|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
NDC 50383077504
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: Aetna Medicare |
$13.21
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: BCBS Trust/PPO |
$29.43
|
| Rate for Payer: BCN Commercial |
$29.43
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$34.63
|
| Rate for Payer: Healthscope Whirlpool |
$35.70
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$31.28
|
| Rate for Payer: Priority Health Narrow Network |
$25.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$35.35
|
|
|
Service Code
|
NDC 54350049
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Medicare |
$13.08
|
| Rate for Payer: ASR ASR |
$34.29
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: BCBS Trust/PPO |
$29.15
|
| Rate for Payer: BCN Commercial |
$29.15
|
| Rate for Payer: Cash Price |
$28.28
|
| Rate for Payer: Cofinity Commercial |
$33.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$34.29
|
| Rate for Payer: Healthscope Whirlpool |
$35.35
|
| Rate for Payer: Mclaren Commercial |
$31.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.05
|
| Rate for Payer: Nomi Health Commercial |
$28.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30.97
|
| Rate for Payer: Priority Health Narrow Network |
$24.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.11
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 17856077502
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: ASR ASR |
$11.64
|
| Rate for Payer: BCBS Trust/PPO |
$9.85
|
| Rate for Payer: BCN Commercial |
$9.85
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$11.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$11.64
|
| Rate for Payer: Healthscope Whirlpool |
$12.00
|
| Rate for Payer: Mclaren Commercial |
$10.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$9.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.56
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
NDC 72888012526
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.77 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Aetna Commercial |
$32.13
|
| Rate for Payer: ASR ASR |
$34.63
|
| Rate for Payer: BCBS Trust/PPO |
$29.32
|
| Rate for Payer: BCN Commercial |
$29.32
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Commercial |
$33.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$34.63
|
| Rate for Payer: Healthscope Whirlpool |
$35.70
|
| Rate for Payer: Mclaren Commercial |
$32.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Nomi Health Commercial |
$29.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.42
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$15.05
|
|
|
Service Code
|
NDC 121090340
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: Aetna Medicare |
$5.57
|
| Rate for Payer: ASR ASR |
$14.60
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.41
|
| Rate for Payer: BCN Commercial |
$12.41
|
| 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 |
$14.60
|
| Rate for Payer: Healthscope Whirlpool |
$15.05
|
| Rate for Payer: Mclaren Commercial |
$13.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.19
|
| Rate for Payer: Priority Health Narrow Network |
$10.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.25
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 54350547
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$117.18
|
| Rate for Payer: ASR ASR |
$126.29
|
| Rate for Payer: BCBS Trust/PPO |
$106.92
|
| Rate for Payer: BCN Commercial |
$106.92
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$122.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$126.29
|
| Rate for Payer: Healthscope Whirlpool |
$130.20
|
| Rate for Payer: Mclaren Commercial |
$117.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Nomi Health Commercial |
$106.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.58
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
OP
|
$76.83
|
|
|
Service Code
|
NDC 527600480
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.43 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$69.14
|
| Rate for Payer: Aetna Medicare |
$28.43
|
| Rate for Payer: ASR ASR |
$74.52
|
| Rate for Payer: BCBS Complete |
$30.73
|
| Rate for Payer: BCBS Trust/PPO |
$63.34
|
| Rate for Payer: BCN Commercial |
$63.34
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Commercial |
$72.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Healthscope Whirlpool |
$76.83
|
| Rate for Payer: Mclaren Commercial |
$69.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.30
|
| Rate for Payer: Nomi Health Commercial |
$63.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$67.31
|
| Rate for Payer: Priority Health Narrow Network |
$53.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.61
