|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.56
|
| Rate for Payer: BCBS Complete |
$9.81
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$43.57
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| 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: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.75
|
| Rate for Payer: Mclaren Medicaid |
$9.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Meridian Medicaid |
$9.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.57
|
| 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: PACE Senior Care Partners |
$12.59
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.11
|
| Rate for Payer: Priority Health Medicare |
$13.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.89
|
| Rate for Payer: Railroad Medicare Medicare |
$13.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.64
|
| Rate for Payer: UHC Core |
$44.26
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicaid |
$9.34
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UHCCP Medicaid |
$9.34
|
| Rate for Payer: VA VA |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.75
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.87
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$18.78 |
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.24
|
| Rate for Payer: BCN Commercial |
$17.24
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: PHP Commercial |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.37
|
| Rate for Payer: UHC Core |
$17.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.65
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.87
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$18.78 |
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.52
|
| Rate for Payer: BCBS Complete |
$3.86
|
| Rate for Payer: BCBS MAPPO |
$5.22
|
| Rate for Payer: BCBS Trust/PPO |
$17.16
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: BCN Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.22
|
| Rate for Payer: Healthscope Commercial |
$18.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.65
|
| Rate for Payer: Mclaren Medicaid |
$3.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.48
|
| Rate for Payer: Meridian Medicaid |
$3.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.96
|
| Rate for Payer: PACE SWMI |
$5.22
|
| Rate for Payer: PHP Commercial |
$17.74
|
| Rate for Payer: PHP Medicare Advantage |
$5.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.16
|
| Rate for Payer: Priority Health Medicare |
$5.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.53
|
| Rate for Payer: Railroad Medicare Medicare |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.37
|
| Rate for Payer: UHC Core |
$17.43
|
| Rate for Payer: UHC Exchange |
$5.22
|
| Rate for Payer: UHC Medicaid |
$3.68
|
| Rate for Payer: UHC Medicare Advantage |
$5.22
|
| Rate for Payer: UHCCP Medicaid |
$3.68
|
| Rate for Payer: VA VA |
$5.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.65
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.37
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Medicare |
$3.36
|
| Rate for Payer: Aetna Medicare |
$3.77
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Aetna Medicare |
$3.32
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.99
|
| Rate for Payer: BCBS Complete |
$4.04
|
| Rate for Payer: BCBS Complete |
$2.36
|
| Rate for Payer: BCBS Complete |
$2.39
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: BCBS Complete |
$2.68
|
| Rate for Payer: BCBS Complete |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.24
|
| Rate for Payer: BCBS MAPPO |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$3.19
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS MAPPO |
$3.23
|
| Rate for Payer: BCBS MAPPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.95
|
| Rate for Payer: BCBS Trust/PPO |
$13.93
|
| Rate for Payer: BCBS Trust/PPO |
$15.62
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCBS Trust/PPO |
$10.49
|
| Rate for Payer: BCBS Trust/PPO |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.92
|
| Rate for Payer: BCN Commercial |
$10.61
|
| Rate for Payer: BCN Commercial |
$10.49
|
| Rate for Payer: BCN Commercial |
$17.95
|
| Rate for Payer: BCN Commercial |
$15.62
|
| Rate for Payer: BCN Commercial |
$13.93
