|
LIDOCAINE HCL (PF) 1 % IJ SOLN
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
NDC 5515016102
|
| Hospital Charge Code |
5515016102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna Government |
$0.77
|
| Rate for Payer: Brighton Health Commercial |
$1.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.23
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.05
|
| Rate for Payer: EmblemHealth Commercial |
$0.77
|
| Rate for Payer: Group Health Inc Commercial |
$0.77
|
| Rate for Payer: Group Health Inc Medicare |
$0.54
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.77
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.77
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.00
|
|
|
LIDOCAINE HCL (PF) 1 % IJ SOLN
|
Facility
|
IP
|
$0.77
|
|
|
Service Code
|
NDC 0409471332
|
| Hospital Charge Code |
0409471332
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.39 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.39
|
|
|
LIDOCAINE HCL (PF) 1 % IJ SOLN
|
Facility
|
OP
|
$0.63
|
|
|
Service Code
|
NDC 6332349216
|
| Hospital Charge Code |
6332349216
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.32
|
| Rate for Payer: Aetna Government |
$0.32
|
| Rate for Payer: Brighton Health Commercial |
$0.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.43
|
| Rate for Payer: EmblemHealth Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Commercial |
$0.32
|
| Rate for Payer: Group Health Inc Medicare |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.41
|
|
|
LIDOCAINE HCL (PF) 1 % IJ SOLN
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
NDC 7329300011
|
| Hospital Charge Code |
7329300011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.32
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.30
|
| Rate for Payer: Aetna Government |
$0.30
|
| Rate for Payer: Brighton Health Commercial |
$0.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.47
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.40
|
| Rate for Payer: EmblemHealth Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Commercial |
$0.30
|
| Rate for Payer: Group Health Inc Medicare |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.38
|
|
|
LIDOCAINE HCL (PF) 1 % IJ SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
NDC 6332349237
|
| Hospital Charge Code |
6332349237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.24 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.24
|
|
|
LIDOCAINE HCL (PF) 1 % IJ SOLN
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6332349208
|
| Hospital Charge Code |
6332349208
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: EmblemHealth Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
NDC 5515016072
|
| Hospital Charge Code |
5515016072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 5515016505
|
| Hospital Charge Code |
5515016505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 0409428212
|
| Hospital Charge Code |
0409428212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 6332349697
|
| Hospital Charge Code |
6332349697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: EmblemHealth Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 6332349527
|
| Hospital Charge Code |
6332349527
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 6332349509
|
| Hospital Charge Code |
6332349509
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.88
|
| Rate for Payer: Aetna Government |
$0.88
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.20
|
| Rate for Payer: EmblemHealth Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$0.86
|
|
|
Service Code
|
NDC 6332349504
|
| Hospital Charge Code |
6332349504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$0.51
|
|
|
Service Code
|
NDC 0409428202
|
| Hospital Charge Code |
0409428202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.26 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 5515016402
|
| Hospital Charge Code |
5515016402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
OP
|
$0.86
|
|
|
Service Code
|
NDC 6332349507
|
| Hospital Charge Code |
6332349507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.43
|
| Rate for Payer: Aetna Government |
$0.43
|
| Rate for Payer: Brighton Health Commercial |
$0.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.69
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.59
|
| Rate for Payer: EmblemHealth Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Commercial |
$0.43
|
| Rate for Payer: Group Health Inc Medicare |
$0.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.56
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$0.83
|
|
|
Service Code
|
NDC 6332349697
|
| Hospital Charge Code |
6332349697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$0.83
|
|
|
Service Code
|
NDC 6332349603
|
| Hospital Charge Code |
6332349603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 0409428212
|
| Hospital Charge Code |
0409428212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Brighton Health Commercial |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: EmblemHealth Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 5515016505
|
| Hospital Charge Code |
5515016505
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: EmblemHealth Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$0.86
|
|
|
Service Code
|
NDC 6332349507
|
| Hospital Charge Code |
6332349507
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.43
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
NDC 5515016072
|
| Hospital Charge Code |
5515016072
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.56
|
| Rate for Payer: Aetna Government |
$0.56
|
| Rate for Payer: Brighton Health Commercial |
$0.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.90
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.77
|
| Rate for Payer: EmblemHealth Commercial |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.56
|
| Rate for Payer: Group Health Inc Medicare |
$0.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.73
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 5515016402
|
| Hospital Charge Code |
5515016402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.12
|
| Rate for Payer: Aetna Government |
$1.12
|
| Rate for Payer: Brighton Health Commercial |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Commercial |
$1.12
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.12
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.12
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.46
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
NDC 6332349509
|
| Hospital Charge Code |
6332349509
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$0.88 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
|
|
LIDOCAINE HCL (PF) 2 % IJ SOLN
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
NDC 6332349603
|
| Hospital Charge Code |
6332349603
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Brighton Health Commercial |
$0.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
| Rate for Payer: EmblemHealth Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
