|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$30.44
|
|
|
Service Code
|
NDC 00536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.96 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna Commercial |
$25.87
|
| Rate for Payer: Aetna Medicare |
$15.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.79
|
| Rate for Payer: BCBS Complete |
$12.18
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cofinity Advantage |
$21.31
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.83
|
| Rate for Payer: PHP Commercial |
$25.87
|
| Rate for Payer: Priority Health SBD |
$19.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.79
|
| Rate for Payer: UHC Core |
$15.86
|
| Rate for Payer: UHC Exchange |
$11.96
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
NDC 96295013458
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.17
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Advantage |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.04
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health SBD |
$11.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.17
|
| Rate for Payer: UHC Core |
$9.75
|
| Rate for Payer: UHC Exchange |
$7.36
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$30.44
|
|
|
Service Code
|
NDC 00536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna Commercial |
$25.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.79
|
| Rate for Payer: Cash Price |
$24.35
|
| Rate for Payer: Cofinity Advantage |
$21.31
|
| Rate for Payer: Cofinity Commercial |
$26.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.35
|
| Rate for Payer: Healthscope Commercial |
$27.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.83
|
| Rate for Payer: PHP Commercial |
$25.87
|
| Rate for Payer: Priority Health SBD |
$19.18
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$18.20
|
|
|
Service Code
|
NDC 00121097005
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Aetna Commercial |
$15.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.83
|
| Rate for Payer: Cash Price |
$14.56
|
| Rate for Payer: Cofinity Advantage |
$12.74
|
| Rate for Payer: Cofinity Commercial |
$15.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.56
|
| Rate for Payer: Healthscope Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.65
|
| Rate for Payer: PHP Commercial |
$15.47
|
| Rate for Payer: Priority Health SBD |
$11.47
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$3.64
|
|
|
Service Code
|
NDC 00121097001
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Advantage |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.73
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.37
|
| Rate for Payer: UHC Core |
$1.90
|
| Rate for Payer: UHC Exchange |
$1.43
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$3.64
|
|
|
Service Code
|
NDC 00121097001
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Advantage |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.73
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.29
|
|
|
LIDOCAINE 4 % WITH EPINEPHRINE TOPICAL SOLUTION
|
Facility
|
IP
|
$599.82
|
|
|
Service Code
|
NDC 09900000211
|
| Hospital Charge Code |
155018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$377.89 |
| Max. Negotiated Rate |
$539.84 |
| Rate for Payer: Aetna Commercial |
$509.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.88
|
| Rate for Payer: Cash Price |
$479.86
|
| Rate for Payer: Cofinity Advantage |
$419.87
|
| Rate for Payer: Cofinity Commercial |
$515.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.86
|
| Rate for Payer: Healthscope Commercial |
$539.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$509.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$449.87
|
| Rate for Payer: PHP Commercial |
$509.85
|
| Rate for Payer: Priority Health SBD |
$377.89
|
|
|
LIDOCAINE 4 % WITH EPINEPHRINE TOPICAL SOLUTION
|
Facility
|
OP
|
$599.82
|
|
|
Service Code
|
NDC 09900000211
|
| Hospital Charge Code |
155018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$235.73 |
| Max. Negotiated Rate |
$539.84 |
| Rate for Payer: Aetna Commercial |
$509.85
|
| Rate for Payer: Aetna Medicare |
$299.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.88
|
| Rate for Payer: BCBS Complete |
$239.93
|
| Rate for Payer: Cash Price |
$479.86
|
| Rate for Payer: Cofinity Advantage |
$419.87
|
| Rate for Payer: Cofinity Commercial |
$515.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.86
|
| Rate for Payer: Healthscope Commercial |
$539.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$479.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$509.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$449.87
|
| Rate for Payer: PHP Commercial |
$509.85
|
| Rate for Payer: Priority Health SBD |
$377.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.88
|
| Rate for Payer: UHC Core |
$312.51
|
| Rate for Payer: UHC Exchange |
$235.73
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 51672302002
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.38 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Medicare |
$48.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Advantage |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.47
|
| Rate for Payer: UHC Core |
$50.88
|
| Rate for Payer: UHC Exchange |
$38.38
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$89.69
|
|
|
Service Code
|
NDC 68462041820
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$80.72 |
| Rate for Payer: Aetna Commercial |
$76.24
|
| Rate for Payer: Aetna Medicare |
$44.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.30
|
| Rate for Payer: BCBS Complete |
$35.88
|
| Rate for Payer: Cash Price |
$71.75
|
| Rate for Payer: Cofinity Advantage |
$62.78
|
| Rate for Payer: Cofinity Commercial |
$77.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.75
|
| Rate for Payer: Healthscope Commercial |
$80.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.27
|
| Rate for Payer: PHP Commercial |
$76.24
|
| Rate for Payer: Priority Health SBD |
$56.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.30
|
| Rate for Payer: UHC Core |
$46.73
|
