.09
Rate for Payer: Cofinity Commercial	$30.62
Rate for Payer: Cofinity Commercial	$15.54
Rate for Payer: Cofinity Commercial	$24.92
Rate for Payer: Healthscope Commercial	$19.98
Rate for Payer: Healthscope Commercial	$32.04
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$30.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.87
Rate for Payer: PHP Commercial	$18.87
Rate for Payer: PHP Commercial	$30.26
Rate for Payer: Priority Health Cigna Priority Health	$15.54
Rate for Payer: Priority Health Cigna Priority Health	$24.92
Rate for Payer: Priority Health SBD	$13.99
Rate for Payer: Priority Health SBD	$22.43

LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE

Facility

$101.53

Service Code	NDC 0409-4904-34
Hospital Charge Code	4457
Hospital Revenue Code	250
Min. Negotiated Rate	$63.96
Max. Negotiated Rate	$91.38
Rate for Payer: Aetna Commercial	$86.30
Rate for Payer: Aetna New Business (MI Preferred)	$65.99
Rate for Payer: Cash Price	$81.22
Rate for Payer: Cofinity Commercial	$71.07
Rate for Payer: Cofinity Commercial	$87.32
Rate for Payer: Healthscope Commercial	$91.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$86.30
Rate for Payer: PHP Commercial	$86.30
Rate for Payer: Priority Health Cigna Priority Health	$71.07
Rate for Payer: Priority Health SBD	$63.96

LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE

Facility

$134.85

Service Code	NDC 0409-9137-05
Hospital Charge Code	4457
Hospital Revenue Code	250
Min. Negotiated Rate	$84.96
Max. Negotiated Rate	$121.36
Rate for Payer: Aetna Commercial	$114.62
Rate for Payer: Aetna New Business (MI Preferred)	$87.65
Rate for Payer: Cash Price	$107.88
Rate for Payer: Cofinity Commercial	$115.97
Rate for Payer: Cofinity Commercial	$94.40
Rate for Payer: Healthscope Commercial	$121.36
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$114.62
Rate for Payer: PHP Commercial	$114.62
Rate for Payer: Priority Health Cigna Priority Health	$94.40
Rate for Payer: Priority Health SBD	$84.96

LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION

Facility

$32.26

Service Code	NDC 0409-4712-01
Hospital Charge Code	27396
Hospital Revenue Code	250
Min. Negotiated Rate	$20.32
Max. Negotiated Rate	$29.03
Rate for Payer: Aetna Commercial	$27.42
Rate for Payer: Aetna New Business (MI Preferred)	$20.97
Rate for Payer: Cash Price	$25.81
Rate for Payer: Cofinity Commercial	$22.58
Rate for Payer: Cofinity Commercial	$27.74
Rate for Payer: Healthscope Commercial	$29.03
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$27.42
Rate for Payer: PHP Commercial	$27.42
Rate for Payer: Priority Health Cigna Priority Health	$22.58
Rate for Payer: Priority Health SBD	$20.32

LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION

Facility

$56.96

Service Code	HCPCS J2001
Hospital Charge Code	105635
Hospital Revenue Code	250
Min. Negotiated Rate	$35.88
Max. Negotiated Rate	$51.26
Rate for Payer: Aetna Commercial	$48.42
Rate for Payer: Aetna New Business (MI Preferred)	$37.02
Rate for Payer: Cash Price	$45.57
Rate for Payer: Cofinity Commercial	$39.87
Rate for Payer: Cofinity Commercial	$48.99
Rate for Payer: Healthscope Commercial	$51.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$48.42
Rate for Payer: PHP Commercial	$48.42
Rate for Payer: Priority Health Cigna Priority Health	$39.87
Rate for Payer: Priority Health SBD	$35.88

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$20.91

Service Code	NDC 0115-1468-53
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$13.17
Max. Negotiated Rate	$18.82
Rate for Payer: Aetna Commercial	$17.77
Rate for Payer: Aetna New Business (MI Preferred)	$13.59
Rate for Payer: Cash Price	$16.73
Rate for Payer: Cofinity Commercial	$14.64
Rate for Payer: Cofinity Commercial	$17.98
Rate for Payer: Healthscope Commercial	$18.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.77
Rate for Payer: PHP Commercial	$17.77
Rate for Payer: Priority Health Cigna Priority Health	$14.64
Rate for Payer: Priority Health SBD	$13.17

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$26.90

Service Code	NDC 0168-0357-55
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$24.21
Rate for Payer: Aetna Commercial	$22.86
Rate for Payer: Aetna New Business (MI Preferred)	$17.48
Rate for Payer: Cash Price	$21.52
Rate for Payer: Cofinity Commercial	$18.83
Rate for Payer: Cofinity Commercial	$23.13
Rate for Payer: Healthscope Commercial	$24.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.86
Rate for Payer: PHP Commercial	$22.86
Rate for Payer: Priority Health Cigna Priority Health	$18.83
Rate for Payer: Priority Health SBD	$16.95

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$26.90

Service Code	NDC 0168-0357-05
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$16.95
Max. Negotiated Rate	$24.21
Rate for Payer: Aetna Commercial	$22.86
Rate for Payer: Aetna New Business (MI Preferred)	$17.48
Rate for Payer: Cash Price	$21.52
Rate for Payer: Cofinity Commercial	$18.83
Rate for Payer: Cofinity Commercial	$23.13
Rate for Payer: Healthscope Commercial	$24.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.86
Rate for Payer: PHP Commercial	$22.86
Rate for Payer: Priority Health Cigna Priority Health	$18.83
Rate for Payer: Priority Health SBD	$16.95

LIDOCAINE-PRILOCAINE 2.5 %-2.5 % TOPICAL CREAM

Facility

$23.07

Service Code	NDC 0591-2070-26
Hospital Charge Code	10434
Hospital Revenue Code	637
Min. Negotiated Rate	$14.53
Max. Negotiated Rate	$20.76
Rate for Payer: Aetna Commercial	$19.61
Rate for Payer: Aetna New Business (MI Preferred)	$15.00
Rate for Payer: Cash Price	$18.46
Rate for Payer: Cofinity Commercial	$16.15
Rate for Payer: Cofinity Commercial	$19.84
Rate for Payer: Healthscope Commercial	$20.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.61
Rate for Payer: PHP Commercial	$19.61
Rate for Payer: Priority Health Cigna Priority Health	$16.15
Rate for Payer: Priority Health SBD	$14.53

Know your out-of-pocket cost for care.

All Charges