|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$45.36
|
|
|
Service Code
|
NDC 4116705840
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: BCBS Trust/PPO |
$35.05
|
| Rate for Payer: BCN Commercial |
$35.05
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.56
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.92
|
| Rate for Payer: UHC Core |
$37.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$27.17
|
|
|
Service Code
|
NDC 0536-1202-15
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.57 |
| Max. Negotiated Rate |
$24.45 |
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: BCBS Trust/PPO |
$21.00
|
| Rate for Payer: BCN Commercial |
$21.00
|
| Rate for Payer: Cash Price |
$21.74
|
| Rate for Payer: Cofinity Commercial |
$23.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Healthscope Commercial |
$24.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.38
|
| 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 HMO/PPO/Tiered Network |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.91
|
| Rate for Payer: UHC Core |
$22.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.38
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
NDC 70000-0366-1
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$14.47
|
| Rate for Payer: BCN Commercial |
$14.47
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| 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 HMO/PPO/Tiered Network |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$130.32
|
|
|
Service Code
|
NDC 0536-1202-07
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.48 |
| Max. Negotiated Rate |
$117.29 |
| Rate for Payer: Aetna Commercial |
$110.77
|
| Rate for Payer: BCBS Trust/PPO |
$100.71
|
| Rate for Payer: BCN Commercial |
$100.71
|
| Rate for Payer: Cash Price |
$104.26
|
| Rate for Payer: Cofinity Commercial |
$112.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.26
|
| Rate for Payer: Healthscope Commercial |
$117.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$110.77
|
| Rate for Payer: PHP Commercial |
$110.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.68
|
| Rate for Payer: UHC Core |
$108.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.74
|
|
|
LIDOCAINE 4 % WITH EPINEPHRINE TOPICAL SOLUTION
|
Facility
|
IP
|
$599.82
|
|
|
Service Code
|
NDC 9900-0002-11
|
| Hospital Charge Code |
155018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$365.83 |
| Max. Negotiated Rate |
$539.84 |
| Rate for Payer: Aetna Commercial |
$509.85
|
| Rate for Payer: BCBS Trust/PPO |
$463.54
|
| Rate for Payer: BCN Commercial |
$463.54
|
| Rate for Payer: Cash Price |
$479.86
|
| Rate for Payer: Cofinity Commercial |
$515.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.86
|
| Rate for Payer: Healthscope Commercial |
$539.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$449.86
|
| 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 HMO/PPO/Tiered Network |
$521.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.84
|
| Rate for Payer: UHC Core |
$500.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$449.86
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$305.64
|
|
|
Service Code
|
NDC 51672-3020-9
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.41 |
| Max. Negotiated Rate |
$275.08 |
| Rate for Payer: Aetna Commercial |
$259.79
|
| Rate for Payer: BCBS Trust/PPO |
$236.20
|
| Rate for Payer: BCN Commercial |
$236.20
|
| Rate for Payer: Cash Price |
$244.51
|
| Rate for Payer: Cofinity Commercial |
$262.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.51
|
| Rate for Payer: Healthscope Commercial |
$275.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.79
|
| Rate for Payer: PHP Commercial |
$259.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$265.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.96
|
| Rate for Payer: UHC Core |
$255.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.23
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$781.21
|
|
|
Service Code
|
NDC 0168-0204-37
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$476.46 |
| Max. Negotiated Rate |
$703.09 |
| Rate for Payer: Aetna Commercial |
$664.03
|
| Rate for Payer: BCBS Trust/PPO |
$603.72
|
| Rate for Payer: BCN Commercial |
$603.72
|
| Rate for Payer: Cash Price |
$624.97
|
| Rate for Payer: Cofinity Commercial |
$671.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.97
|
| Rate for Payer: Healthscope Commercial |
$703.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$585.91
|
| 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 HMO/PPO/Tiered Network |
$679.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$476.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.46
|
| Rate for Payer: UHC Core |
$652.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$585.91
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$39.08
|
|
|
Service Code
|
NDC 33342-405-35
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$35.17 |
| Rate for Payer: Aetna Commercial |
$33.22
|
| Rate for Payer: BCBS Trust/PPO |
$30.20
|
| Rate for Payer: BCN Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.26
|
| Rate for Payer: Healthscope Commercial |
$35.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.22
|
| Rate for Payer: PHP Commercial |
$33.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.39
|
| Rate for Payer: UHC Core |
$32.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.31
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$34.36
|
|
|
Service Code
|
NDC 52565-008-14
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$30.92 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$26.55
|
| Rate for Payer: BCN Commercial |
$26.55
|
| Rate for Payer: Cash Price |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$29.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.49
|
| Rate for Payer: Healthscope Commercial |
$30.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.77
|
| 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 HMO/PPO/Tiered Network |
$29.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.24
|
| Rate for Payer: UHC Core |
$28.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.77
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$89.69
|
|
|
Service Code
|
NDC 68462-418-20
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.70 |
| Max. Negotiated Rate |
$80.72 |
| Rate for Payer: Aetna Commercial |
$76.24
|
| Rate for Payer: BCBS Trust/PPO |
$69.31
|
| Rate for Payer: BCN Commercial |
$69.31
|
| Rate for Payer: Cash Price |
$71.75
|