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
OP
|
$130.20
|
|
|
Service Code
|
NDC 54350547
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.17 |
| Max. Negotiated Rate |
$130.20 |
| Rate for Payer: Aetna Commercial |
$117.18
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: ASR ASR |
$126.29
|
| Rate for Payer: BCBS Complete |
$52.08
|
| Rate for Payer: BCBS Trust/PPO |
$107.35
|
| Rate for Payer: BCN Commercial |
$107.35
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$122.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$126.29
|
| Rate for Payer: Healthscope Whirlpool |
$130.20
|
| Rate for Payer: Mclaren Commercial |
$117.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Nomi Health Commercial |
$106.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$114.08
|
| Rate for Payer: Priority Health Narrow Network |
$91.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.58
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$76.83
|
|
|
Service Code
|
NDC 527600480
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.62 |
| Max. Negotiated Rate |
$76.83 |
| Rate for Payer: Aetna Commercial |
$69.14
|
| Rate for Payer: ASR ASR |
$74.52
|
| Rate for Payer: BCBS Trust/PPO |
$63.09
|
| Rate for Payer: BCN Commercial |
$63.09
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Commercial |
$72.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Healthscope Commercial |
$74.52
|
| Rate for Payer: Healthscope Whirlpool |
$76.83
|
| Rate for Payer: Mclaren Commercial |
$69.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.30
|
| Rate for Payer: Nomi Health Commercial |
$63.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.61
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.37 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Aetna Commercial |
$34.04
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: ASR ASR |
$32.37
|
| Rate for Payer: ASR ASR |
$36.69
|
| Rate for Payer: BCBS Trust/PPO |
$27.41
|
| Rate for Payer: BCBS Trust/PPO |
$31.06
|
| Rate for Payer: BCN Commercial |
$27.41
|
| Rate for Payer: BCN Commercial |
$31.06
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$35.56
|
| Rate for Payer: Cofinity Commercial |
$31.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$32.37
|
| Rate for Payer: Healthscope Commercial |
$36.69
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Healthscope Whirlpool |
$33.38
|
| Rate for Payer: Mclaren Commercial |
$34.04
|
| Rate for Payer: Mclaren Commercial |
$30.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.37
|
| Rate for Payer: Nomi Health Commercial |
$31.02
|
| Rate for Payer: Nomi Health Commercial |
$27.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.37
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
OP
|
$37.83
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Aetna Commercial |
$34.04
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Medicare |
$12.35
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: ASR ASR |
$32.37
|
| Rate for Payer: ASR ASR |
$36.69
|
| Rate for Payer: BCBS Complete |
$13.35
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$27.52
|
| Rate for Payer: BCBS Trust/PPO |
$31.19
|
| Rate for Payer: BCN Commercial |
$27.52
|
| Rate for Payer: BCN Commercial |
$31.19
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$31.37
|
| Rate for Payer: Cofinity Commercial |
$35.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Healthscope Commercial |
$36.69
|
| Rate for Payer: Healthscope Commercial |
$32.37
|
| Rate for Payer: Healthscope Whirlpool |
$33.38
|
| Rate for Payer: Healthscope Whirlpool |
$37.83
|
| Rate for Payer: Mclaren Commercial |
$30.04
|
| Rate for Payer: Mclaren Commercial |
$34.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.37
|
| Rate for Payer: Nomi Health Commercial |
$31.02
|
| Rate for Payer: Nomi Health Commercial |
$27.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$33.14
|
| Rate for Payer: Priority Health Narrow Network |
$23.40
|
| Rate for Payer: Priority Health Narrow Network |
$26.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.29
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$25.79
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.34 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: ASR ASR |
$29.27
|
| Rate for Payer: ASR ASR |
$25.01
|
| Rate for Payer: ASR ASR |
$26.09
|
| Rate for Payer: BCBS Trust/PPO |
$24.78
|
| Rate for Payer: BCBS Trust/PPO |
$21.18
|
| Rate for Payer: BCBS Trust/PPO |
$22.09
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: BCN Commercial |
$21.18
|
| Rate for Payer: BCN Commercial |
$24.78
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Cofinity Commercial |
$25.29
|
| Rate for Payer: Cofinity Commercial |
$28.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.52
