|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$572.99
|
|
|
Service Code
|
NDC 70512001430
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$398.80 |
| Max. Negotiated Rate |
$515.69 |
| Rate for Payer: Aetna Commercial |
$487.04
|
| Rate for Payer: BCBS Trust/PPO |
$473.23
|
| Rate for Payer: BCN Commercial |
$473.23
|
| Rate for Payer: Cash Price |
$458.39
|
| Rate for Payer: Cofinity Commercial |
$492.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.39
|
| Rate for Payer: Healthscope Commercial |
$515.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.04
|
| Rate for Payer: Nomi Health Commercial |
$469.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.74
|
| Rate for Payer: PHP Commercial |
$487.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.23
|
| Rate for Payer: UHC Core |
$478.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.74
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$104.84
|
|
|
Service Code
|
NDC 00121097030
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$94.36 |
| Rate for Payer: Aetna Commercial |
$89.11
|
| Rate for Payer: BCBS Trust/PPO |
$86.59
|
| Rate for Payer: BCN Commercial |
$86.59
|
| Rate for Payer: Cash Price |
$83.87
|
| Rate for Payer: Cofinity Commercial |
$90.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.87
|
| Rate for Payer: Healthscope Commercial |
$94.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.11
|
| Rate for Payer: Nomi Health Commercial |
$85.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.63
|
| Rate for Payer: PHP Commercial |
$89.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.26
|
| Rate for Payer: UHC Core |
$87.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.63
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$20.79
|
|
|
Service Code
|
NDC 70000036601
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.47 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$17.17
|
| Rate for Payer: BCN Commercial |
$17.17
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$17.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.30
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
NDC 96295013458
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Medicare |
$4.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$3.47
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCN Commercial |
$15.39
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Mclaren Medicaid |
$3.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: Meridian Medicaid |
$3.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.04
|
| Rate for Payer: PACE Senior Care Partners |
$4.45
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Medicare |
$4.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.03
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Medicaid |
$3.30
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: UHCCP Medicaid |
$3.30
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$405.12
|
|
|
Service Code
|
NDC 00536120229
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.42 |
| Max. Negotiated Rate |
$364.61 |
| Rate for Payer: Aetna Commercial |
$344.35
|
| Rate for Payer: Aetna Medicare |
$105.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$126.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$126.60
|
| Rate for Payer: BCBS Complete |
$74.99
|
| Rate for Payer: BCBS MAPPO |
$101.28
|
| Rate for Payer: BCBS Trust/PPO |
$333.05
|
| Rate for Payer: BCN Commercial |
$333.05
|
| Rate for Payer: BCN Medicare Advantage |
$101.28
|
| Rate for Payer: Cash Price |
$324.10
|
| Rate for Payer: Cofinity Commercial |
$348.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.28
|
| Rate for Payer: Healthscope Commercial |
$364.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$303.84
|
| Rate for Payer: Mclaren Medicaid |
$71.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.34
|
| Rate for Payer: Meridian Medicaid |
$74.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$344.35
|
| Rate for Payer: Nomi Health Commercial |
$332.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.84
|
| Rate for Payer: PACE Senior Care Partners |
$96.22
|
| Rate for Payer: PACE SWMI |
$101.28
|
| Rate for Payer: PHP Commercial |
$344.35
|
| Rate for Payer: PHP Medicare Advantage |
$101.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$352.45
|
| Rate for Payer: Priority Health Medicare |
$102.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$281.96
|
| Rate for Payer: Railroad Medicare Medicare |
$101.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$356.51
|
| Rate for Payer: UHC Core |
$338.28
|
| Rate for Payer: UHC Exchange |
$101.28
|
| Rate for Payer: UHC Medicaid |
$71.42
|
| Rate for Payer: UHC Medicare Advantage |
$101.28
|
| Rate for Payer: UHCCP Medicaid |
$71.42
|
| Rate for Payer: VA VA |
$101.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$303.84
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$145.59
|
|
|
Service Code
|
NDC 00536120207
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.33 |
| Max. Negotiated Rate |
$131.03 |
| Rate for Payer: Aetna Commercial |
$123.75
|
| Rate for Payer: BCBS Trust/PPO |
$120.24
|
| Rate for Payer: BCN Commercial |
