|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
NDC 52565000950
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.41 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Trust/PPO |
$58.18
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
NDC 00054350547
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: ASR ASR |
$129.01
|
| Rate for Payer: ASR Commercial |
$129.01
|
| Rate for Payer: BCBS Trust/PPO |
$108.38
|
| Rate for Payer: BCN Commercial |
$103.11
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$125.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$133.00
|
| Rate for Payer: Healthscope Whirlpool |
$129.01
|
| Rate for Payer: Mclaren Commercial |
$119.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Nomi Health Commercial |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.04
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$90.47
|
|
|
Service Code
|
NDC 00527600480
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.81 |
| Max. Negotiated Rate |
$90.47 |
| Rate for Payer: Aetna Commercial |
$81.42
|
| Rate for Payer: ASR ASR |
$87.76
|
| Rate for Payer: ASR Commercial |
$87.76
|
| Rate for Payer: BCBS Trust/PPO |
$73.72
|
| Rate for Payer: BCN Commercial |
$70.14
|
| Rate for Payer: Cash Price |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$85.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.38
|
| Rate for Payer: Healthscope Commercial |
$90.47
|
| Rate for Payer: Healthscope Whirlpool |
$87.76
|
| Rate for Payer: Mclaren Commercial |
$81.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.90
|
| Rate for Payer: Nomi Health Commercial |
$74.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.61
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
NDC 52565000950
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$71.40 |
| Rate for Payer: Aetna Commercial |
$64.26
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: ASR ASR |
$69.26
|
| Rate for Payer: ASR Commercial |
$69.26
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$58.47
|
| Rate for Payer: BCN Commercial |
$55.36
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$67.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$71.40
|
| Rate for Payer: Healthscope Whirlpool |
$69.26
|
| Rate for Payer: Mclaren Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Nomi Health Commercial |
$58.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.56
|
| Rate for Payer: Priority Health Narrow Network |
$50.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.83
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
NDC 00054350547
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: ASR ASR |
$129.01
|
| Rate for Payer: ASR Commercial |
$129.01
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS Trust/PPO |
$108.91
|
| Rate for Payer: BCN Commercial |
$103.11
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$125.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$133.00
|
| Rate for Payer: Healthscope Whirlpool |
$129.01
|
| Rate for Payer: Mclaren Commercial |
$119.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Nomi Health Commercial |
$109.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.53
|
| Rate for Payer: Priority Health Narrow Network |
$93.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.04
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
OP
|
$33.38
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.35 |
| Max. Negotiated Rate |
$33.38 |
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Commercial |
$34.05
|
| Rate for Payer: Aetna Medicare |
$16.69
|
| Rate for Payer: Aetna Medicare |
$18.92
|
| Rate for Payer: ASR ASR |
$32.38
|
| Rate for Payer: ASR ASR |
$36.70
|
| Rate for Payer: ASR Commercial |
$36.70
|
| Rate for Payer: ASR Commercial |
$32.38
|
| Rate for Payer: BCBS Complete |
$13.35
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: BCBS Trust/PPO |
$27.33
|
| Rate for Payer: BCBS Trust/PPO |
$30.98
|
| Rate for Payer: BCN Commercial |
$29.33
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Cofinity Commercial |
$35.56
|
| 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 |
$33.38
|
| Rate for Payer: Healthscope Commercial |
$37.83
|
| Rate for Payer: Healthscope Whirlpool |
$32.38
|
| Rate for Payer: Healthscope Whirlpool |
$36.70
|
| Rate for Payer: Mclaren Commercial |
$30.04
|
| Rate for Payer: Mclaren Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.37
|
| Rate for Payer: Nomi Health Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health Narrow Network |
$26.52
|
| Rate for Payer: Priority Health Narrow Network |
$23.40
|
| 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
|
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.59 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Aetna Commercial |
$34.05
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: ASR ASR |
$32.38
|
| Rate for Payer: ASR ASR |
$36.70
|
| Rate for Payer: ASR Commercial |
$32.38
|
| Rate for Payer: ASR Commercial |
$36.70
|
| Rate for Payer: BCBS Trust/PPO |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$30.83
|
| Rate for Payer: BCN Commercial |
$29.33
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Cofinity Commercial |
$35.56
|
