|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health SBD |
$23.83
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
OP
|
$37.83
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Medicare |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health SBD |
$23.83
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$24.17
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$24.17
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna Medicare |
$12.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: BCBS Complete |
$9.67
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
NDC 00409490311
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$24.17
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.23 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$15.23
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
NDC 00409490311
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.26 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$24.17
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare |
$12.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: BCBS Complete |
$9.67
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$15.23
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$14.58
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.80
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$15.12 |
| Rate for Payer: Aetna Commercial |
$14.28
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$11.76
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$15.12
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$14.28
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health SBD |
$10.58
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: Priority Health SBD |
$14.25
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$12.74
|
| Rate for Payer: Priority Health SBD |
$7.31
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$20.23
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Commercial |
$14.28
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$9.86
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Aetna Medicare |
$8.40
|
| Rate for Payer: Aetna Medicare |
$8.70
|
| Rate for Payer: Aetna Medicare |
$11.31
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna Medicare |
$8.03
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: BCBS Complete |
$8.09
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: BCBS Complete |
$9.05
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$9.28
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$8.12
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$11.23
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$11.76
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$18.93
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$14.16
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$10.44
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$15.12
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$9.86
|
| Rate for Payer: PHP Commercial |
$14.28
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$14.25
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: Priority Health SBD |
$10.58
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: Priority Health SBD |
$12.74
|
| Rate for Payer: Priority Health SBD |
$15.97
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: Aetna Commercial |
$11.00
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$17.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.87
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$8.48
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Cofinity Commercial |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: PHP Commercial |
$15.26
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: PHP Commercial |
$11.00
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Commercial |
$17.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.41
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Priority Health SBD |
$13.15
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: Priority Health SBD |
$8.15
|
| Rate for Payer: Priority Health SBD |
$7.63
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: Priority Health SBD |
$17.63
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$20.88
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Aetna Commercial |
$17.75
|
| Rate for Payer: Aetna Commercial |
$11.00
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$15.26
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: Aetna Medicare |
$8.97
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| Rate for Payer: Aetna Medicare |
$14.21
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: BCBS Complete |
$11.37
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS Complete |
$7.18
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$14.36
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$8.48
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$11.13
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$12.56
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Cofinity Commercial |
$19.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$11.65
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$16.16
|
| Rate for Payer: Healthscope Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$15.26
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: PHP Commercial |
$11.00
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$17.75
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.19
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$11.31
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: Priority Health SBD |
$7.63
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: Priority Health SBD |
$8.15
|
| Rate for Payer: Priority Health SBD |
$13.15
|
| Rate for Payer: Priority Health SBD |
$17.90
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.03
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.67
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.67
|
| Rate for Payer: Priority Health SBD |
$13.25
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.03
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.67
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.67
|
| Rate for Payer: Priority Health SBD |
$13.25
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna Medicare |
$10.47
|
| Rate for Payer: Aetna Medicare |
$18.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: BCBS Complete |
$14.69
|
| Rate for Payer: BCBS Complete |
$8.38
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.21
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.87
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Priority Health SBD |
$13.20
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
IP
|
$36.72
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.13 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.21
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| Rate for Payer: Priority Health SBD |
$13.20
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
NDC 00409428301
|
| 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: Cofinity Medicare Advantage |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$13.20
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
OP
|
$20.95
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna Medicare |
$10.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.62
|
| Rate for Payer: BCBS Complete |
$8.38
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$13.20
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| 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 |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: Priority Health SBD |
$13.99
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| 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 |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: Priority Health SBD |
$13.99
|
|
|
LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$73.87
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.55 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna Commercial |
$42.58
|
| Rate for Payer: Aetna Medicare |
$25.05
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: BCBS Complete |
$29.55
|
| Rate for Payer: BCBS Complete |
$20.04
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$45.08
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: PHP Commercial |
$42.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health SBD |
$46.54
|
| Rate for Payer: Priority Health SBD |
$31.56
|
|
|
LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$73.87
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$66.48 |
| Rate for Payer: Aetna Commercial |
$62.79
|
| Rate for Payer: Aetna Commercial |
$42.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.02
|
| Rate for Payer: Cash Price |
$40.07
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cofinity Commercial |
$35.06
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$63.53
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.10
|
| Rate for Payer: Healthscope Commercial |
$45.08
|
| Rate for Payer: Healthscope Commercial |
$66.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.79
|
| Rate for Payer: PHP Commercial |
$42.58
|
| Rate for Payer: PHP Commercial |
$62.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.56
|
| Rate for Payer: Priority Health SBD |
$46.54
|
| Rate for Payer: Priority Health SBD |
$31.56
|
|
|
LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION
|
Facility
|
OP
|
$32.26
|
|
|
Service Code
|
NDC 00409471201
|
| Hospital Charge Code |
27396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$29.03 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: Aetna Medicare |
$16.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.97
|
| Rate for Payer: BCBS Complete |
$12.90
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$27.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$29.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.42
|
| Rate for Payer: PHP Commercial |
$27.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.97
|
| Rate for Payer: Priority Health SBD |
$20.32
|
|