|
| Rate for Payer: Healthscope Commercial |
$26.09
|
| Rate for Payer: Healthscope Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$29.27
|
| Rate for Payer: Healthscope Whirlpool |
$26.90
|
| Rate for Payer: Healthscope Whirlpool |
$30.17
|
| Rate for Payer: Healthscope Whirlpool |
$25.79
|
| Rate for Payer: Mclaren Commercial |
$24.21
|
| Rate for Payer: Mclaren Commercial |
$23.21
|
| Rate for Payer: Mclaren Commercial |
$27.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Nomi Health Commercial |
$22.06
|
| Rate for Payer: Nomi Health Commercial |
$21.15
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.69
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$25.79
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$9.95
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna Medicare |
$11.16
|
| Rate for Payer: ASR ASR |
$29.27
|
| Rate for Payer: ASR ASR |
$25.01
|
| Rate for Payer: ASR ASR |
$26.09
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS Complete |
$12.07
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: BCBS Trust/PPO |
$21.26
|
| Rate for Payer: BCBS Trust/PPO |
$22.18
|
| Rate for Payer: BCBS Trust/PPO |
$24.88
|
| Rate for Payer: BCN Commercial |
$21.26
|
| Rate for Payer: BCN Commercial |
$22.18
|
| Rate for Payer: BCN Commercial |
$24.88
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$24.14
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Commercial |
$25.29
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Cofinity Commercial |
$28.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.52
|
| Rate for Payer: Healthscope Commercial |
$29.27
|
| Rate for Payer: Healthscope Commercial |
$25.01
|
| Rate for Payer: Healthscope Commercial |
$26.09
|
| Rate for Payer: Healthscope Whirlpool |
$26.90
|
| Rate for Payer: Healthscope Whirlpool |
$25.79
|
| Rate for Payer: Healthscope Whirlpool |
$30.17
|
| Rate for Payer: Mclaren Commercial |
$27.15
|
| Rate for Payer: Mclaren Commercial |
$24.21
|
| Rate for Payer: Mclaren Commercial |
$23.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Nomi Health Commercial |
$24.74
|
| Rate for Payer: Nomi Health Commercial |
$21.15
|
| Rate for Payer: Nomi Health Commercial |
$22.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.69
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$25.79
|
|
|
Service Code
|
NDC 409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.34 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: ASR ASR |
$25.01
|
| Rate for Payer: BCBS Trust/PPO |
$21.18
|
| Rate for Payer: BCN Commercial |
$21.18
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$25.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.79
|
| Rate for Payer: Mclaren Commercial |
$23.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Nomi Health Commercial |
$21.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.69
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$25.79
|
|
|
Service Code
|
NDC 409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna Commercial |
$23.21
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: ASR ASR |
$25.01
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.26
|
| Rate for Payer: BCN Commercial |
$21.26
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$25.01
|
| Rate for Payer: Healthscope Whirlpool |
$25.79
|
| Rate for Payer: Mclaren Commercial |
$23.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Nomi Health Commercial |
$21.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.60
|
| Rate for Payer: Priority Health Narrow Network |
$18.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.69
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$26.90
|
|
|
Service Code
|
NDC 409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.18 |
| Max. Negotiated Rate |
$26.90 |
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: ASR ASR |
$26.09
|
| Rate for Payer: BCBS Trust/PPO |
$22.09
|
| Rate for Payer: BCN Commercial |
$22.09
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cofinity Commercial |
$25.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.52
|
| Rate for Payer: Healthscope Commercial |
$26.09
|
| Rate for Payer: Healthscope Whirlpool |
$26.90
|
| Rate for Payer: Mclaren Commercial |
$24.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Nomi Health Commercial |
$22.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.67
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$26.90
|
|
|
Service Code
|
NDC 409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$26.90 |
| Rate for Payer: Aetna Commercial |
$24.21
|
| Rate for Payer: Aetna Medicare |
$9.95
|
| Rate for Payer: ASR ASR |
$26.09
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: BCBS Trust/PPO |
$22.18
|
| Rate for Payer: BCN Commercial |
