|
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
|
$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) 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 |
$6.15 |
| Max. Negotiated Rate |
$15.37 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Commercial |
$15.11
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$41.70
|
| 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 |
$23.08
|
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Aetna Commercial |
$11.68
|
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Aetna Medicare |
$13.92
|
| Rate for Payer: Aetna Medicare |
$12.82
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna Medicare |
$5.87
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Aetna Medicare |
$23.16
|
| Rate for Payer: Aetna Medicare |
$7.79
|
| Rate for Payer: ASR ASR |
$24.87
|
| Rate for Payer: ASR ASR |
$26.24
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$15.12
|
| Rate for Payer: ASR ASR |
$12.59
|
| Rate for Payer: ASR ASR |
$19.44
|
| Rate for Payer: ASR ASR |
$18.35
|
| Rate for Payer: ASR ASR |
$20.19
|
| Rate for Payer: ASR ASR |
$44.94
|
| Rate for Payer: ASR ASR |
$16.29
|
| Rate for Payer: ASR ASR |
$27.00
|
| Rate for Payer: ASR ASR |
$14.91
|
| Rate for Payer: ASR Commercial |
$19.44
|
| Rate for Payer: ASR Commercial |
$44.94
|
| Rate for Payer: ASR Commercial |
$24.87
|
| Rate for Payer: ASR Commercial |
$11.39
|
| Rate for Payer: ASR Commercial |
$15.12
|
| Rate for Payer: ASR Commercial |
$16.29
|
| Rate for Payer: ASR Commercial |
$26.24
|
| Rate for Payer: ASR Commercial |
$14.91
|
| Rate for Payer: ASR Commercial |
$12.59
|
| Rate for Payer: ASR Commercial |
$27.00
|
| Rate for Payer: ASR Commercial |
$18.35
|
| Rate for Payer: ASR Commercial |
$20.19
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS Complete |
$8.02
|
| Rate for Payer: BCBS Complete |
$5.19
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$6.72
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Complete |
$18.53
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$8.32
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Complete |
$10.26
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS Trust/PPO |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.77
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$10.63
|
| Rate for Payer: BCBS Trust/PPO |
$12.59
|
| Rate for Payer: BCBS Trust/PPO |
$37.94
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$22.15
|
| Rate for Payer: BCBS Trust/PPO |
$21.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.04
|
| Rate for Payer: BCBS Trust/PPO |
$15.49
|
| Rate for Payer: BCN Commercial |
$20.97
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: BCN Commercial |
$21.58
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$10.06
|
| Rate for Payer: BCN Commercial |
$16.13
|
| Rate for Payer: BCN Commercial |
$14.67
|
| Rate for Payer: BCN Commercial |
$35.92
|
| Rate for Payer: BCN Commercial |
$15.54
|
| Rate for Payer: BCN Commercial |
$13.02
|
| Rate for Payer: BCN Commercial |
$19.88
|
| Rate for Payer: BCN Commercial |
$12.09
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$16.03
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$13.43
|
| Rate for Payer: Cash Price |
$20.51
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cofinity Commercial |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$25.43
|
| 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 |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$24.10
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Cofinity Commercial |
$12.20
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.39
|
| 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 |
$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 |
$20.81
|
| Rate for Payer: Healthscope Commercial |
$46.33
|
| Rate for Payer: Healthscope Commercial |
$15.37
|
| Rate for Payer: Healthscope Commercial |
$27.84
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$16.79
|
| Rate for Payer: Healthscope Commercial |
$27.05
|
| Rate for Payer: Healthscope Commercial |
$15.59
|
| Rate for Payer: Healthscope Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$18.92
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$44.94