| 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 |
$33.38
|
| Rate for Payer: Healthscope Commercial |
$37.83
|
| Rate for Payer: Healthscope Whirlpool |
$36.70
|
| Rate for Payer: Healthscope Whirlpool |
$32.38
|
| Rate for Payer: Mclaren Commercial |
$30.04
|
| Rate for Payer: Mclaren Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| 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: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| 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
|
$24.45
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$24.45 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Commercial |
$21.12
|
| Rate for Payer: Aetna Commercial |
$24.69
|
| Rate for Payer: ASR ASR |
$22.77
|
| Rate for Payer: ASR ASR |
$23.72
|
| Rate for Payer: ASR ASR |
$26.61
|
| Rate for Payer: ASR Commercial |
$23.72
|
| Rate for Payer: ASR Commercial |
$22.77
|
| Rate for Payer: ASR Commercial |
$26.61
|
| Rate for Payer: BCBS Trust/PPO |
$22.35
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: BCN Commercial |
$18.96
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cash Price |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$25.78
|
| Rate for Payer: Cofinity Commercial |
$22.06
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Healthscope Commercial |
$23.47
|
| Rate for Payer: Healthscope Commercial |
$24.45
|
| Rate for Payer: Healthscope Commercial |
$27.43
|
| Rate for Payer: Healthscope Whirlpool |
$23.72
|
| Rate for Payer: Healthscope Whirlpool |
$22.77
|
| Rate for Payer: Healthscope Whirlpool |
$26.61
|
| Rate for Payer: Mclaren Commercial |
$22.00
|
| Rate for Payer: Mclaren Commercial |
$21.12
|
| Rate for Payer: Mclaren Commercial |
$24.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.95
|
| Rate for Payer: Nomi Health Commercial |
$20.05
|
| Rate for Payer: Nomi Health Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$22.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.65
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$23.47
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Aetna Commercial |
$21.12
|
| Rate for Payer: Aetna Commercial |
$24.69
|
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare |
$13.72
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Aetna Medicare |
$12.22
|
| Rate for Payer: ASR ASR |
$23.72
|
| Rate for Payer: ASR ASR |
$22.77
|
| Rate for Payer: ASR ASR |
$26.61
|
| Rate for Payer: ASR Commercial |
$23.72
|
| Rate for Payer: ASR Commercial |
$22.77
|
| Rate for Payer: ASR Commercial |
$26.61
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS Complete |
$10.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.46
|
| Rate for Payer: BCBS Trust/PPO |
$19.22
|
| Rate for Payer: BCBS Trust/PPO |
$20.02
|
| Rate for Payer: BCN Commercial |
$18.96
|
| Rate for Payer: BCN Commercial |
$21.27
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cash Price |
$21.95
|
| Rate for Payer: Cash Price |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$25.78
|
| Rate for Payer: Cofinity Commercial |
$22.06
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$27.43
|
| Rate for Payer: Healthscope Commercial |
$24.45
|
| Rate for Payer: Healthscope Commercial |
$23.47
|
| Rate for Payer: Healthscope Whirlpool |
$26.61
|
| Rate for Payer: Healthscope Whirlpool |
$23.72
|
| Rate for Payer: Healthscope Whirlpool |
$22.77
|
| Rate for Payer: Mclaren Commercial |
$22.00
|
| Rate for Payer: Mclaren Commercial |
$24.69
|
| Rate for Payer: Mclaren Commercial |
$21.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.95
|
| Rate for Payer: Nomi Health Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$22.49
|
| Rate for Payer: Nomi Health Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: 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 |
$20.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.14
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$24.45
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$24.45 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: ASR ASR |
$23.72
|
| Rate for Payer: ASR Commercial |
$23.72
|
| Rate for Payer: BCBS Trust/PPO |
$19.92
|
| Rate for Payer: BCN Commercial |
$18.96
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$24.45
|
| Rate for Payer: Healthscope Whirlpool |
$23.72
|
| Rate for Payer: Mclaren Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.78
|
| Rate for Payer: Nomi Health Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.52
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$23.47
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Aetna Commercial |
$21.12
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: ASR ASR |
$22.77
|
| Rate for Payer: ASR Commercial |
$22.77
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS Trust/PPO |
$19.22
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$22.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.78
|
| Rate for Payer: Healthscope Commercial |
$23.47
|
| Rate for Payer: Healthscope Whirlpool |
$22.77
|
| Rate for Payer: Mclaren Commercial |
$21.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.95
|
| Rate for Payer: Nomi Health Commercial |
$19.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.56
|