$120.24
|
| Rate for Payer: Cash Price |
$116.47
|
| Rate for Payer: Cofinity Commercial |
$125.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.47
|
| Rate for Payer: Healthscope Commercial |
$131.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.75
|
| Rate for Payer: Nomi Health Commercial |
$119.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.19
|
| Rate for Payer: PHP Commercial |
$123.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.12
|
| Rate for Payer: UHC Core |
$121.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.19
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$104.84
|
|
|
Service Code
|
NDC 00121097030
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$94.36 |
| Rate for Payer: Aetna Commercial |
$89.11
|
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.76
|
| Rate for Payer: BCBS Complete |
$19.41
|
| Rate for Payer: BCBS MAPPO |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$86.19
|
| Rate for Payer: BCN Commercial |
$86.19
|
| Rate for Payer: BCN Medicare Advantage |
$26.21
|
| Rate for Payer: Cash Price |
$83.87
|
| Rate for Payer: Cofinity Commercial |
$90.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.21
|
| Rate for Payer: Healthscope Commercial |
$94.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.63
|
| Rate for Payer: Mclaren Medicaid |
$18.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.52
|
| Rate for Payer: Meridian Medicaid |
$19.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.11
|
| Rate for Payer: Nomi Health Commercial |
$85.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.63
|
| Rate for Payer: PACE Senior Care Partners |
$24.90
|
| Rate for Payer: PACE SWMI |
$26.21
|
| Rate for Payer: PHP Commercial |
$89.11
|
| Rate for Payer: PHP Medicare Advantage |
$26.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.21
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.97
|
| Rate for Payer: Railroad Medicare Medicare |
$26.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.26
|
| Rate for Payer: UHC Core |
$87.54
|
| Rate for Payer: UHC Exchange |
$26.21
|
| Rate for Payer: UHC Medicaid |
$18.48
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: UHCCP Medicaid |
$18.48
|
| Rate for Payer: VA VA |
$26.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.63
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$20.79
|
|
|
Service Code
|
NDC 70000036601
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$18.71 |
| Rate for Payer: Aetna Commercial |
$17.67
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.50
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS MAPPO |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCN Commercial |
$17.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.20
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cofinity Commercial |
$17.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.20
|
| Rate for Payer: Healthscope Commercial |
$18.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.46
|
| Rate for Payer: Meridian Medicaid |
$3.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$17.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.59
|
| Rate for Payer: PACE Senior Care Partners |
$4.94
|
| Rate for Payer: PACE SWMI |
$5.20
|
| Rate for Payer: PHP Commercial |
$17.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.09
|
| Rate for Payer: Priority Health Medicare |
$5.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.47
|
| Rate for Payer: Railroad Medicare Medicare |
$5.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.30
|
| Rate for Payer: UHC Core |
$17.36
|
| Rate for Payer: UHC Exchange |
$5.20
|
| Rate for Payer: UHC Medicaid |
$3.67
|
| Rate for Payer: UHC Medicare Advantage |
$5.20
|
| Rate for Payer: UHCCP Medicaid |
$3.67
|
| Rate for Payer: VA VA |
$5.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$572.99
|
|
|
Service Code
|
NDC 70512001430
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.02 |
| Max. Negotiated Rate |
$515.69 |
| Rate for Payer: Aetna Commercial |
$487.04
|
| Rate for Payer: Aetna Medicare |
$148.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$179.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$179.06
|
| Rate for Payer: BCBS Complete |
$106.06
|
| Rate for Payer: BCBS MAPPO |
$143.25
|
| Rate for Payer: BCBS Trust/PPO |
$471.06
|
| Rate for Payer: BCN Commercial |
$471.06
|
| Rate for Payer: BCN Medicare Advantage |
$143.25
|
| Rate for Payer: Cash Price |
$458.39
|
| Rate for Payer: Cofinity Commercial |
$492.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$458.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.25
|
| Rate for Payer: Healthscope Commercial |
$515.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$429.74
|
| Rate for Payer: Mclaren Medicaid |
$101.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.41
|
| Rate for Payer: Meridian Medicaid |
$106.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$164.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$487.04
|
| Rate for Payer: Nomi Health Commercial |
$469.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$429.74
|
| Rate for Payer: PACE Senior Care Partners |
$136.09
|
| Rate for Payer: PACE SWMI |
