|
LIDOCAINE-COLLAGEN-ALOE VERA 2 % EX GEL [77011]
|
Facility
|
OP
|
$0.23
|
|
|
Service Code
|
NDC 66977010003
|
| Hospital Charge Code |
66977010003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.15
|
|
|
LIDOCAINE/EPINEPHRINE
|
Facility
|
IP
|
$7.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.94
|
|
|
LIDOCAINE/EPINEPHRINE
|
Facility
|
IP
|
$7.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.94
|
|
|
LIDOCAINE/EPINEPHRINE
|
Facility
|
OP
|
$7.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41640393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.94
|
| Rate for Payer: Aetna Government |
$3.94
|
| Rate for Payer: Brighton Health Commercial |
$4.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.53
|
| Rate for Payer: Group Health Inc Commercial |
$3.94
|
| Rate for Payer: Group Health Inc Medicare |
$2.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.12
|
|
|
LIDOCAINE/EPINEPHRINE
|
Facility
|
OP
|
$7.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
41650393
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$5.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.94
|
| Rate for Payer: Aetna Government |
$3.94
|
| Rate for Payer: Brighton Health Commercial |
$4.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.53
|
| Rate for Payer: Group Health Inc Commercial |
$3.94
|
| Rate for Payer: Group Health Inc Medicare |
$2.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.94
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.12
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 63323048217
|
| Hospital Charge Code |
63323048217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]
|
Facility
|
OP
|
$0.14
|
|
|
Service Code
|
NDC 00409317801
|
| Hospital Charge Code |
00409317801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 63323048203
|
| Hospital Charge Code |
63323048203
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]
|
Facility
|
OP
|
$0.42
|
|
|
Service Code
|
NDC 63323048201
|
| Hospital Charge Code |
63323048201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN [10427]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 63323048227
|
| Hospital Charge Code |
63323048227
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN [10428]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 63323048737
|
| Hospital Charge Code |
63323048737
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN [10428]
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 63323048707
|
| Hospital Charge Code |
63323048707
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
LIDOCAINE-EPINEPHRINE 1 %-1:200000 IJ SOLN [10428]
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 63323048717
|
| Hospital Charge Code |
63323048717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.64
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Brighton Health Commercial |
$0.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.93
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.79
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.41
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.76
|
|
|
LIDOCAINE-EPINEPHRINE 1.5 %-1:200000 IJ SOLN [10429]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
NDC 63323048801
|
| Hospital Charge Code |
63323048801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.63
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.58
|
| Rate for Payer: Aetna Government |
$0.58
|
| Rate for Payer: Brighton Health Commercial |
$0.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.92
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.58
|
| Rate for Payer: Group Health Inc Medicare |
$0.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.58
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.75
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 00409318201
|
| Hospital Charge Code |
00409318201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 00409318211
|
| Hospital Charge Code |
00409318211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 63323048303
|
| Hospital Charge Code |
63323048303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]
|
Facility
|
OP
|
$0.22
|
|
|
Service Code
|
NDC 63323048301
|
| Hospital Charge Code |
63323048301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.11
|
| Rate for Payer: Aetna Government |
$0.11
|
| Rate for Payer: Brighton Health Commercial |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.18
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.15
|
| Rate for Payer: Group Health Inc Commercial |
$0.11
|
| Rate for Payer: Group Health Inc Medicare |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.11
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.14
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN [10430]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 63323048327
|
| Hospital Charge Code |
63323048327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.19
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN [10431]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 63323048917
|
| Hospital Charge Code |
63323048917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.62
|
| Rate for Payer: Aetna Government |
$0.62
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.80
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN [10431]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 63323048902
|
| Hospital Charge Code |
63323048902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna Government |
$0.54
|
| Rate for Payer: Brighton Health Commercial |
$0.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: Group Health Inc Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN [10431]
|
Facility
|
OP
|
$1.09
|
|
|
Service Code
|
NDC 63323048927
|
| Hospital Charge Code |
63323048927
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.54
|
| Rate for Payer: Aetna Government |
$0.54
|
| Rate for Payer: Brighton Health Commercial |
$0.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.74
|
| Rate for Payer: Group Health Inc Commercial |
$0.54
|
| Rate for Payer: Group Health Inc Medicare |
$0.38
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.71
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN [10431]
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 63323048901
|
| Hospital Charge Code |
63323048901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.62
|
| Rate for Payer: Aetna Government |
$0.62
|
| Rate for Payer: Brighton Health Commercial |
$0.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.84
|
| Rate for Payer: Group Health Inc Commercial |
$0.62
|
| Rate for Payer: Group Health Inc Medicare |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.62
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.80
|
|
|
LIDOCAINE-EPINEPHRINE 2 %-1:200000 IJ SOLN [10431]
|
Facility
|
OP
|
$0.30
|
|
|
Service Code
|
NDC 00409318301
|
| Hospital Charge Code |
00409318301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.15
|
| Rate for Payer: Aetna Government |
$0.15
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.15
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
LIDOCAINE + EPINEPHRINE + TETRACAINE SOL
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
41643917
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