|
| Rate for Payer: Healthscope Whirlpool |
$16.29
|
| Rate for Payer: Healthscope Whirlpool |
$14.91
|
| Rate for Payer: Healthscope Whirlpool |
$27.00
|
| Rate for Payer: Healthscope Whirlpool |
$12.59
|
| Rate for Payer: Healthscope Whirlpool |
$11.39
|
| Rate for Payer: Healthscope Whirlpool |
$26.24
|
| Rate for Payer: Healthscope Whirlpool |
$15.12
|
| Rate for Payer: Healthscope Whirlpool |
$19.44
|
| Rate for Payer: Healthscope Whirlpool |
$18.35
|
| Rate for Payer: Healthscope Whirlpool |
$24.87
|
| Rate for Payer: Mclaren Commercial |
$23.08
|
| Rate for Payer: Mclaren Commercial |
$14.03
|
| Rate for Payer: Mclaren Commercial |
$18.04
|
| Rate for Payer: Mclaren Commercial |
$17.03
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$11.68
|
| Rate for Payer: Mclaren Commercial |
$15.11
|
| Rate for Payer: Mclaren Commercial |
$13.83
|
| Rate for Payer: Mclaren Commercial |
$18.73
|
| Rate for Payer: Mclaren Commercial |
$41.70
|
| Rate for Payer: Mclaren Commercial |
$25.06
|
| Rate for Payer: Mclaren Commercial |
$24.34
|
| 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 |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| 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 |
$11.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Nomi Health Commercial |
$15.51
|
| Rate for Payer: Nomi Health Commercial |
$21.02
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: Nomi Health Commercial |
$12.78
|
| Rate for Payer: Nomi Health Commercial |
$16.43
|
| Rate for Payer: Nomi Health Commercial |
$13.77
|
| Rate for Payer: Nomi Health Commercial |
$22.83
|
| Rate for Payer: Nomi Health Commercial |
$17.06
|
| Rate for Payer: Nomi Health Commercial |
$10.64
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$22.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.63
|
| 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 |
$13.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.23
|
| Rate for Payer: Priority Health Narrow Network |
$10.77
|
| Rate for Payer: Priority Health Narrow Network |
$9.10
|
| Rate for Payer: Priority Health Narrow Network |
$14.59
|
| Rate for Payer: Priority Health Narrow Network |
$32.48
|
| Rate for Payer: Priority Health Narrow Network |
$18.96
|
| Rate for Payer: Priority Health Narrow Network |
$10.93
|
| Rate for Payer: Priority Health Narrow Network |
$17.97
|
| Rate for Payer: Priority Health Narrow Network |
$14.05
|
| Rate for Payer: Priority Health Narrow Network |
$19.52
|
| Rate for Payer: Priority Health Narrow Network |
$8.23
|
| Rate for Payer: Priority Health Narrow Network |
$13.26
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.80
|
|
|
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) 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 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.88
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$15.88 |
| Rate for Payer: Aetna Commercial |
$14.29
|
| Rate for Payer: Aetna Commercial |
$25.97
|
| Rate for Payer: Aetna Commercial |
$12.20
|
| Rate for Payer: Aetna Commercial |
$17.23
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna Medicare |
$7.94
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna Medicare |
$6.78
|
| Rate for Payer: ASR ASR |
$18.57
|
| Rate for Payer: ASR ASR |
$13.15
|
| Rate for Payer: ASR ASR |
$27.99
|
| Rate for Payer: ASR ASR |
$15.40
|
| Rate for Payer: ASR Commercial |
$15.40
|
| Rate for Payer: ASR Commercial |
$18.57
|
| Rate for Payer: ASR Commercial |
$27.99
|
| Rate for Payer: ASR Commercial |
$13.15
|
| Rate for Payer: BCBS Complete |
$5.42
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Complete |
$6.35
|
| Rate for Payer: BCBS Trust/PPO |
$13.00
|
| Rate for Payer: BCBS Trust/PPO |
$23.63
|
| Rate for Payer: BCBS Trust/PPO |
$11.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.67
|
| Rate for Payer: BCN Commercial |
$22.38
|
| Rate for Payer: BCN Commercial |
$12.31
|
| Rate for Payer: BCN Commercial |
$10.51
|
| Rate for Payer: BCN Commercial |
$14.84
|
| 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 |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$14.93
|
| Rate for Payer: Cofinity Commercial |
$17.99
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.70