$143.25
|
| Rate for Payer: PHP Commercial |
$487.04
|
| Rate for Payer: PHP Medicare Advantage |
$143.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$498.50
|
| Rate for Payer: Priority Health Medicare |
$144.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$398.80
|
| Rate for Payer: Railroad Medicare Medicare |
$143.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$504.23
|
| Rate for Payer: UHC Core |
$478.45
|
| Rate for Payer: UHC Exchange |
$143.25
|
| Rate for Payer: UHC Medicaid |
$101.02
|
| Rate for Payer: UHC Medicare Advantage |
$143.25
|
| Rate for Payer: UHCCP Medicaid |
$101.02
|
| Rate for Payer: VA VA |
$143.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$429.74
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$145.59
|
|
|
Service Code
|
NDC 00536120207
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$131.03 |
| Rate for Payer: Aetna Commercial |
$123.75
|
| Rate for Payer: Aetna Medicare |
$37.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.50
|
| Rate for Payer: BCBS Complete |
$26.95
|
| Rate for Payer: BCBS MAPPO |
$36.40
|
| Rate for Payer: BCBS Trust/PPO |
$119.69
|
| Rate for Payer: BCN Commercial |
$119.69
|
| Rate for Payer: BCN Medicare Advantage |
$36.40
|
| Rate for Payer: Cash Price |
$116.47
|
| Rate for Payer: Cofinity Commercial |
$125.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.40
|
| Rate for Payer: Healthscope Commercial |
$131.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.19
|
| Rate for Payer: Mclaren Medicaid |
$25.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.22
|
| Rate for Payer: Meridian Medicaid |
$26.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.75
|
| Rate for Payer: Nomi Health Commercial |
$119.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.19
|
| Rate for Payer: PACE Senior Care Partners |
$34.58
|
| Rate for Payer: PACE SWMI |
$36.40
|
| Rate for Payer: PHP Commercial |
$123.75
|
| Rate for Payer: PHP Medicare Advantage |
$36.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.66
|
| Rate for Payer: Priority Health Medicare |
$36.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.33
|
| Rate for Payer: Railroad Medicare Medicare |
$36.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.12
|
| Rate for Payer: UHC Core |
$121.57
|
| Rate for Payer: UHC Exchange |
$36.40
|
| Rate for Payer: UHC Medicaid |
$25.67
|
| Rate for Payer: UHC Medicare Advantage |
$36.40
|
| Rate for Payer: UHCCP Medicaid |
$25.67
|
| Rate for Payer: VA VA |
$36.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.19
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$45.36
|
|
|
Service Code
|
NDC 41167005840
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.18
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$11.34
|
| Rate for Payer: BCBS Trust/PPO |
$37.29
|
| Rate for Payer: BCN Commercial |
$37.29
|
| Rate for Payer: BCN Medicare Advantage |
$11.34
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.02
|
| Rate for Payer: Mclaren Medicaid |
$8.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.91
|
| Rate for Payer: Meridian Medicaid |
$8.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$37.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.77
|
| Rate for Payer: PACE SWMI |
$11.34
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: PHP Medicare Advantage |
$11.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.46
|
| Rate for Payer: Priority Health Medicare |
$11.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.57
|
| Rate for Payer: Railroad Medicare Medicare |
$11.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.92
|
| Rate for Payer: UHC Core |
$37.88
|
| Rate for Payer: UHC Exchange |
$11.34
|
| Rate for Payer: UHC Medicaid |
$8.00
|
| Rate for Payer: UHC Medicare Advantage |
$11.34
|
| Rate for Payer: UHCCP Medicaid |
$8.00
|
| Rate for Payer: VA VA |
$11.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$45.36
|
|
|
Service Code
|
NDC 41167005840
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.57 |
| Max. Negotiated Rate |
$40.82 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: BCBS Trust/PPO |
$37.46
|
| Rate for Payer: BCN Commercial |
$37.46
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$39.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$40.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$37.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.02
|
| Rate for Payer: PHP Commercial |
$38.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.92
|
| Rate for Payer: UHC Core |
$37.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
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 |
$417.47 |
| Max. Negotiated Rate |
$539.84 |
| Rate for Payer: Aetna Commercial |
$509.85
|
| Rate for Payer: BCBS Trust/PPO |
$495.39
|
| Rate for Payer: BCN Commercial |
$495.39
|
| Rate for Payer: Cash Price |
$479.86
|
| 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: Lakeland Regional Health Systems Commercial |
$449.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$509.85
|
| Rate for Payer: Nomi Health Commercial |
$491.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$449.87
|
| Rate for Payer: PHP Commercial |