| Rate for Payer: Priority Health Narrow Network |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.65
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$24.45
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$24.45 |
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare |
$12.22
|
| Rate for Payer: ASR ASR |
$23.72
|
| Rate for Payer: ASR Commercial |
$23.72
|
| Rate for Payer: BCBS Complete |
$9.78
|
| Rate for Payer: BCBS Trust/PPO |
$20.02
|
| Rate for Payer: BCN Commercial |
$18.96
|
| Rate for Payer: Cash Price |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.56
|
| Rate for Payer: Healthscope Commercial |
$24.45
|
| Rate for Payer: Healthscope Whirlpool |
$23.72
|
| Rate for Payer: Mclaren Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.78
|
| Rate for Payer: Nomi Health Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.52
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$23.47
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.26 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Aetna Commercial |
$21.12
|
| Rate for Payer: ASR ASR |
$22.77
|
| Rate for Payer: ASR Commercial |
$22.77
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cofinity Commercial |
$22.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.78
|
| Rate for Payer: Healthscope Commercial |
$23.47
|
| Rate for Payer: Healthscope Whirlpool |
$22.77
|
| Rate for Payer: Mclaren Commercial |
$21.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.95
|
| Rate for Payer: Nomi Health Commercial |
$19.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.65
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$18.92
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.30 |
| Max. Negotiated Rate |
$18.92 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$11.68
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$41.70
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: ASR ASR |
$27.00
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$18.35
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR ASR |
$26.24
|
| Rate for Payer: ASR ASR |
$12.59
|
| Rate for Payer: ASR ASR |
$15.12
|
| Rate for Payer: ASR ASR |
$44.94
|
| Rate for Payer: ASR ASR |
$24.87
|
| Rate for Payer: ASR ASR |
$16.29
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$19.44
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: ASR Commercial |
$27.00
|
| Rate for Payer: ASR Commercial |
$26.24
|
| Rate for Payer: ASR Commercial |
$14.91
|
| Rate for Payer: ASR Commercial |
$16.29
|
| Rate for Payer: ASR Commercial |
$15.12
|
| Rate for Payer: ASR Commercial |
$12.59
|
| Rate for Payer: ASR Commercial |
$11.39
|
| Rate for Payer: ASR Commercial |
$19.44
|
| Rate for Payer: ASR Commercial |
$18.35
|
| Rate for Payer: ASR Commercial |
$44.94
|
| Rate for Payer: ASR Commercial |
$24.87
|
| Rate for Payer: BCBS Trust/PPO |
$15.42
|
| Rate for Payer: BCBS Trust/PPO |
$16.33
|
| Rate for Payer: BCBS Trust/PPO |
$12.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.70
|
| Rate for Payer: BCBS Trust/PPO |
$37.75
|
| Rate for Payer: BCBS Trust/PPO |
$20.89
|
| Rate for Payer: BCBS Trust/PPO |
$10.58
|
| Rate for Payer: BCBS Trust/PPO |
$9.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.68
|
| Rate for Payer: BCBS Trust/PPO |
$22.04
|
| Rate for Payer: BCBS Trust/PPO |
$16.96
|
| Rate for Payer: BCBS Trust/PPO |
$22.69
|
| Rate for Payer: BCN Commercial |
$13.02
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: BCN Commercial |
$10.06
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$12.09
|
| Rate for Payer: BCN Commercial |
$35.92
|
| Rate for Payer: BCN Commercial |
$21.58
|
| Rate for Payer: BCN Commercial |
$20.97
|
| Rate for Payer: BCN Commercial |
$19.88
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Commercial |
$14.67
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$20.51
|
| Rate for Payer: Cofinity Commercial |
$24.10
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$12.20
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$25.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Healthscope Commercial |
$16.79
|
| Rate for Payer: Healthscope Commercial |
$27.84
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Commercial |
$18.92
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$15.37
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Healthscope Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$27.05
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Whirlpool |
$11.39
|
| Rate for Payer: Healthscope Whirlpool |
$12.59
|
| Rate for Payer: Healthscope Whirlpool |
$44.94
|
| Rate for Payer: Healthscope Whirlpool |
$27.00
|
| Rate for Payer: Healthscope Whirlpool |
$18.35
|
| Rate for Payer: Healthscope Whirlpool |
$15.12
|
| Rate for Payer: Healthscope Whirlpool |
$26.24
|
| Rate for Payer: Healthscope Whirlpool |
$16.29
|
| Rate for Payer: Healthscope Whirlpool |
$19.44
|
| Rate for Payer: Healthscope Whirlpool |
$24.87
|
| Rate for Payer: Healthscope Whirlpool |
$14.91
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$14.03
|
| Rate for Payer: Mclaren Commercial |
$24.34
|
| Rate for Payer: Mclaren Commercial |
$41.70
|
| Rate for Payer: Mclaren Commercial |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$15.11
