|
LIDOCAINE 4 %-EPINEPHRINE 0.18 %-TETRACAINE 0.5 % TOPICAL GEL
|
Facility
|
IP
|
$29.92
|
|
|
Service Code
|
NDC 71266-6290-1
|
| Hospital Charge Code |
196007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$29.92 |
| Rate for Payer: Aetna Commercial |
$26.93
|
| Rate for Payer: ASR ASR |
$29.02
|
| Rate for Payer: BCBS Trust/PPO |
$23.20
|
| Rate for Payer: BCN Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$28.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$29.92
|
| Rate for Payer: Healthscope Whirlpool |
$29.02
|
| Rate for Payer: Mclaren Commercial |
$26.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.33
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$16.51
|
|
|
Service Code
|
NDC 96295-13458
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.56 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna Commercial |
$14.86
|
| Rate for Payer: ASR ASR |
$16.01
|
| Rate for Payer: BCBS Trust/PPO |
$12.80
|
| Rate for Payer: BCN Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.21
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Healthscope Whirlpool |
$16.01
|
| Rate for Payer: Mclaren Commercial |
$14.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.53
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$45.36
|
|
|
Service Code
|
NDC 4116705840
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$35.17
|
| Rate for Payer: BCN Commercial |
$35.17
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$42.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Healthscope Whirlpool |
$44.00
|
| Rate for Payer: Mclaren Commercial |
$40.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$38.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.92
|
|
|
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 |
$19.02 |
| Max. Negotiated Rate |
$27.17 |
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: ASR ASR |
$26.35
|
| Rate for Payer: BCBS Trust/PPO |
$21.06
|
| Rate for Payer: BCN Commercial |
$21.06
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cofinity Commercial |
$25.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.74
|
| Rate for Payer: Healthscope Commercial |
$27.17
|
| Rate for Payer: Healthscope Whirlpool |
$26.35
|
| Rate for Payer: Mclaren Commercial |
$24.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.91
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$48.86
|
|
|
Service Code
|
NDC 63323-487-37
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$48.86 |
| Rate for Payer: Aetna Commercial |
$43.97
|
| Rate for Payer: ASR ASR |
$47.39
|
| Rate for Payer: BCBS Trust/PPO |
$37.88
|
| Rate for Payer: BCN Commercial |
$37.88
|
| Rate for Payer: Cash Price |
$39.09
|
| Rate for Payer: Cofinity Commercial |
$45.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.09
|
| Rate for Payer: Healthscope Commercial |
$48.86
|
| Rate for Payer: Healthscope Whirlpool |
$47.39
|
| Rate for Payer: Mclaren Commercial |
$43.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.00
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.87
|
|
|
Service Code
|
NDC 9900-0010-74
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.18
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Healthscope Whirlpool |
$20.24
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.37
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$35.11
|
|
|
Service Code
|
NDC 63323-487-17
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: ASR ASR |
$34.06
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCN Commercial |
$27.22
|
| Rate for Payer: Cash Price |
$28.09
|
| Rate for Payer: Cofinity Commercial |
$33.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.09
|
| Rate for Payer: Healthscope Commercial |
$35.11
|
| Rate for Payer: Healthscope Whirlpool |
$34.06
|
| Rate for Payer: Mclaren Commercial |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.90
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$35.11
|
|
|
Service Code
|
NDC 63323-487-01
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.58 |
| Max. Negotiated Rate |
$35.11 |
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: ASR ASR |
$34.06
|
| Rate for Payer: BCBS Trust/PPO |
$27.22
|
| Rate for Payer: BCN Commercial |
$27.22
|
| Rate for Payer: Cash Price |
$28.09
|
| Rate for Payer: Cofinity Commercial |
$33.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.09
|
| Rate for Payer: Healthscope Commercial |
$35.11
|
| Rate for Payer: Healthscope Whirlpool |
$34.06
|
| Rate for Payer: Mclaren Commercial |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.90
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$74.76
|
|
|
Service Code
|
NDC 63323-489-27
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.33 |
| Max. Negotiated Rate |
$74.76 |
| Rate for Payer: Aetna Commercial |
$67.28
|
| Rate for Payer: ASR ASR |
$72.52
|
| Rate for Payer: BCBS Trust/PPO |
$57.96
|
| Rate for Payer: BCN Commercial |
$57.96
|
| Rate for Payer: Cash Price |
$59.81
|
| Rate for Payer: Cofinity Commercial |
$70.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.81
|
| Rate for Payer: Healthscope Commercial |
$74.76
|
| Rate for Payer: Healthscope Whirlpool |
$72.52
|
| Rate for Payer: Mclaren Commercial |
$67.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$63.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.79
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
NDC 63323-489-17
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$32.91
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$39.96
|
|
|
Service Code
|
NDC 63323-489-21
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$39.96 |
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: ASR ASR |
$38.76
|
| Rate for Payer: BCBS Trust/PPO |
$30.98
|
| Rate for Payer: BCN Commercial |
$30.98
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$37.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.97
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: Healthscope Whirlpool |
$38.76
|
| Rate for Payer: Mclaren Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.87
|
|
|
Service Code
|
NDC 0409-3183-01
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.18
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Healthscope Whirlpool |