|
| Rate for Payer: Healthscope Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Healthscope Commercial |
$15.88
|
| Rate for Payer: Healthscope Commercial |
$28.86
|
| Rate for Payer: Healthscope Whirlpool |
$27.99
|
| Rate for Payer: Healthscope Whirlpool |
$18.57
|
| Rate for Payer: Healthscope Whirlpool |
$15.40
|
| Rate for Payer: Healthscope Whirlpool |
$13.15
|
| Rate for Payer: Mclaren Commercial |
$12.20
|
| Rate for Payer: Mclaren Commercial |
$14.29
|
| Rate for Payer: Mclaren Commercial |
$17.23
|
| Rate for Payer: Mclaren Commercial |
$25.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.53
|
| 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 |
$16.27
|
| Rate for Payer: Nomi Health Commercial |
$15.69
|
| Rate for Payer: Nomi Health Commercial |
$13.02
|
| Rate for Payer: Nomi Health Commercial |
$23.67
|
| Rate for Payer: Nomi Health Commercial |
$11.12
|
| 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: Priority Health Cigna Priority Health |
$8.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.88
|
| Rate for Payer: Priority Health Narrow Network |
$13.42
|
| Rate for Payer: Priority Health Narrow Network |
$11.13
|
| Rate for Payer: Priority Health Narrow Network |
$20.23
|
| Rate for Payer: Priority Health Narrow Network |
$9.51
|
| 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 |
$25.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.97
|
|
|
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 |
$8.41 |
| 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: 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 |
$18.42
|
| Rate for Payer: Priority Health Narrow Network |
$14.74
|
| 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 |
$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 %) 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
|
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
|
|
|
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) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$15.91 |
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$51.26
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna Medicare |
$28.48
|
| Rate for Payer: ASR ASR |
$15.43
|
| Rate for Payer: ASR ASR |
$55.25
|
| Rate for Payer: ASR Commercial |
$55.25
|
| Rate for Payer: ASR Commercial |
$15.43
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: BCBS Complete |
$22.78
|
| Rate for Payer: BCBS Trust/PPO |
$13.03
|
| Rate for Payer: BCBS Trust/PPO |
$46.64
|
| Rate for Payer: BCN Commercial |
$44.16
|
| Rate for Payer: BCN Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$53.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Healthscope Commercial |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$56.96
|
| Rate for Payer: Healthscope Whirlpool |
$15.43
|
| Rate for Payer: Healthscope Whirlpool |
$55.25
|
| Rate for Payer: Mclaren Commercial |
$14.32
|
| Rate for Payer: Mclaren Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Nomi Health Commercial |
$46.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.91
|
| Rate for Payer: Priority Health Narrow Network |
$39.93
|
| Rate for Payer: Priority Health Narrow Network |
$11.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.00
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$56.96
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.02 |
| Max. Negotiated Rate |
$56.96 |
| Rate for Payer: Aetna Commercial |
$51.26
|
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: ASR ASR |
$15.43
|
| Rate for Payer: ASR ASR |
$55.25
|
| Rate for Payer: ASR Commercial |
$15.43
|
| Rate for Payer: ASR Commercial |
$55.25
|
| Rate for Payer: BCBS Trust/PPO |
$12.97
|
| Rate for Payer: BCBS Trust/PPO |
$46.42
|
| Rate for Payer: BCN Commercial |
$44.16
|
| Rate for Payer: BCN Commercial |
$12.34
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$53.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Healthscope Commercial |
$15.91
|
| Rate for Payer: Healthscope Commercial |
$56.96
|
| Rate for Payer: Healthscope Whirlpool |
$55.25
|
| Rate for Payer: Healthscope Whirlpool |
$15.43
|
| Rate for Payer: Mclaren Commercial |
$14.32
|
| Rate for Payer: Mclaren Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Nomi Health Commercial |