| Rate for Payer: Cofinity Commercial |
$77.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.75
|
| Rate for Payer: Healthscope Commercial |
$80.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.27
|
| 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 HMO/PPO/Tiered Network |
$78.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.93
|
| Rate for Payer: UHC Core |
$74.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.27
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$48.87
|
|
|
Service Code
|
NDC 63323-487-07
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.81 |
| Max. Negotiated Rate |
$43.98 |
| Rate for Payer: Aetna Commercial |
$41.54
|
| Rate for Payer: BCBS Trust/PPO |
$37.77
|
| Rate for Payer: BCN Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$39.10
|
| Rate for Payer: Cofinity Commercial |
$42.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.10
|
| Rate for Payer: Healthscope Commercial |
$43.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.65
|
| 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 HMO/PPO/Tiered Network |
$42.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.01
|
| Rate for Payer: UHC Core |
$40.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.65
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$48.87
|
|
|
Service Code
|
NDC 63323-487-37
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.81 |
| Max. Negotiated Rate |
$43.98 |
| Rate for Payer: Aetna Commercial |
$41.54
|
| Rate for Payer: BCBS Trust/PPO |
$37.77
|
| Rate for Payer: BCN Commercial |
$37.77
|
| Rate for Payer: Cash Price |
$39.10
|
| Rate for Payer: Cofinity Commercial |
$42.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.10
|
| Rate for Payer: Healthscope Commercial |
$43.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.65
|
| 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 HMO/PPO/Tiered Network |
$42.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.01
|
| Rate for Payer: UHC Core |
$40.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.65
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.58
|
|
|
Service Code
|
NDC 0409-3183-11
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.90
|
| Rate for Payer: BCN Commercial |
$15.90
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.49
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.11
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.58
|
|
|
Service Code
|
NDC 0409-3183-01
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.90
|
| Rate for Payer: BCN Commercial |
$15.90
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.49
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.11
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$12.47
|
|
|
Service Code
|
NDC 0409-4276-01
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| 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 HMO/PPO/Tiered Network |
$10.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.97
|
| Rate for Payer: UHC Core |
$10.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
NDC 0409-4276-02
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.87
|
| Rate for Payer: BCN Commercial |
$16.87
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.21
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 63323-201-10
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: BCBS Trust/PPO |
$14.68
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.25
|
| 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 HMO/PPO/Tiered Network |
$16.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.72
|
| Rate for Payer: UHC Core |
$15.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.25
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.94
|
|
|
Service Code
|
NDC 63323-201-02
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.40
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.70
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
NDC 0409-4276-17
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.31 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: BCBS Trust/PPO |
$16.87
|
| Rate for Payer: BCN Commercial |
$16.87
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.21
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
NDC 55150-251-10
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$11.88
|
| Rate for Payer: BCN Commercial |
$11.88
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| 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 HMO/PPO/Tiered Network |
$13.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$12.47
|
|
|
Service Code
|
NDC 0409-4276-16
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| 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 HMO/PPO/Tiered Network |
$10.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.97
|
| Rate for Payer: UHC Core |
$10.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$23.78
|
|
|
Service Code
|
NDC 63323-486-17
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$21.40 |
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: BCBS Trust/PPO |
$18.38
|
| Rate for Payer: BCN Commercial |
$18.38
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.21
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.93
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.26
|
|
|
Service Code
|
NDC 0409-4277-01
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.63 |
| Max. Negotiated Rate |
$24.53 |
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: BCBS Trust/PPO |
$21.07
|
| Rate for Payer: BCN Commercial |
$21.07
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.81
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.17
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.99
|
| Rate for Payer: UHC Core |
$22.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$11.89
|
|
|
Service Code
|
NDC 55150-255-20
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.25 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: BCBS Trust/PPO |
$9.19
|
| Rate for Payer: BCN Commercial |
$9.19
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.11
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.46
|
| Rate for Payer: UHC Core |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$23.20
|
|
|
Service Code
|
NDC 63323-486-27
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$20.88 |
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: BCBS Trust/PPO |
$17.93
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.72
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC Core |
$19.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
|