$20.24
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.37
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.87
|
|
|
Service Code
|
NDC 0409-3183-11
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.18
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Healthscope Whirlpool |
$20.24
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.37
|
|
|
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 |
$15.28 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.18
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$12.76
|
|
|
Service Code
|
NDC 0409-4276-16
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: ASR ASR |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$9.89
|
| Rate for Payer: BCN Commercial |
$9.89
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cofinity Commercial |
$11.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Healthscope Whirlpool |
$12.38
|
| Rate for Payer: Mclaren Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.23
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
NDC 55150-252-20
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$13.05 |
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: ASR ASR |
$12.66
|
| Rate for Payer: BCBS Trust/PPO |
$10.12
|
| Rate for Payer: BCN Commercial |
$10.12
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cofinity Commercial |
$12.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.44
|
| Rate for Payer: Healthscope Commercial |
$13.05
|
| Rate for Payer: Healthscope Whirlpool |
$12.66
|
| Rate for Payer: Mclaren Commercial |
$11.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.48
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$12.76
|
|
|
Service Code
|
NDC 0409-4276-01
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: ASR ASR |
$12.38
|
| Rate for Payer: BCBS Trust/PPO |
$9.89
|
| Rate for Payer: BCN Commercial |
$9.89
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cofinity Commercial |
$11.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Healthscope Whirlpool |
$12.38
|
| Rate for Payer: Mclaren Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.23
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.42
|
|
|
Service Code
|
NDC 63323-485-57
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Aetna Commercial |
$21.98
|
| Rate for Payer: ASR ASR |
$23.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.93
|
| Rate for Payer: BCN Commercial |
$18.93
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cofinity Commercial |
$22.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$24.42
|
| Rate for Payer: Healthscope Whirlpool |
$23.69
|
| Rate for Payer: Mclaren Commercial |
$21.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.49
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.36
|
|
|
Service Code
|
NDC 63323-485-01
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$24.36 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: ASR ASR |
$23.63
|
| Rate for Payer: BCBS Trust/PPO |
$18.89
|
| Rate for Payer: BCN Commercial |
$18.89
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Healthscope Commercial |
$24.36
|
| Rate for Payer: Healthscope Whirlpool |
$23.63
|
| Rate for Payer: Mclaren Commercial |
$21.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.44
|
|
|
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 |
$13.30 |
| Max. Negotiated Rate |
$19.00 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: ASR ASR |
$18.43
|
| Rate for Payer: BCBS Trust/PPO |
$14.73
|
| Rate for Payer: BCN Commercial |
$14.73
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| Rate for Payer: Healthscope Commercial |
$19.00
|
| Rate for Payer: Healthscope Whirlpool |
$18.43
|
| Rate for Payer: Mclaren Commercial |
$17.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.72
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.52
|
|
|
Service Code
|
NDC 55150-251-10
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: ASR ASR |
$15.05
|
| Rate for Payer: BCBS Trust/PPO |
$12.03
|
| Rate for Payer: BCN Commercial |
$12.03
|
| Rate for Payer: Cash Price |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$14.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Healthscope Whirlpool |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.66
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.93
|
|
|
Service Code
|
NDC 63323-201-02
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$16.93 |
| Rate for Payer: Aetna Commercial |
$15.24
|
| Rate for Payer: ASR ASR |
$16.42
|
| Rate for Payer: BCBS Trust/PPO |
$13.13
|
| Rate for Payer: BCN Commercial |
$13.13
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$15.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.54
|
| Rate for Payer: Healthscope Commercial |
$16.93
|
| Rate for Payer: Healthscope Whirlpool |
$16.42
|
| Rate for Payer: Mclaren Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.90
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.36
|
|
|
Service Code
|
NDC 63323-485-27
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.05 |
| Max. Negotiated Rate |
$24.36 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: ASR ASR |
$23.63
|
| Rate for Payer: BCBS Trust/PPO |
$18.89
|
| Rate for Payer: BCN Commercial |
$18.89
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cofinity Commercial |
$22.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Healthscope Commercial |
$24.36
|
| Rate for Payer: Healthscope Whirlpool |
$23.63
|
| Rate for Payer: Mclaren Commercial |
$21.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.44
|
|
|
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 |
$15.28 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.18
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.05
|
|
|
Service Code
|
NDC 0121-0903-40
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$13.54
|
| Rate for Payer: ASR ASR |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$11.67
|
| Rate for Payer: BCN Commercial |
$11.67
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.04
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Whirlpool |
$14.60
|
| Rate for Payer: Mclaren Commercial |
$13.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.24
|
|
