|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
OP
|
$130.20
|
|
|
Service Code
|
NDC 00054350547
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.17 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: Aetna Medicare |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.63
|
| Rate for Payer: BCBS Complete |
$52.08
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Advantage |
$91.14
|
| Rate for Payer: Cofinity Commercial |
$111.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Healthscope Commercial |
$117.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health SBD |
$82.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.63
|
| Rate for Payer: UHC Core |
$67.83
|
| Rate for Payer: UHC Exchange |
$51.17
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
OP
|
$76.83
|
|
|
Service Code
|
NDC 00527600480
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna Medicare |
$38.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.94
|
| Rate for Payer: BCBS Complete |
$30.73
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Advantage |
$53.78
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Healthscope Commercial |
$69.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: Priority Health SBD |
$48.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.94
|
| Rate for Payer: UHC Core |
$40.03
|
| Rate for Payer: UHC Exchange |
$30.19
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
IP
|
$125.11
|
|
|
Service Code
|
NDC 76329630005
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.82 |
| Max. Negotiated Rate |
$112.60 |
| Rate for Payer: Aetna Commercial |
$106.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.32
|
| Rate for Payer: Cash Price |
$100.09
|
| Rate for Payer: Cofinity Advantage |
$87.58
|
| Rate for Payer: Cofinity Commercial |
$107.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.09
|
| Rate for Payer: Healthscope Commercial |
$112.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.83
|
| Rate for Payer: PHP Commercial |
$106.34
|
| Rate for Payer: Priority Health SBD |
$78.82
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
OP
|
$125.11
|
|
|
Service Code
|
NDC 76329630005
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.17 |
| Max. Negotiated Rate |
$112.60 |
| Rate for Payer: Aetna Commercial |
$106.34
|
| Rate for Payer: Aetna Medicare |
$62.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.32
|
| Rate for Payer: BCBS Complete |
$50.04
|
| Rate for Payer: Cash Price |
$100.09
|
| Rate for Payer: Cofinity Advantage |
$87.58
|
| Rate for Payer: Cofinity Commercial |
$107.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.09
|
| Rate for Payer: Healthscope Commercial |
$112.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$100.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.83
|
| Rate for Payer: PHP Commercial |
$106.34
|
| Rate for Payer: Priority Health SBD |
$78.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.32
|
| Rate for Payer: UHC Core |
$65.18
|
| Rate for Payer: UHC Exchange |
$49.17
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Advantage |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health SBD |
$23.83
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
OP
|
$37.83
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Medicare |
$18.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: BCBS Complete |
$15.13
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Advantage |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.26
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health SBD |
$23.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.91
|
| Rate for Payer: UHC Core |
$18.91
|
| Rate for Payer: UHC Exchange |
$18.91
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$26.91
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$24.22 |
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: BCBS Complete |
$10.32
|
| 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: Cash Price |
$20.63
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Advantage |
$18.05
|
| Rate for Payer: Cofinity Advantage |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: PHP Commercial |
$21.92
|
| Rate for Payer: Priority Health SBD |
$16.25
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| 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 Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$25.79
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Advantage |
$18.05
|
| Rate for Payer: Cofinity Advantage |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PHP Commercial |
$21.92
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: Priority Health SBD |
$16.25
|
| Rate for Payer: Priority Health SBD |
$16.95
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$25.79
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.76
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Advantage |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: PHP Commercial |
$21.92
|
| Rate for Payer: Priority Health SBD |
$16.25
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$25.79
|
|
|
Service Code
|
NDC 00409490311
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.76
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Advantage |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: PHP Commercial |
$21.92
|
| Rate for Payer: Priority Health SBD |
$16.25
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$26.91
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$24.22 |
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Advantage |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.49
|
| Rate for Payer: UHC Core |
$14.02
|
| Rate for Payer: UHC Exchange |
$10.58
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$26.91
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$24.22 |
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Advantage |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: Priority Health SBD |
$16.95
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$25.79
|
|
|
Service Code
|
NDC 00409490311
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.76
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Advantage |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: PHP Commercial |
$21.92
|
| Rate for Payer: Priority Health SBD |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$13.44
|
| Rate for Payer: UHC Exchange |
$10.14
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$25.79
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.76
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Advantage |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: PHP Commercial |
$21.92
|
| Rate for Payer: Priority Health SBD |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$13.44
|
| Rate for Payer: UHC Exchange |
$10.14
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$21.98
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Medicare |
$10.99
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: Aetna Medicare |
$8.70
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS Complete |
$4.87
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Complete |
$8.79
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Complete |
$8.09
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS Complete |
$5.72
|
| Rate for Payer: BCBS Complete |
$10.82
|
| 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: 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: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cofinity Advantage |
$11.41
|
| Rate for Payer: Cofinity Advantage |
$8.53
|
| Rate for Payer: Cofinity Advantage |
$8.22
|
| Rate for Payer: Cofinity Advantage |
$15.39
|
| Rate for Payer: Cofinity Advantage |
$12.18
|
| Rate for Payer: Cofinity Advantage |
$17.75
|
| Rate for Payer: Cofinity Advantage |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$14.16
|
| Rate for Payer: Cofinity Advantage |
$18.93
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Advantage |
$10.66
|
| Rate for Payer: Cofinity Advantage |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$10.47
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$18.90
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$10.57
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$12.86
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Healthscope Commercial |
$19.78
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: PHP Commercial |
$12.15
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$10.35
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$18.68