$509.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$521.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$417.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.84
|
| Rate for Payer: UHC Core |
$500.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$449.87
|
|
|
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 |
$105.75 |
| Max. Negotiated Rate |
$539.84 |
| Rate for Payer: Aetna Commercial |
$509.85
|
| Rate for Payer: Aetna Medicare |
$155.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$187.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$187.44
|
| Rate for Payer: BCBS Complete |
$111.03
|
| Rate for Payer: BCBS MAPPO |
$149.96
|
| Rate for Payer: BCBS Trust/PPO |
$493.11
|
| Rate for Payer: BCN Commercial |
$493.11
|
| Rate for Payer: BCN Medicare Advantage |
$149.96
|
| Rate for Payer: Cash Price |
$479.86
|
| Rate for Payer: Cofinity Commercial |
$515.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.96
|
| Rate for Payer: Healthscope Commercial |
$539.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$449.87
|
| Rate for Payer: Mclaren Medicaid |
$105.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.45
|
| Rate for Payer: Meridian Medicaid |
$111.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$164.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$509.85
|
| Rate for Payer: Nomi Health Commercial |
$491.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$449.87
|
| Rate for Payer: PACE Senior Care Partners |
$142.46
|
| Rate for Payer: PACE SWMI |
$149.96
|
| Rate for Payer: PHP Commercial |
$509.85
|
| Rate for Payer: PHP Medicare Advantage |
$149.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$521.84
|
| Rate for Payer: Priority Health Medicare |
$151.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$417.47
|
| Rate for Payer: Railroad Medicare Medicare |
$149.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$527.84
|
| Rate for Payer: UHC Core |
$500.85
|
| Rate for Payer: UHC Exchange |
$149.96
|
| Rate for Payer: UHC Medicaid |
$105.75
|
| Rate for Payer: UHC Medicare Advantage |
$149.96
|
| Rate for Payer: UHCCP Medicaid |
$105.75
|
| Rate for Payer: VA VA |
$149.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$449.87
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$81.38
|
|
|
Service Code
|
NDC 51672302009
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$69.17
|
| Rate for Payer: BCBS Trust/PPO |
$67.21
|
| Rate for Payer: BCN Commercial |
$67.21
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.10
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.17
|
| Rate for Payer: Nomi Health Commercial |
$66.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.03
|
| Rate for Payer: PHP Commercial |
$69.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.61
|
| Rate for Payer: UHC Core |
$67.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.03
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$737.67
|
|
|
Service Code
|
NDC 00168020437
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.05 |
| Max. Negotiated Rate |
$663.90 |
| Rate for Payer: Aetna Commercial |
$627.02
|
| Rate for Payer: Aetna Medicare |
$191.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$230.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$230.52
|
| Rate for Payer: BCBS Complete |
$136.54
|
| Rate for Payer: BCBS MAPPO |
$184.42
|
| Rate for Payer: BCBS Trust/PPO |
$606.44
|
| Rate for Payer: BCN Commercial |
$606.44
|
| Rate for Payer: BCN Medicare Advantage |
$184.42
|
| Rate for Payer: Cash Price |
$590.14
|
| Rate for Payer: Cofinity Commercial |
$634.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$590.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.42
|
| Rate for Payer: Healthscope Commercial |
$663.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$553.25
|
| Rate for Payer: Mclaren Medicaid |
$130.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.64
|
| Rate for Payer: Meridian Medicaid |
$136.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$202.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.02
|
| Rate for Payer: Nomi Health Commercial |
$604.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$553.25
|
| Rate for Payer: PACE Senior Care Partners |
$175.20
|
| Rate for Payer: PACE SWMI |
$184.42
|
| Rate for Payer: PHP Commercial |
$627.02
|
| Rate for Payer: PHP Medicare Advantage |
$184.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$641.77
|
| Rate for Payer: Priority Health Medicare |
$186.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.42
|
| Rate for Payer: Railroad Medicare Medicare |
$184.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$649.15
|
| Rate for Payer: UHC Core |
$615.95
|
| Rate for Payer: UHC Exchange |
$184.42
|
| Rate for Payer: UHC Medicaid |
$130.05
|
| Rate for Payer: UHC Medicare Advantage |
$184.42
|
| Rate for Payer: UHCCP Medicaid |
$130.05
|
| Rate for Payer: VA VA |
$184.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.25
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$32.50
|
|
|
Service Code
|
NDC 33342040535
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.62 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: BCBS Trust/PPO |