$46.71
|
| Rate for Payer: Nomi Health Commercial |
$13.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.12
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$10.49
|
|
|
Service Code
|
NDC 00496088205
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: ASR ASR |
$10.18
|
| Rate for Payer: ASR Commercial |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.13
|
| Rate for Payer: Cash Price |
$8.39
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.39
|
| Rate for Payer: Healthscope Commercial |
$10.49
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.92
|
| Rate for Payer: Nomi Health Commercial |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.23
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
OP
|
$59.61
|
|
|
Service Code
|
NDC 24357070107
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.84 |
| Max. Negotiated Rate |
$59.61 |
| Rate for Payer: Aetna Commercial |
$53.65
|
| Rate for Payer: Aetna Medicare |
$29.80
|
| Rate for Payer: ASR ASR |
$57.82
|
| Rate for Payer: ASR Commercial |
$57.82
|
| Rate for Payer: BCBS Complete |
$23.84
|
| Rate for Payer: BCBS Trust/PPO |
$48.81
|
| Rate for Payer: BCN Commercial |
$46.22
|
| Rate for Payer: Cash Price |
$47.69
|
| Rate for Payer: Cofinity Commercial |
$56.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.69
|
| Rate for Payer: Healthscope Commercial |
$59.61
|
| Rate for Payer: Healthscope Whirlpool |
$57.82
|
| Rate for Payer: Mclaren Commercial |
$53.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.67
|
| Rate for Payer: Nomi Health Commercial |
$48.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.23
|
| Rate for Payer: Priority Health Narrow Network |
$41.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.46
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$59.61
|
|
|
Service Code
|
NDC 24357070107
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.75 |
| Max. Negotiated Rate |
$59.61 |
| Rate for Payer: Aetna Commercial |
$53.65
|
| Rate for Payer: ASR ASR |
$57.82
|
| Rate for Payer: ASR Commercial |
$57.82
|
| Rate for Payer: BCBS Trust/PPO |
$48.58
|
| Rate for Payer: BCN Commercial |
$46.22
|
| Rate for Payer: Cash Price |
$47.69
|
| Rate for Payer: Cofinity Commercial |
$56.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.69
|
| Rate for Payer: Healthscope Commercial |
$59.61
|
| Rate for Payer: Healthscope Whirlpool |
$57.82
|
| Rate for Payer: Mclaren Commercial |
$53.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.67
|
| Rate for Payer: Nomi Health Commercial |
$48.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.46
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
OP
|
$10.49
|
|
|
Service Code
|
NDC 00496088205
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: Aetna Commercial |
$9.44
|
| Rate for Payer: Aetna Medicare |
$5.25
|
| Rate for Payer: ASR ASR |
$10.18
|
| Rate for Payer: ASR Commercial |
$10.18
|
| Rate for Payer: BCBS Complete |
$4.20
|
| Rate for Payer: BCBS Trust/PPO |
$8.59
|
| Rate for Payer: BCN Commercial |
$8.13
|
| Rate for Payer: Cash Price |
$8.39
|
| Rate for Payer: Cofinity Commercial |
$9.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.39
|
| Rate for Payer: Healthscope Commercial |
$10.49
|
| Rate for Payer: Healthscope Whirlpool |
$10.18
|
| Rate for Payer: Mclaren Commercial |
$9.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.92
|
| Rate for Payer: Nomi Health Commercial |
$8.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.19
|
| Rate for Payer: Priority Health Narrow Network |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.23
|
|
|
LINACLOTIDE 72 MCG CAPSULE
|
Facility
|
OP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120330
|
| Hospital Charge Code |
182047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$781.35 |
| Max. Negotiated Rate |
$1,953.38 |
| Rate for Payer: Aetna Commercial |
$1,758.04
|
| Rate for Payer: Aetna Medicare |
$976.69
|
| Rate for Payer: ASR ASR |
$1,894.78
|
| Rate for Payer: ASR Commercial |
$1,894.78
|
| Rate for Payer: BCBS Complete |
$781.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,599.62
|
| Rate for Payer: BCN Commercial |
$1,514.46