$22.18
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cofinity Commercial |
$25.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.52
|
| Rate for Payer: Healthscope Commercial |
$26.09
|
| Rate for Payer: Healthscope Whirlpool |
$26.90
|
| Rate for Payer: Mclaren Commercial |
$24.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Nomi Health Commercial |
$22.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.57
|
| Rate for Payer: Priority Health Narrow Network |
$18.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.67
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Commercial |
$23.07
|
| Rate for Payer: Aetna Commercial |
$41.69
|
| Rate for Payer: Aetna Commercial |
$24.66
|
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Medicare |
$10.14
|
| Rate for Payer: Aetna Medicare |
$10.01
|
| Rate for Payer: Aetna Medicare |
$5.28
|
| Rate for Payer: Aetna Medicare |
$4.59
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$7.41
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: Aetna Medicare |
$17.14
|
| Rate for Payer: Aetna Medicare |
$9.49
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: ASR ASR |
$13.85
|
| Rate for Payer: ASR ASR |
$44.94
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$26.24
|
| Rate for Payer: ASR ASR |
$12.03
|
| Rate for Payer: ASR ASR |
$20.18
|
| Rate for Payer: ASR ASR |
$26.58
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$24.87
|
| Rate for Payer: ASR ASR |
$19.44
|
| Rate for Payer: ASR ASR |
$18.36
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS Complete |
$10.25
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Complete |
$4.96
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$18.53
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: BCBS Trust/PPO |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$11.78
|
| Rate for Payer: BCBS Trust/PPO |
$9.68
|
| Rate for Payer: BCBS Trust/PPO |
$10.22
|
| Rate for Payer: BCBS Trust/PPO |
$38.19
|
| Rate for Payer: BCBS Trust/PPO |
$22.60
|
| Rate for Payer: BCBS Trust/PPO |
$22.30
|
| Rate for Payer: BCBS Trust/PPO |
$21.14
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCBS Trust/PPO |
$12.67
|
| Rate for Payer: BCBS Trust/PPO |
$16.52
|
| Rate for Payer: BCN Commercial |
$16.52
|
| Rate for Payer: BCN Commercial |
$15.60
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: BCN Commercial |
$12.67
|
| Rate for Payer: BCN Commercial |
$11.78
|
| Rate for Payer: BCN Commercial |
$10.22
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: BCN Commercial |
$22.30
|
| Rate for Payer: BCN Commercial |
$38.19
|
| Rate for Payer: BCN Commercial |
$22.60
|
| Rate for Payer: BCN Commercial |
$21.14
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.51
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$20.51
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$11.65
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$17.79
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$24.10
|
| Rate for Payer: Cofinity Commercial |
$25.42
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.92
|
| Rate for Payer: Healthscope Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$24.87
|
| Rate for Payer: Healthscope Commercial |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$12.03
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$19.44
|
| Rate for Payer: Healthscope Commercial |
$26.58
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Healthscope Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Whirlpool |
$12.40
|
| Rate for Payer: Healthscope Whirlpool |
$18.92
|
| Rate for Payer: Healthscope Whirlpool |
$15.37
|
| Rate for Payer: Healthscope Whirlpool |
$20.04
|
| Rate for Payer: Healthscope Whirlpool |
$27.41
|
| Rate for Payer: Healthscope Whirlpool |
$46.33
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$14.28
|
| Rate for Payer: Healthscope Whirlpool |
$25.64
|
| Rate for Payer: Healthscope Whirlpool |
$27.05
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$24.34
|
| Rate for Payer: Mclaren Commercial |
$11.16
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Commercial |
$23.07
|
| Rate for Payer: Mclaren Commercial |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$24.66
|
| Rate for Payer: Mclaren Commercial |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$12.85
|
| Rate for Payer: Mclaren Commercial |
$41.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.08
|
| Rate for Payer: Nomi Health Commercial |
$11.71
|
| Rate for Payer: Nomi Health Commercial |
$10.17
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$22.47
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: Nomi Health Commercial |
$21.02
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$15.52
|
| Rate for Payer: Nomi Health Commercial |