$26.84
|
| Rate for Payer: BCN Commercial |
$26.84
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.00
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: Nomi Health Commercial |
$26.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.38
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.60
|
| Rate for Payer: UHC Core |
$27.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.38
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$32.50
|
|
|
Service Code
|
NDC 33342040535
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$27.62
|
| Rate for Payer: Aetna Medicare |
$8.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.16
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: BCBS MAPPO |
$8.12
|
| Rate for Payer: BCBS Trust/PPO |
$26.72
|
| Rate for Payer: BCN Commercial |
$26.72
|
| Rate for Payer: BCN Medicare Advantage |
$8.12
|
| Rate for Payer: Cash Price |
$26.00
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.12
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.38
|
| Rate for Payer: Mclaren Medicaid |
$5.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.53
|
| Rate for Payer: Meridian Medicaid |
$6.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.62
|
| Rate for Payer: Nomi Health Commercial |
$26.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.38
|
| Rate for Payer: PACE Senior Care Partners |
$7.72
|
| Rate for Payer: PACE SWMI |
$8.12
|
| Rate for Payer: PHP Commercial |
$27.62
|
| Rate for Payer: PHP Medicare Advantage |
$8.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.27
|
| Rate for Payer: Priority Health Medicare |
$8.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.60
|
| Rate for Payer: UHC Core |
$27.14
|
| Rate for Payer: UHC Exchange |
$8.12
|
| Rate for Payer: UHC Medicaid |
$5.73
|
| Rate for Payer: UHC Medicare Advantage |
$8.12
|
| Rate for Payer: UHCCP Medicaid |
$5.73
|
| Rate for Payer: VA VA |
$8.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.38
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$28.66
|
|
|
Service Code
|
NDC 70752011303
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.95 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna Commercial |
$24.36
|
| Rate for Payer: BCBS Trust/PPO |
$23.67
|
| Rate for Payer: BCN Commercial |
$23.67
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$24.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.93
|
| Rate for Payer: Healthscope Commercial |
$25.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.36
|
| Rate for Payer: Nomi Health Commercial |
$23.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.50
|
| Rate for Payer: PHP Commercial |
$24.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.22
|
| Rate for Payer: UHC Core |
$23.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.50
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$81.38
|
|
|
Service Code
|
NDC 51672302009
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.35 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$69.17
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.43
|
| Rate for Payer: BCBS Complete |
$15.06
|
| Rate for Payer: BCBS MAPPO |
$20.34
|
| Rate for Payer: BCBS Trust/PPO |
$66.90
|
| Rate for Payer: BCN Commercial |
$66.90
|
| Rate for Payer: BCN Medicare Advantage |
$20.34
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cofinity Commercial |
$69.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.34
|
| Rate for Payer: Healthscope Commercial |
$73.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.03
|
| Rate for Payer: Mclaren Medicaid |
$14.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.36
|
| Rate for Payer: Meridian Medicaid |
$15.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.17
|
| Rate for Payer: Nomi Health Commercial |
$66.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.03
|
| Rate for Payer: PACE Senior Care Partners |
$19.33
|
| Rate for Payer: PACE SWMI |
$20.34
|
| Rate for Payer: PHP Commercial |
$69.17
|
| Rate for Payer: PHP Medicare Advantage |
$20.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$70.80
|
| Rate for Payer: Priority Health Medicare |
$20.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.64
|
| Rate for Payer: Railroad Medicare Medicare |
$20.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.61
|
| Rate for Payer: UHC Core |
$67.95
|
| Rate for Payer: UHC Exchange |
$20.34
|
| Rate for Payer: UHC Medicaid |
$14.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.34
|
| Rate for Payer: UHCCP Medicaid |
$14.35
|
| Rate for Payer: VA VA |
$20.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.03
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$28.66
|
|
|
Service Code
|
NDC 70752011303
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.05 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Aetna Commercial |
$24.36
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.96
|
| Rate for Payer: BCBS Complete |
$5.30
|
| Rate for Payer: BCBS MAPPO |
$7.17
|
| Rate for Payer: BCBS Trust/PPO |
$23.56
|
| Rate for Payer: BCN Commercial |
$23.56
|
| Rate for Payer: BCN Medicare Advantage |
$7.17
|
