|
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
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.26
|
|
|
Service Code
|
NDC 0409-4277-16
|
| 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
|
$25.53
|
|
|
Service Code
|
NDC 63323-486-57
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$22.98 |
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.70
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.47
|
| Rate for Payer: UHC Core |
$21.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.15
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.94
|
|
|
Service Code
|
NDC 63323-202-02
|
| Hospital Charge Code |
4454
|
|
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 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 0121-0903-15
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$11.64
|
| Rate for Payer: BCN Commercial |
$11.64
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50383-775-15
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 0121-0903-40
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$11.64
|
| Rate for Payer: BCN Commercial |
$11.64
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.80
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 9900-0003-39
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.35 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$4.24
|
| Rate for Payer: BCN Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.67
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50383-775-17
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.60
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$23.45
|
|
|
Service Code
|
NDC 50383-775-04
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$21.10 |
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: BCBS Trust/PPO |
$18.12
|
| Rate for Payer: BCN Commercial |
$18.12
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$20.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$21.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.93
|
| Rate for Payer: PHP Commercial |
$19.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.64
|
| Rate for Payer: UHC Core |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.59
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
NDC 0054-3505-47
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.12 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$102.78
|
| Rate for Payer: BCN Commercial |
$102.78
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$114.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$119.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.05
|
| Rate for Payer: PHP Commercial |
$113.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.04
|
| Rate for Payer: UHC Core |
$111.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.75
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
IP
|
$94.56
|
|
|
Service Code
|
NDC 76329-6300-5
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.67 |
| Max. Negotiated Rate |
$85.10 |
| Rate for Payer: Aetna Commercial |
$80.38
|
| Rate for Payer: BCBS Trust/PPO |
$73.08
|
| Rate for Payer: BCN Commercial |
$73.08
|
| Rate for Payer: Cash Price |
$75.65
|
| Rate for Payer: Cofinity Commercial |
$81.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.65
|
| Rate for Payer: Healthscope Commercial |
$85.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$80.38
|
| Rate for Payer: PHP Commercial |
$80.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.21
|
| Rate for Payer: UHC Core |
$78.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.92
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.87
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.54
|
| Rate for Payer: UHC Core |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$19.12
|
|
|
Service Code
|
NDC 0409-4903-11
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Aetna Commercial |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.78
|
| Rate for Payer: BCN Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$17.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.25
|
| Rate for Payer: PHP Commercial |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.83
|
| Rate for Payer: UHC Core |
$15.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.34
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$19.99
|
|
|
Service Code
|
NDC 0409-1323-05
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.99
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.59
|
| Rate for Payer: UHC Core |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.99
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
NDC 76329-3390-1
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$22.36 |
| Rate for Payer: Aetna Commercial |
$21.11
|
| Rate for Payer: BCBS Trust/PPO |
$19.20
|
| Rate for Payer: BCN Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.87
|
| Rate for Payer: Healthscope Commercial |
$22.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.11
|
| Rate for Payer: PHP Commercial |
$21.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.86
|
| Rate for Payer: UHC Core |
$20.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.63
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$19.12
|
|
|
Service Code
|
NDC 0409-4903-34
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Aetna Commercial |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.78
|
| Rate for Payer: BCN Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$17.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.25
|
| Rate for Payer: PHP Commercial |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.83
|
| Rate for Payer: UHC Core |
$15.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.34
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$19.99
|
|
|
Service Code
|
NDC 0409-1323-05
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$17.99 |
| Rate for Payer: Aetna Commercial |
$16.99
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: Cash Price |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$17.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.99
|
| Rate for Payer: Healthscope Commercial |
$17.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.99
|
| Rate for Payer: PHP Commercial |
$16.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.59
|
| Rate for Payer: UHC Core |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.99
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$19.12
|
|
|
Service Code
|
NDC 0409-4903-34
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$17.21 |
| Rate for Payer: Aetna Commercial |
$16.25
|
| Rate for Payer: BCBS Trust/PPO |
$14.78
|
| Rate for Payer: BCN Commercial |
$14.78
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.30
|
| Rate for Payer: Healthscope Commercial |
$17.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.25
|
| Rate for Payer: PHP Commercial |
$16.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.83
|
| Rate for Payer: UHC Core |
$15.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.34
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.05
|
|
|
Service Code
|
NDC 0409-4713-32
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: BCBS Trust/PPO |
$12.40
|
| Rate for Payer: BCN Commercial |
$12.40
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC Core |
$13.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.94
|
|
|
Service Code
|
NDC 0143-9595-25
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna Commercial |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.27
|
| Rate for Payer: BCN Commercial |
$19.27
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.95
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.20
|
| Rate for Payer: PHP Commercial |
$21.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.95
|
| Rate for Payer: UHC Core |
$20.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.70
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$17.40
|
|
|
Service Code
|
NDC 55150-163-30
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$15.66 |
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: BCBS Trust/PPO |
$13.45
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.79
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.31
|
| Rate for Payer: UHC Core |
$14.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.94
|
|
|
Service Code
|
NDC 0143-9595-01
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.21 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna Commercial |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.27
|
| Rate for Payer: BCN Commercial |
$19.27
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.95
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.20
|
| Rate for Payer: PHP Commercial |
$21.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.95
|
| Rate for Payer: UHC Core |
$20.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.70
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$46.33
|
|
|
Service Code
|
NDC 63323-492-37
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.26 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$35.80
|
| Rate for Payer: BCN Commercial |
$35.80
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Healthscope Commercial |
$41.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.38
|
| Rate for Payer: PHP Commercial |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.77
|
| Rate for Payer: UHC Core |
$38.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.75
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$25.35
|
|
|
Service Code
|
NDC 63323-492-04
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: BCBS Trust/PPO |
$19.59
|
| Rate for Payer: BCN Commercial |
$19.59
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.55
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.31
|
| Rate for Payer: UHC Core |
$21.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
|