$16.43
|
| Rate for Payer: Nomi Health Commercial |
$22.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$14.28
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$14.28 |
| Rate for Payer: Aetna Commercial |
$12.85
|
| Rate for Payer: Aetna Commercial |
$24.66
|
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Commercial |
$23.07
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$41.69
|
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: ASR ASR |
$26.24
|
| Rate for Payer: ASR ASR |
$44.94
|
| Rate for Payer: ASR ASR |
$24.87
|
| Rate for Payer: ASR ASR |
$12.03
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$20.18
|
| Rate for Payer: ASR ASR |
$18.36
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$19.44
|
| Rate for Payer: ASR ASR |
$13.85
|
| Rate for Payer: ASR ASR |
$26.58
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCBS Trust/PPO |
$21.05
|
| Rate for Payer: BCBS Trust/PPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$16.46
|
| Rate for Payer: BCBS Trust/PPO |
$15.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.62
|
| Rate for Payer: BCBS Trust/PPO |
$38.04
|
| Rate for Payer: BCBS Trust/PPO |
$22.21
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCBS Trust/PPO |
$22.50
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Commercial |
$22.50
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Commercial |
$11.73
|
| Rate for Payer: BCN Commercial |
$21.05
|
| Rate for Payer: BCN Commercial |
$22.21
|
| Rate for Payer: BCN Commercial |
$16.46
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: BCN Commercial |
$38.04
|
| Rate for Payer: BCN Commercial |
$10.18
|
| Rate for Payer: BCN Commercial |
$12.62
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$9.92
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: Cash Price |
$20.51
|
| Rate for Payer: Cofinity Commercial |
$13.43
|
| Rate for Payer: Cofinity Commercial |
$11.65
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$24.10
|
| Rate for Payer: Cofinity Commercial |
$17.79
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$25.76
|
| Rate for Payer: Cofinity Commercial |
$25.42
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Healthscope Commercial |
$19.44
|
| Rate for Payer: Healthscope Commercial |
$26.24
|
| Rate for Payer: Healthscope Commercial |
$24.87
|
| Rate for Payer: Healthscope Commercial |
$44.94
|
| Rate for Payer: Healthscope Commercial |
$12.03
|
| Rate for Payer: Healthscope Commercial |
$14.91
|
| Rate for Payer: Healthscope Commercial |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$18.36
|
| Rate for Payer: Healthscope Commercial |
$20.18
|
| Rate for Payer: Healthscope Commercial |
$26.58
|
| Rate for Payer: Healthscope Whirlpool |
$27.41
|
| Rate for Payer: Healthscope Whirlpool |
$15.37
|
| Rate for Payer: Healthscope Whirlpool |
$12.40
|
| Rate for Payer: Healthscope Whirlpool |
$14.28
|
| Rate for Payer: Healthscope Whirlpool |
$18.92
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Healthscope Whirlpool |
$20.04
|
| Rate for Payer: Healthscope Whirlpool |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$25.64
|
| Rate for Payer: Healthscope Whirlpool |
$27.05
|
| Rate for Payer: Healthscope Whirlpool |
$46.33
|
| Rate for Payer: Mclaren Commercial |
$24.66
|
| Rate for Payer: Mclaren Commercial |
$24.34
|
| Rate for Payer: Mclaren Commercial |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$12.85
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Commercial |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$11.16
|
| Rate for Payer: Mclaren Commercial |
$23.07
|
| Rate for Payer: Mclaren Commercial |
$41.69
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$10.17
|
| Rate for Payer: Nomi Health Commercial |
$11.71
|
| Rate for Payer: Nomi Health Commercial |
$16.43
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: Nomi Health Commercial |
$22.47
|
| Rate for Payer: Nomi Health Commercial |
$15.52
|
| Rate for Payer: Nomi Health Commercial |
$21.02
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Nomi Health Commercial |
$22.18
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$17.22
|
| Rate for Payer: Aetna Commercial |
$14.29
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Commercial |
$12.20
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: ASR ASR |
$18.56
|
| Rate for Payer: ASR ASR |
$15.40
|
| Rate for Payer: ASR ASR |
$13.15
|
| Rate for Payer: BCBS Trust/PPO |
$15.72
|
| Rate for Payer: BCBS Trust/PPO |
$11.13
|
| Rate for Payer: BCBS Trust/PPO |
$13.04
|
| Rate for Payer: BCBS Trust/PPO |
$23.70
|
| Rate for Payer: BCN Commercial |
$11.13
|
| Rate for Payer: BCN Commercial |
$23.70
|
| Rate for Payer: BCN Commercial |
$13.04
|
| Rate for Payer: BCN Commercial |
$15.72