| Rate for Payer: Cash Price |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$24.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.17
|
| Rate for Payer: Healthscope Commercial |
$25.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.50
|
| Rate for Payer: Mclaren Medicaid |
$5.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.52
|
| Rate for Payer: Meridian Medicaid |
$5.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.36
|
| Rate for Payer: Nomi Health Commercial |
$23.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.50
|
| Rate for Payer: PACE Senior Care Partners |
$6.81
|
| Rate for Payer: PACE SWMI |
$7.17
|
| Rate for Payer: PHP Commercial |
$24.36
|
| Rate for Payer: PHP Medicare Advantage |
$7.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.93
|
| Rate for Payer: Priority Health Medicare |
$7.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.95
|
| Rate for Payer: Railroad Medicare Medicare |
$7.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.22
|
| Rate for Payer: UHC Core |
$23.93
|
| Rate for Payer: UHC Exchange |
$7.17
|
| Rate for Payer: UHC Medicaid |
$5.05
|
| Rate for Payer: UHC Medicare Advantage |
$7.17
|
| Rate for Payer: UHCCP Medicaid |
$5.05
|
| Rate for Payer: VA VA |
$7.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.50
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$89.69
|
|
|
Service Code
|
NDC 68462041820
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$80.72 |
| Rate for Payer: Aetna Commercial |
$76.24
|
| Rate for Payer: Aetna Medicare |
$23.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.03
|
| Rate for Payer: BCBS Complete |
$16.60
|
| Rate for Payer: BCBS MAPPO |
$22.42
|
| Rate for Payer: BCBS Trust/PPO |
$73.73
|
| Rate for Payer: BCN Commercial |
$73.73
|
| Rate for Payer: BCN Medicare Advantage |
$22.42
|
| Rate for Payer: Cash Price |
$71.75
|
| Rate for Payer: Cofinity Commercial |
$77.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.42
|
| Rate for Payer: Healthscope Commercial |
$80.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.27
|
| Rate for Payer: Mclaren Medicaid |
$15.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.54
|
| Rate for Payer: Meridian Medicaid |
$16.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.24
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.27
|
| Rate for Payer: PACE Senior Care Partners |
$21.30
|
| Rate for Payer: PACE SWMI |
$22.42
|
| Rate for Payer: PHP Commercial |
$76.24
|
| Rate for Payer: PHP Medicare Advantage |
$22.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.03
|
| Rate for Payer: Priority Health Medicare |
$22.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.42
|
| Rate for Payer: Railroad Medicare Medicare |
$22.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.93
|
| Rate for Payer: UHC Core |
$74.89
|
| Rate for Payer: UHC Exchange |
$22.42
|
| Rate for Payer: UHC Medicaid |
$15.81
|
| Rate for Payer: UHC Medicare Advantage |
$22.42
|
| Rate for Payer: UHCCP Medicaid |
$15.81
|
| Rate for Payer: VA VA |
$22.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.27
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$737.67
|
|
|
Service Code
|
NDC 00168020437
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$513.42 |
| Max. Negotiated Rate |
$663.90 |
| Rate for Payer: Aetna Commercial |
$627.02
|
| Rate for Payer: BCBS Trust/PPO |
$609.24
|
| Rate for Payer: BCN Commercial |
$609.24
|
| Rate for Payer: Cash Price |
$590.14
|
| 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: Lakeland Regional Health Systems Commercial |
$553.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.02
|
| Rate for Payer: Nomi Health Commercial |
$604.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$553.25
|
| Rate for Payer: PHP Commercial |
$627.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$641.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$649.15
|
| Rate for Payer: UHC Core |
$615.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.25
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$89.69
|
|
|
Service Code
|
NDC 68462041820
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.42 |
| Max. Negotiated Rate |
$80.72 |
| Rate for Payer: Aetna Commercial |
$76.24
|
| Rate for Payer: BCBS Trust/PPO |
$74.07
|
| Rate for Payer: BCN Commercial |
$74.07
|
| Rate for Payer: Cash Price |
$71.75
|
| 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: Lakeland Regional Health Systems Commercial |
$67.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.24
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.27
|
| Rate for Payer: PHP Commercial |
$76.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.93
|
| Rate for Payer: UHC Core |
$74.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.27
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.89 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: BCBS Trust/PPO |
$43.77
|
| Rate for Payer: BCN Commercial |
$43.77
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$45.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Nomi Health Commercial |
$43.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.64
|
| Rate for Payer: UHC Core |
$44.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.75
|
|