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: Priority Health SBD |
$10.27
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: Priority Health SBD |
$12.74
|
| Rate for Payer: Priority Health SBD |
$13.85
|
| Rate for Payer: Priority Health SBD |
$7.67
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| 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 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 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
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$10.65
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.71 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$17.20
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$18.68
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$16.18
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cofinity Advantage |
$12.18
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Advantage |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$15.39
|
| Rate for Payer: Cofinity Advantage |
$8.22
|
| Rate for Payer: Cofinity Advantage |
$8.53
|
| Rate for Payer: Cofinity Advantage |
$10.66
|
| Rate for Payer: Cofinity Advantage |
$14.16
|
| Rate for Payer: Cofinity Advantage |
$11.41
|
| Rate for Payer: Cofinity Advantage |
$10.00
|
| Rate for Payer: Cofinity Advantage |
$18.93
|
| Rate for Payer: Cofinity Advantage |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$10.47
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$10.11
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$18.90
|
| Rate for Payer: Cofinity Commercial |
$17.40
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$19.78
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$12.86
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$10.57
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$18.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.42
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$17.20
|
| Rate for Payer: PHP Commercial |
$18.68
|
| Rate for Payer: PHP Commercial |
$12.15
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$10.35
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: Priority Health SBD |
$13.85
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: Priority Health SBD |
$7.67
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: Priority Health SBD |
$10.27
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$12.74
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$9.59
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$26.25
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$23.62 |
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.62
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cofinity Advantage |
$19.89
|
| Rate for Payer: Cofinity Advantage |
$20.19
|
| Rate for Payer: Cofinity Advantage |
$12.52
|
| Rate for Payer: Cofinity Advantage |
$9.04
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Advantage |
$8.48
|
| Rate for Payer: Cofinity Advantage |
$9.19
|
| Rate for Payer: Cofinity Advantage |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Cofinity Commercial |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Commercial |
$22.31
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: Priority Health SBD |
$7.63
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: Priority Health SBD |
$8.24
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$11.26
|
| Rate for Payer: Priority Health SBD |
$8.13
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$12.91
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$22.31
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna Medicare |
$6.46
|
| Rate for Payer: Aetna Medicare |
$6.54
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Aetna Medicare |
$14.21
|
| Rate for Payer: Aetna Medicare |
$13.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.06
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: BCBS Complete |
$11.37
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS Complete |
$5.23
|
| Rate for Payer: BCBS Complete |
$10.50
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$7.15
|
| 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: 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 |
$10.33
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$10.46
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Advantage |
$8.48
|
| Rate for Payer: Cofinity Advantage |
$18.38
|
| Rate for Payer: Cofinity Advantage |
$9.16
|
| Rate for Payer: Cofinity Advantage |
$20.19
|
| Rate for Payer: Cofinity Advantage |
$9.04
|
| Rate for Payer: Cofinity Advantage |
$9.19
|
| Rate for Payer: Cofinity Advantage |
$12.52
|
| Rate for Payer: Cofinity Advantage |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$22.57
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$15.38
|
| Rate for Payer: Cofinity Commercial |
$11.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.00
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$11.77
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Healthscope Commercial |
$16.09
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.85
|
| Rate for Payer: PHP Commercial |
$11.12
|
| Rate for Payer: PHP Commercial |
$15.20
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$22.31
|
| Rate for Payer: Priority Health SBD |
$8.13
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$16.54
|
| Rate for Payer: Priority Health SBD |
$8.24
|
| Rate for Payer: Priority Health SBD |
$11.26
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Priority Health SBD |
$7.63
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| 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 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 (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.88
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Aetna Commercial |
$17.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.66
|
| Rate for Payer: PHP Commercial |
$17.75
|
| Rate for Payer: Priority Health SBD |
$13.15
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.88
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Aetna Commercial |
$17.75
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.07
|
| Rate for Payer: BCN Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$18.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.66
|
| Rate for Payer: PHP Commercial |
$17.75
|
| Rate for Payer: Priority Health SBD |
$13.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
OP
|
$36.72
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$18.36
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: BCBS Complete |
$14.69
|
| Rate for Payer: BCBS Complete |
$8.50
|
| 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: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Advantage |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.54
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: Priority Health SBD |
$23.13
|
| 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 Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
|
|
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 |
$13.38 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.87
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$29.38
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Advantage |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Cofinity Commercial |
$31.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$33.05
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.54
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: PHP Commercial |
$31.21
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: Priority Health SBD |
$23.13
|
|
|
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 |
$8.35 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.81
|
| Rate for Payer: UHC Core |
$11.07
|
| Rate for Payer: UHC Exchange |
$8.35
|
|
|
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 |
$13.38 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$37.83
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.83 |
| Max. Negotiated Rate |
$34.05 |
| Rate for Payer: Aetna Commercial |
$32.16
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.59
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$30.26
|
| Rate for Payer: Cofinity Advantage |
$26.48
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| 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 |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$34.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$32.16
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: Priority Health SBD |
$23.83
|
|
