|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.23
|
|
|
Service Code
|
NDC 55150-162-05
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$13.71 |
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: BCBS Trust/PPO |
$11.77
|
| Rate for Payer: BCN Commercial |
$11.77
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.95
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.40
|
| Rate for Payer: UHC Core |
$12.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$46.33
|
|
|
Service Code
|
NDC 63323-492-07
|
| 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 63323-492-27
|
| 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
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.05
|
|
|
Service Code
|
NDC 63323-492-57
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: BCBS Trust/PPO |
$20.90
|
| Rate for Payer: BCN Commercial |
$20.90
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.99
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.80
|
| Rate for Payer: UHC Core |
$22.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$22.62
|
|
|
Service Code
|
NDC 0409-4279-16
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: BCBS Trust/PPO |
$17.48
|
| Rate for Payer: BCN Commercial |
$17.48
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.23
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.91
|
| Rate for Payer: UHC Core |
$18.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$22.62
|
|
|
Service Code
|
NDC 0409-4279-02
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: BCBS Trust/PPO |
$17.48
|
| Rate for Payer: BCN Commercial |
$17.48
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.23
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.91
|
| Rate for Payer: UHC Core |
$18.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
NDC 0409-2066-10
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.10
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.31
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.78
|
| Rate for Payer: UHC Core |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.39
|
|
|
Service Code
|
NDC 0143-9594-25
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$19.25 |
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.53
|
| Rate for Payer: BCN Commercial |
$16.53
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Healthscope Commercial |
$19.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.18
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.82
|
| Rate for Payer: UHC Core |
$17.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.04
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
NDC 0409-2066-05
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: BCBS Trust/PPO |
$12.10
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.31
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.78
|
| Rate for Payer: UHC Core |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.39
|
|
|
Service Code
|
NDC 0143-9594-01
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$19.25 |
| Rate for Payer: Aetna Commercial |
$18.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.53
|
| Rate for Payer: BCN Commercial |
$16.53
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cofinity Commercial |
$18.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.11
|
| Rate for Payer: Healthscope Commercial |
$19.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.18
|
| Rate for Payer: PHP Commercial |
$18.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.82
|
| Rate for Payer: UHC Core |
$17.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.04
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$28.42
|
|
|
Service Code
|
NDC 63323-495-07
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$25.58 |
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: BCBS Trust/PPO |
$21.96
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.16
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.01
|
| Rate for Payer: UHC Core |
$23.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.32
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
NDC 55150-165-05
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.15
|
| Rate for Payer: BCN Commercial |
$10.15
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.16
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.55
|
| Rate for Payer: UHC Core |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
NDC 0409-4283-11
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$16.19
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
NDC 0409-4283-01
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$16.19
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
NDC 0409-4283-25
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$16.19
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
NDC 0409-4283-01
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.78 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: BCBS Trust/PPO |
$16.19
|
| Rate for Payer: BCN Commercial |
$16.19
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
14868
|
|
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) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION
|
Facility
|
IP
|
$32.26
|
|
|
Service Code
|
NDC 0409-4712-01
|
| Hospital Charge Code |
27396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$29.03 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: BCBS Trust/PPO |
$24.93
|
| Rate for Payer: BCN Commercial |
$24.93
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$27.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$29.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.42
|
| Rate for Payer: PHP Commercial |
$27.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.39
|
| Rate for Payer: UHC Core |
$26.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.20
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.54
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.48 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: BCBS Trust/PPO |
$12.01
|
| Rate for Payer: BCBS Trust/PPO |
$44.02
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: BCN Commercial |
$44.02
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cofinity Commercial |
$48.99
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.42
|
| Rate for Payer: PHP Commercial |
$48.42
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Core |
$47.56
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.72
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
NDC 0496-0882-05
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.04
|
| Rate for Payer: BCN Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.84
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$14.18
|
|
|
Service Code
|
NDC 0496-0882-07
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.96
|
| Rate for Payer: BCN Commercial |
$10.96
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.05
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.48
|
| Rate for Payer: UHC Core |
$11.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.64
|
|
|
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE; EXTRA-ARTICULAR
|
Facility
|
OP
|
$4,927.66
|
|
|
Service Code
|
CPT 27427
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,693.01 |
| Max. Negotiated Rate |
$4,927.66 |
| Rate for Payer: BCBS Complete |
$4,927.66
|
| Rate for Payer: Mclaren Medicaid |
$4,693.01
|
| Rate for Payer: Meridian Medicaid |
$4,927.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,693.01
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
IP
|
$1,409.26
|
|
|
Service Code
|
NDC 0597-0140-30
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$859.51 |
| Max. Negotiated Rate |
$1,268.33 |
| Rate for Payer: Aetna Commercial |
$1,197.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.08
|
| Rate for Payer: BCN Commercial |
$1,089.08
|
| Rate for Payer: Cash Price |
$1,127.41
|
| Rate for Payer: Cofinity Commercial |
$1,211.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,127.41
|
| Rate for Payer: Healthscope Commercial |
$1,268.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,056.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,197.87
|
| Rate for Payer: PHP Commercial |
$1,197.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,226.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$859.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,240.15
|
| Rate for Payer: UHC Core |
$1,176.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,056.94
|
|
|
LINAGLIPTIN 5 MG TABLET
|
Facility
|
IP
|
$4,697.89
|
|
|
Service Code
|
NDC 0597-0140-61
|
| Hospital Charge Code |
152649
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,865.24 |
| Max. Negotiated Rate |
$4,228.10 |
| Rate for Payer: Aetna Commercial |
$3,993.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,630.53
|
| Rate for Payer: BCN Commercial |
$3,630.53
|
| Rate for Payer: Cash Price |
$3,758.31
|
| Rate for Payer: Cofinity Commercial |
$4,040.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,758.31
|
| Rate for Payer: Healthscope Commercial |
$4,228.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,523.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,993.21
|
| Rate for Payer: PHP Commercial |
$3,993.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,288.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,087.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,865.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,134.14
|
| Rate for Payer: UHC Core |
$3,922.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,523.42
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$228.78
|
|
|
Service Code
|
NDC 0904-6553-04
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.53 |
| Max. Negotiated Rate |
$205.90 |
| Rate for Payer: Aetna Commercial |
$194.46
|
| Rate for Payer: BCBS Trust/PPO |
$176.80
|
| Rate for Payer: BCN Commercial |
$176.80
|
| Rate for Payer: Cash Price |
$183.02
|
| Rate for Payer: Cofinity Commercial |
$196.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.02
|
| Rate for Payer: Healthscope Commercial |
$205.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.46
|
| Rate for Payer: PHP Commercial |
$194.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.33
|
| Rate for Payer: UHC Core |
$191.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.58
|
|