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Commercial |
$25.06
|
| Rate for Payer: Mclaren Commercial |
$11.68
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$23.08
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| 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 |
$14.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.25
|
| 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 |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.08
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$12.78
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Nomi Health Commercial |
$16.43
|
| Rate for Payer: Nomi Health Commercial |
$22.83
|
| Rate for Payer: Nomi Health Commercial |
$22.18
|
| Rate for Payer: Nomi Health Commercial |
$15.51
|
| Rate for Payer: Nomi Health Commercial |
$10.64
|
| Rate for Payer: Nomi Health Commercial |
$21.02
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.56
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.37
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$41.70
|
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Aetna Commercial |
$18.04
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$11.68
|
| Rate for Payer: Aetna Medicare |
$13.92
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Aetna Medicare |
$5.87
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$8.40
|
| Rate for Payer: Aetna Medicare |
$12.82
|
| Rate for Payer: Aetna Medicare |
$23.16
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: ASR ASR |
$15.12
|
| Rate for Payer: ASR ASR |
$16.29
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR ASR |
$27.00
|
| Rate for Payer: ASR ASR |
$24.87
|
| Rate for Payer: ASR ASR |
$12.59
|
| Rate for Payer: ASR ASR |
$44.94
|
| Rate for Payer: ASR ASR |
$18.35
|
| Rate for Payer: ASR ASR |
$26.24
|
| Rate for Payer: ASR ASR |
$19.44
|
| Rate for Payer: ASR Commercial |
$16.29
|
| Rate for Payer: ASR Commercial |
$44.94
|
| Rate for Payer: ASR Commercial |
$24.87
|
| Rate for Payer: ASR Commercial |
$14.91
|
| Rate for Payer: ASR Commercial |
$19.44
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: ASR Commercial |
$11.39
|
| Rate for Payer: ASR Commercial |
$12.59
|
| Rate for Payer: ASR Commercial |
$27.00
|
| Rate for Payer: ASR Commercial |
$26.24
|
| Rate for Payer: ASR Commercial |
$18.35
|
| Rate for Payer: ASR Commercial |
$15.12
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Complete |
$5.19
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$18.53
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$10.26
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS Trust/PPO |
$21.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCBS Trust/PPO |
$12.59
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$22.15
|
| Rate for Payer: BCBS Trust/PPO |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$10.63
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$37.94
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Commercial |
$21.58
|
| Rate for Payer: BCN Commercial |
$19.88
|
| Rate for Payer: BCN Commercial |
$14.67
|
| Rate for Payer: BCN Commercial |
$13.02
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$10.06
|
| Rate for Payer: BCN Commercial |
$35.92
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: BCN Commercial |
$12.09
|
| Rate for Payer: BCN Commercial |
$20.97
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$37.06
|
| 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 |
$15.14
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$20.51
|
| Rate for Payer: Cofinity Commercial |
$12.20
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| 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 |
$25.43
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Healthscope Commercial |
$15.37
|
| Rate for Payer: Healthscope Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$27.84
|
| Rate for Payer: Healthscope Commercial |
$16.79
|
| Rate for Payer: Healthscope Commercial |
$18.92
|
| Rate for Payer: Healthscope Commercial |
$27.05
|
| Rate for Payer: Healthscope Commercial |
$20.81
|
| Rate for Payer: Healthscope Whirlpool |
$12.59
|
| Rate for Payer: Healthscope Whirlpool |
$11.39
|
| Rate for Payer: Healthscope Whirlpool |
$15.12
|
| Rate for Payer: Healthscope Whirlpool |
$26.24
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$19.44
|
| Rate for Payer: Healthscope Whirlpool |
$24.87
|
| Rate for Payer: Healthscope Whirlpool |
$14.91
|
| Rate for Payer: Healthscope Whirlpool |
$16.29
|
| Rate for Payer: Healthscope Whirlpool |
$27.00
|
| Rate for Payer: Healthscope Whirlpool |
$44.94
|
| Rate for Payer: Healthscope Whirlpool |
$18.35
|
| Rate for Payer: Mclaren Commercial |
$11.68
|
| Rate for Payer: Mclaren Commercial |
$15.11
|
| Rate for Payer: Mclaren Commercial |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$41.70
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Commercial |
$14.03
|
| Rate for Payer: Mclaren Commercial |
$23.08
|
| Rate for Payer: Mclaren Commercial |
$24.34
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$25.06
|
| Rate for Payer: Mclaren Commercial |
$17.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.27
|
| 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 |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Nomi Health Commercial |