| Rate for Payer: UHC Exchange |
$35.25
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$89.69
|
|
|
Service Code
|
NDC 68462041820
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$80.72 |
| Rate for Payer: Aetna Commercial |
$76.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.30
|
| Rate for Payer: Cash Price |
$71.75
|
| Rate for Payer: Cofinity Advantage |
$62.78
|
| Rate for Payer: Cofinity Commercial |
$77.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.75
|
| Rate for Payer: Healthscope Commercial |
$80.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.27
|
| Rate for Payer: PHP Commercial |
$76.24
|
| Rate for Payer: Priority Health SBD |
$56.50
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$737.67
|
|
|
Service Code
|
NDC 00168020437
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$464.73 |
| Max. Negotiated Rate |
$663.90 |
| Rate for Payer: Aetna Commercial |
$627.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.49
|
| Rate for Payer: Cash Price |
$590.14
|
| Rate for Payer: Cofinity Advantage |
$516.37
|
| Rate for Payer: Cofinity Commercial |
$634.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.14
|
| Rate for Payer: Healthscope Commercial |
$663.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$553.25
|
| Rate for Payer: PHP Commercial |
$627.02
|
| Rate for Payer: Priority Health SBD |
$464.73
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$737.67
|
|
|
Service Code
|
NDC 00168020437
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.90 |
| Max. Negotiated Rate |
$663.90 |
| Rate for Payer: Aetna Commercial |
$627.02
|
| Rate for Payer: Aetna Medicare |
$368.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.49
|
| Rate for Payer: BCBS Complete |
$295.07
|
| Rate for Payer: Cash Price |
$590.14
|
| Rate for Payer: Cofinity Advantage |
$516.37
|
| Rate for Payer: Cofinity Commercial |
$634.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.14
|
| Rate for Payer: Healthscope Commercial |
$663.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$590.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$553.25
|
| Rate for Payer: PHP Commercial |
$627.02
|
| Rate for Payer: Priority Health SBD |
$464.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$479.49
|
| Rate for Payer: UHC Core |
$384.33
|
| Rate for Payer: UHC Exchange |
$289.90
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 51672302002
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.52 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Advantage |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.24
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health SBD |
$61.52
|
|
|
LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
14870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Commercial |
$26.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.40
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Cofinity Advantage |
$11.65
|
| Rate for Payer: Cofinity Advantage |
$21.97
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$26.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$28.24
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.54
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: PHP Commercial |
$26.67
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$19.77
|
|
|
LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$31.38
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
14870
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$28.24 |
| Rate for Payer: Aetna Commercial |
$26.67
|
| Rate for Payer: Aetna Commercial |
$14.15
|
| Rate for Payer: Aetna Medicare |
$15.69
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.40
|
| Rate for Payer: BCBS Complete |
$12.55
|
| Rate for Payer: BCBS Complete |
$6.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$13.32
|
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Cofinity Advantage |
$11.65
|
| Rate for Payer: Cofinity Advantage |
$21.97
|
| Rate for Payer: Cofinity Commercial |
$26.99
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.32
|
| Rate for Payer: Healthscope Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$28.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.54
|
| Rate for Payer: PHP Commercial |
$26.67
|
| Rate for Payer: PHP Commercial |
$14.15
|
| Rate for Payer: Priority Health SBD |
$10.49
|
| Rate for Payer: Priority Health SBD |
$19.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$38.05
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Commercial |
$33.82
|
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna Medicare |
$19.02
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.45
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS Complete |
$15.92
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cofinity Advantage |
$27.85
|
| Rate for Payer: Cofinity Advantage |
$26.64
|
| Rate for Payer: Cofinity Advantage |
$37.10
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Cofinity Commercial |
$34.22
|
| Rate for Payer: Cofinity Commercial |
$45.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Healthscope Commercial |
$35.81
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$33.82
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| Rate for Payer: Priority Health SBD |
$33.39
|
| Rate for Payer: Priority Health SBD |
$25.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$38.05
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Commercial |
$33.82
|
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.45
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$31.83
|
| Rate for Payer: Cofinity Advantage |
$26.64
|
| Rate for Payer: Cofinity Advantage |
$37.10
|
| Rate for Payer: Cofinity Advantage |
$27.85
|
| Rate for Payer: Cofinity Commercial |
$45.58
|
| Rate for Payer: Cofinity Commercial |
$34.22
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.83
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Healthscope Commercial |
$35.81
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.84
|
| Rate for Payer: PHP Commercial |
$33.82
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: Priority Health SBD |
$33.39