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,836.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,953.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,894.78
|
| Rate for Payer: Mclaren Commercial |
$1,758.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: Nomi Health Commercial |
$1,601.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,711.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,369.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,718.97
|
|
|
LINACLOTIDE 72 MCG CAPSULE
|
Facility
|
IP
|
$1,953.38
|
|
|
Service Code
|
NDC 00456120330
|
| Hospital Charge Code |
182047
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,269.70 |
| Max. Negotiated Rate |
$1,953.38 |
| Rate for Payer: Aetna Commercial |
$1,758.04
|
| Rate for Payer: ASR ASR |
$1,894.78
|
| Rate for Payer: ASR Commercial |
$1,894.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,591.81
|
| Rate for Payer: BCN Commercial |
$1,514.46
|
| Rate for Payer: Cash Price |
$1,562.70
|
| Rate for Payer: Cofinity Commercial |
$1,836.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,562.70
|
| Rate for Payer: Healthscope Commercial |
$1,953.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,894.78
|
| Rate for Payer: Mclaren Commercial |
$1,758.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.37
|
| Rate for Payer: Nomi Health Commercial |
$1,601.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,718.97
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
OP
|
$275.39
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.16 |
| Max. Negotiated Rate |
$275.39 |
| Rate for Payer: Aetna Commercial |
$247.85
|
| Rate for Payer: Aetna Medicare |
$137.69
|
| Rate for Payer: ASR ASR |
$267.13
|
| Rate for Payer: ASR Commercial |
$267.13
|
| Rate for Payer: BCBS Complete |
$110.16
|
| Rate for Payer: BCBS Trust/PPO |
$225.52
|
| Rate for Payer: BCN Commercial |
$213.51
|
| Rate for Payer: Cash Price |
$220.31
|
| Rate for Payer: Cofinity Commercial |
$258.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.31
|
| Rate for Payer: Healthscope Commercial |
$275.39
|
| Rate for Payer: Healthscope Whirlpool |
$267.13
|
| Rate for Payer: Mclaren Commercial |
$247.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.08
|
| Rate for Payer: Nomi Health Commercial |
$225.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.30
|
| Rate for Payer: Priority Health Narrow Network |
$193.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.34
|
|
|
LINEZOLID 600 MG TABLET
|
Facility
|
IP
|
$275.39
|
|
|
Service Code
|
NDC 00904655304
|
| Hospital Charge Code |
28224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$275.39 |
| Rate for Payer: Aetna Commercial |
$247.85
|
| Rate for Payer: ASR ASR |
$267.13
|
| Rate for Payer: ASR Commercial |
$267.13
|
| Rate for Payer: BCBS Trust/PPO |
$224.42
|
| Rate for Payer: BCN Commercial |
$213.51
|
| Rate for Payer: Cash Price |
$220.31
|
| Rate for Payer: Cofinity Commercial |
$258.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.31
|
| Rate for Payer: Healthscope Commercial |
$275.39
|
| Rate for Payer: Healthscope Whirlpool |
$267.13
|
| Rate for Payer: Mclaren Commercial |
$247.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.08
|
| Rate for Payer: Nomi Health Commercial |
$225.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.34
|
|
|
LIOTHYRONINE 5 MCG TABLET
|
Facility
|
IP
|
$245.28
|
|
|
Service Code
|
NDC 62756058988
|
| Hospital Charge Code |
10443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.43 |
| Max. Negotiated Rate |
$245.28 |
| Rate for Payer: Aetna Commercial |
$220.75
|
| Rate for Payer: ASR ASR |
$237.92
|
| Rate for Payer: ASR Commercial |
$237.92
|
| Rate for Payer: BCBS Trust/PPO |
$199.88
|
| Rate for Payer: BCN Commercial |
$190.17
|
| Rate for Payer: Cash Price |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$230.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.22
|
| Rate for Payer: Healthscope Commercial |
$245.28
|
| Rate for Payer: Healthscope Whirlpool |
$237.92
|
| Rate for Payer: Mclaren Commercial |
$220.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.49
|
| Rate for Payer: Nomi Health Commercial |
$201.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$215.85
|
|