$10.64
|
| Rate for Payer: Nomi Health Commercial |
$15.51
|
| Rate for Payer: Nomi Health Commercial |
$21.02
|
| Rate for Payer: Nomi Health Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$16.43
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: Nomi Health Commercial |
$12.78
|
| Rate for Payer: Nomi Health Commercial |
$22.83
|
| Rate for Payer: Nomi Health Commercial |
$22.18
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: 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: Priority Health Narrow Network |
$0.01
|
| 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 |
$13.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.56
|
|
|
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 |
$17.23
|
| Rate for Payer: Aetna Commercial |
$12.20
|
| Rate for Payer: Aetna Commercial |
$14.29
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna Medicare |
$6.78
|
| Rate for Payer: Aetna Medicare |
$7.94
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: ASR ASR |
$13.15
|
| Rate for Payer: ASR ASR |
$15.40
|
| Rate for Payer: ASR ASR |
$18.57
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: ASR Commercial |
$13.15
|
| Rate for Payer: ASR Commercial |
$18.57
|
| Rate for Payer: ASR Commercial |
$27.99
|
| Rate for Payer: ASR Commercial |
$15.40
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$5.42
|
| Rate for Payer: BCBS Complete |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.63
|
| Rate for Payer: BCBS Trust/PPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.67
|
| Rate for Payer: BCN Commercial |
$10.51
|
| Rate for Payer: BCN Commercial |
$22.38
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Commercial |
$14.84
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cash Price |
$10.85
|
| 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 |
$15.31
|
| Rate for Payer: Cash Price |
$23.08
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.85
|
| Rate for Payer: Healthscope Commercial |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Healthscope Commercial |
$19.14
|
| Rate for Payer: Healthscope Whirlpool |
$15.40
|
| Rate for Payer: Healthscope Whirlpool |
$13.15
|
| Rate for Payer: Healthscope Whirlpool |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$27.99
|
| Rate for Payer: Mclaren Commercial |
$17.23
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: Mclaren Commercial |
$12.20
|
| Rate for Payer: Mclaren Commercial |
$14.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Nomi Health Commercial |
$13.02
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$23.67
|
| Rate for Payer: Nomi Health Commercial |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: 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 |
$25.40
|
| 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 %) INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.44 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$17.23
|
| 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 |
$13.15
|
| Rate for Payer: ASR ASR |
$18.57
|
| Rate for Payer: ASR ASR |
$15.40
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: ASR Commercial |
$18.57
|
| Rate for Payer: ASR Commercial |
$27.99
|
| Rate for Payer: ASR Commercial |
$15.40
|
| Rate for Payer: ASR Commercial |
$13.15
|
| Rate for Payer: BCBS Trust/PPO |
$23.52
|
| Rate for Payer: BCBS Trust/PPO |
$11.05
|
| Rate for Payer: BCBS Trust/PPO |
$12.94
|
| Rate for Payer: BCBS Trust/PPO |
$15.60
|
| Rate for Payer: BCN Commercial |
$22.38
|
| Rate for Payer: BCN Commercial |
$10.51
|
| Rate for Payer: BCN Commercial |
$14.84
|
| Rate for Payer: BCN Commercial |
$12.31
|
| 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 |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$12.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Healthscope Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$28.86
|
| Rate for Payer: Healthscope Whirlpool |
$27.99
|
| Rate for Payer: Healthscope Whirlpool |
$15.40
|
| Rate for Payer: Healthscope Whirlpool |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$13.15
|
| Rate for Payer: Mclaren Commercial |
$17.23
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: Mclaren Commercial |
$14.29
|
| Rate for Payer: Mclaren Commercial |
$12.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.50
|
| 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 |
$11.53
|
| Rate for Payer: Nomi Health Commercial |
$11.12
|
| Rate for Payer: Nomi Health Commercial |
$23.67
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$13.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.93
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.02
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$21.02 |
| Rate for Payer: Aetna Commercial |
$18.92
|
| Rate for Payer: ASR ASR |
$20.39
|
| Rate for Payer: ASR Commercial |
$20.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.13
|
| Rate for Payer: BCN Commercial |
$16.30
|
| 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 |
$21.02
|
| Rate for Payer: Healthscope Whirlpool |
$20.39
|
| 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: Priority Health Cigna Priority Health |
$13.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.50