|
| Rate for Payer: Priority Health SBD |
$25.07
|
| Rate for Payer: Priority Health SBD |
$23.97
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15956
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.93 |
| Max. Negotiated Rate |
$35.61 |
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.72
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cofinity Advantage |
$27.70
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$35.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.68
|
| Rate for Payer: PHP Commercial |
$33.63
|
| Rate for Payer: Priority Health SBD |
$24.93
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15956
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$35.61 |
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna Medicare |
$19.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.72
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cofinity Advantage |
$27.70
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$35.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.68
|
| Rate for Payer: PHP Commercial |
$33.63
|
| Rate for Payer: Priority Health SBD |
$24.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$39.52
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.90 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$68.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.64
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Advantage |
$56.69
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$69.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$72.89
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.74
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$68.84
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$51.02
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$80.99
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$72.89 |
| Rate for Payer: Aetna Commercial |
$68.84
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Medicare |
$40.49
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.64
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cofinity Advantage |
$27.66
|
| Rate for Payer: Cofinity Advantage |
$56.69
|
| Rate for Payer: Cofinity Commercial |
$69.65
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$72.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.74
|
| Rate for Payer: PHP Commercial |
$68.84
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$51.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$14.21
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$12.79 |
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Commercial |
$20.71
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Medicare |
$8.47
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$6.38
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Aetna Medicare |
$7.11
|
| Rate for Payer: Aetna Medicare |
$13.41
|
| Rate for Payer: Aetna Medicare |
$12.21
|
| Rate for Payer: Aetna Medicare |
$12.18
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.29
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS Complete |
$5.68
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS Complete |
$9.74
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cofinity Advantage |
$18.78
|
| Rate for Payer: Cofinity Advantage |
$11.86
|
| Rate for Payer: Cofinity Advantage |
$9.95
|
| Rate for Payer: Cofinity Advantage |
$9.04
|
| Rate for Payer: Cofinity Advantage |
$13.30
|
| Rate for Payer: Cofinity Advantage |
$10.76
|
| Rate for Payer: Cofinity Advantage |
$8.93
|
| Rate for Payer: Cofinity Advantage |
$17.09
|
| Rate for Payer: Cofinity Advantage |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$20.95
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$12.79
|
| Rate for Payer: Healthscope Commercial |
$21.92
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.71
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$20.71
|
| Rate for Payer: PHP Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$12.08
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health SBD |
$15.35
|
| Rate for Payer: Priority Health SBD |
$10.67
|
| Rate for Payer: Priority Health SBD |
$8.04
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: Priority Health SBD |
$8.95
|
| Rate for Payer: Priority Health SBD |
$11.97
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$22.81
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$20.71
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.44
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$21.46
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cofinity Advantage |
$10.76
|
| Rate for Payer: Cofinity Advantage |
$8.93
|
| Rate for Payer: Cofinity Advantage |
$13.30
|
| Rate for Payer: Cofinity Advantage |
$9.04
|
| Rate for Payer: Cofinity Advantage |
$11.86
|
| Rate for Payer: Cofinity Advantage |
$9.95
|
| Rate for Payer: Cofinity Advantage |
$17.09
|
| Rate for Payer: Cofinity Advantage |
$18.78
|
| Rate for Payer: Cofinity Advantage |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$20.95
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$21.92
|
| Rate for Payer: Healthscope Commercial |
$12.79
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Healthscope Commercial |
$24.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.12
|
| Rate for Payer: PHP Commercial |
$20.71
|
| Rate for Payer: PHP Commercial |
$22.81
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: PHP Commercial |
$12.08
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health SBD |
$16.90
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: Priority Health SBD |
$8.04
|
| Rate for Payer: Priority Health SBD |
$10.67
|
| Rate for Payer: Priority Health SBD |
$15.35
|
| Rate for Payer: Priority Health SBD |
$11.97
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: Priority Health SBD |
$8.95
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION-DIALYSIS ONLY
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
NDC 55150025110
|
| Hospital Charge Code |
300842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Advantage |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health SBD |
$9.68
|
|