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$12.70
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.85
|
| Rate for Payer: Healthscope Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$13.15
|
| Rate for Payer: Healthscope Commercial |
$15.40
|
| Rate for Payer: Healthscope Commercial |
$27.99
|
| Rate for Payer: Healthscope Whirlpool |
$19.14
|
| Rate for Payer: Healthscope Whirlpool |
$28.86
|
| Rate for Payer: Healthscope Whirlpool |
$13.56
|
| Rate for Payer: Healthscope Whirlpool |
$15.88
|
| Rate for Payer: Mclaren Commercial |
$12.20
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: Mclaren Commercial |
$14.29
|
| Rate for Payer: Mclaren Commercial |
$17.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.52
|
| Rate for Payer: Nomi Health Commercial |
$13.02
|
| Rate for Payer: Nomi Health Commercial |
$23.66
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$11.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.39
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$28.86
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$28.86 |
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Commercial |
$14.29
|
| Rate for Payer: Aetna Commercial |
$17.22
|
| Rate for Payer: Aetna Commercial |
$12.20
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Aetna Medicare |
$10.68
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: Aetna Medicare |
$5.87
|
| Rate for Payer: ASR ASR |
$18.56
|
| Rate for Payer: ASR ASR |
$15.40
|
| Rate for Payer: ASR ASR |
$13.15
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: BCBS Complete |
$7.65
|
| Rate for Payer: BCBS Complete |
$5.42
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.09
|
| Rate for Payer: BCBS Trust/PPO |
$23.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.78
|
| Rate for Payer: BCBS Trust/PPO |
$11.18
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: BCN Commercial |
$15.78
|
| Rate for Payer: BCN Commercial |
$11.18
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$12.70
|
| Rate for Payer: Cash Price |
$12.70
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$27.99
|
| Rate for Payer: Healthscope Commercial |
$13.15
|
| Rate for Payer: Healthscope Commercial |
$15.40
|
| Rate for Payer: Healthscope Commercial |
$18.56
|
| Rate for Payer: Healthscope Whirlpool |
$13.56
|
| Rate for Payer: Healthscope Whirlpool |
$19.14
|
| Rate for Payer: Healthscope Whirlpool |
$28.86
|
| Rate for Payer: Healthscope Whirlpool |
$15.88
|
| Rate for Payer: Mclaren Commercial |
$17.22
|
| Rate for Payer: Mclaren Commercial |
$14.29
|
| Rate for Payer: Mclaren Commercial |
$12.20
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Nomi Health Commercial |
$11.12
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$23.66
|
| Rate for Payer: Nomi Health Commercial |
$13.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.97
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.03
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: ASR ASR |
$20.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.27
|
| Rate for Payer: BCN Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$19.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Whirlpool |
$21.02
|
| Rate for Payer: Mclaren Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.87
|
| Rate for Payer: Nomi Health Commercial |
$17.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.50
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.03
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: Aetna Medicare |
$7.78
|
| Rate for Payer: ASR ASR |
$20.39
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$17.34
|
| Rate for Payer: BCN Commercial |
$17.34
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$19.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$20.39
|
| Rate for Payer: Healthscope Whirlpool |
$21.02
|
| Rate for Payer: Mclaren Commercial |
$18.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.87
|
| Rate for Payer: Nomi Health Commercial |
$17.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.50
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: Aetna Medicare |
$7.86
|
| Rate for Payer: ASR ASR |
$20.60
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$17.51
|
| Rate for Payer: BCN Commercial |
$17.51
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Healthscope Whirlpool |
$21.24
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.69
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$19.11
|
| Rate for Payer: ASR ASR |
$20.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$19.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$20.60
|
| Rate for Payer: Healthscope Whirlpool |
$21.24
|
| Rate for Payer: Mclaren Commercial |
$19.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.69
|
|