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.02
|
|
|
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 |
$10.51
|
| Rate for Payer: ASR ASR |
$20.39
|
| Rate for Payer: ASR Commercial |
$20.39
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$17.21
|
| Rate for Payer: BCN Commercial |
$16.30
|
| 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 |
$21.02
|
| Rate for Payer: Healthscope Whirlpool |
$20.39
|
| 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: Priority Health Cigna Priority Health |
$13.66
|
| Rate for Payer: 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 |
$19.12
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: ASR ASR |
$20.60
|
| Rate for Payer: ASR Commercial |
$20.60
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$17.39
|
| Rate for Payer: BCN Commercial |
$16.47
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Healthscope Whirlpool |
$20.60
|
| Rate for Payer: Mclaren Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.81
|
| Rate for Payer: 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 |
$13.81 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: ASR ASR |
$20.60
|
| Rate for Payer: ASR Commercial |
$20.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.31
|
| Rate for Payer: BCN Commercial |
$16.47
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Healthscope Whirlpool |
$20.60
|
| Rate for Payer: Mclaren Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.69
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: ASR ASR |
$20.60
|
| Rate for Payer: ASR Commercial |
$20.60
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$17.39
|
| Rate for Payer: BCN Commercial |
$16.47
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Healthscope Whirlpool |
$20.60
|
| Rate for Payer: Mclaren Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.61
|
| Rate for Payer: Priority Health Narrow Network |
$14.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.69
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$21.24 |
| Rate for Payer: Aetna Commercial |
$19.12
|
| Rate for Payer: ASR ASR |
$20.60
|
| Rate for Payer: ASR Commercial |
$20.60
|
| Rate for Payer: BCBS Trust/PPO |
$17.31
|
| Rate for Payer: BCN Commercial |
$16.47
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$19.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$21.24
|
| Rate for Payer: Healthscope Whirlpool |
$20.60
|
| Rate for Payer: Mclaren Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Nomi Health Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.69
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$33.38
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$33.38 |
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$34.05
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: ASR ASR |
$32.38
|
| Rate for Payer: ASR ASR |
$36.70
|
| Rate for Payer: ASR Commercial |
$32.38
|
| Rate for Payer: ASR Commercial |
$21.53
|
| Rate for Payer: ASR Commercial |
$36.70
|
| Rate for Payer: BCBS Trust/PPO |
$30.83
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$27.20
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Commercial |
$29.33
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$35.56
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$22.20
|
| Rate for Payer: Healthscope Commercial |
$33.38
|
| Rate for Payer: Healthscope Commercial |
$37.83
|
| Rate for Payer: Healthscope Whirlpool |
$32.38
|
| Rate for Payer: Healthscope Whirlpool |
$21.53
|
| Rate for Payer: Healthscope Whirlpool |
$36.70
|
| Rate for Payer: Mclaren Commercial |
$30.04
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Nomi Health Commercial |
$27.37
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Nomi Health Commercial |
$31.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$22.20 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Commercial |
$34.05
|
| Rate for Payer: ASR ASR |
$32.38
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: ASR ASR |
$36.70
|
| Rate for Payer: ASR Commercial |
$32.38
|
| Rate for Payer: ASR Commercial |
$21.53
|
| Rate for Payer: ASR Commercial |
$36.70
|
| Rate for Payer: BCBS Trust/PPO |
$18.18
|
| Rate for Payer: BCBS Trust/PPO |
$30.98
|
| Rate for Payer: BCBS Trust/PPO |
$27.33
|
| Rate for Payer: BCN Commercial |
$29.33
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| 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 |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.70
|
| Rate for Payer: Healthscope Commercial |
$33.38
|
| Rate for Payer: Healthscope Commercial |
$22.20
|
| Rate for Payer: Healthscope Commercial |
$37.83
|
| Rate for Payer: Healthscope Whirlpool |
$21.53
|
| Rate for Payer: Healthscope Whirlpool |
$32.38
|
| Rate for Payer: Healthscope Whirlpool |
$36.70
|
| Rate for Payer: Mclaren Commercial |
$30.04
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| 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: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.45
|
| Rate for Payer: Priority Health Narrow Network |
$15.56
|
| Rate for Payer: Priority Health Narrow Network |
$26.52
|
| Rate for Payer: Priority Health Narrow Network |
$23.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.37
|
|