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: BCN Medicare Advantage |
$3.84
|
| Rate for Payer: BCN Medicare Advantage |
$3.23
|
| Rate for Payer: BCN Medicare Advantage |
$5.46
|
| Rate for Payer: BCN Medicare Advantage |
$3.62
|
| Rate for Payer: BCN Medicare Advantage |
$3.19
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: BCN Medicare Advantage |
$4.24
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Mclaren Medicaid |
$3.35
|
| Rate for Payer: Mclaren Medicaid |
$2.28
|
| Rate for Payer: Mclaren Medicaid |
$2.25
|
| Rate for Payer: Mclaren Medicaid |
$2.71
|
| Rate for Payer: Mclaren Medicaid |
$2.99
|
| Rate for Payer: Mclaren Medicaid |
$3.85
|
| Rate for Payer: Mclaren Medicaid |
$2.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.03
|
| Rate for Payer: Meridian Medicaid |
$2.39
|
| Rate for Payer: Meridian Medicaid |
$2.36
|
| Rate for Payer: Meridian Medicaid |
$2.68
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Medicaid |
$3.14
|
| Rate for Payer: Meridian Medicaid |
$3.52
|
| Rate for Payer: Meridian Medicaid |
$4.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.15
|
| Rate for Payer: Nomi Health Commercial |
$11.89
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$10.59
|
| Rate for Payer: Nomi Health Commercial |
$10.46
|
| Rate for Payer: Nomi Health Commercial |
$15.58
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.25
|
| Rate for Payer: PACE Senior Care Partners |
$4.02
|
| Rate for Payer: PACE Senior Care Partners |
$3.07
|
| Rate for Payer: PACE Senior Care Partners |
$3.03
|
| Rate for Payer: PACE Senior Care Partners |
$4.51
|
| Rate for Payer: PACE Senior Care Partners |
$3.44
|
| Rate for Payer: PACE Senior Care Partners |
$5.18
|
| Rate for Payer: PACE Senior Care Partners |
$3.65
|
| Rate for Payer: PACE SWMI |
$3.62
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PACE SWMI |
$4.24
|
| Rate for Payer: PACE SWMI |
$3.23
|
| Rate for Payer: PACE SWMI |
$3.84
|
| Rate for Payer: PACE SWMI |
$5.46
|
| Rate for Payer: PACE SWMI |
$3.19
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$12.32
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: PHP Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Medicare Advantage |
$3.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.24
|
| Rate for Payer: PHP Medicare Advantage |
$3.19
|
| Rate for Payer: PHP Medicare Advantage |
$3.62
|
| Rate for Payer: PHP Medicare Advantage |
$3.84
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: PHP Medicare Advantage |
$5.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.37
|
| Rate for Payer: Priority Health Medicare |
$4.80
|
| Rate for Payer: Priority Health Medicare |
$5.51
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$3.66
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$3.88
|
| Rate for Payer: Priority Health Medicare |
$3.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.99
|
| Rate for Payer: Railroad Medicare Medicare |
$3.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.19
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.23
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: UHC Core |
$10.65
|
| Rate for Payer: UHC Core |
$12.11
|
| Rate for Payer: UHC Core |
$15.87
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Core |
$10.78
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: UHC Exchange |
$3.23
|
| Rate for Payer: UHC Exchange |
$4.24
|
| Rate for Payer: UHC Exchange |
$3.19
|
| Rate for Payer: UHC Exchange |
$4.75
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Exchange |
$3.62
|
| Rate for Payer: UHC Exchange |
$5.46
|
| Rate for Payer: UHC Medicaid |
$3.85
|
| Rate for Payer: UHC Medicaid |
$3.35
|
| Rate for Payer: UHC Medicaid |
$2.56
|
| Rate for Payer: UHC Medicaid |
$2.25
|
| Rate for Payer: UHC Medicaid |
$2.28
|
| Rate for Payer: UHC Medicaid |
$2.99
|
| Rate for Payer: UHC Medicaid |
$2.71
|
| Rate for Payer: UHC Medicare Advantage |
$3.23
|
| Rate for Payer: UHC Medicare Advantage |
$5.46
|
| Rate for Payer: UHC Medicare Advantage |
$3.19
|
| Rate for Payer: UHC Medicare Advantage |
$3.84
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHC Medicare Advantage |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$3.62
|
| Rate for Payer: UHCCP Medicaid |
$2.25
|
| Rate for Payer: UHCCP Medicaid |
$3.85
|
| Rate for Payer: UHCCP Medicaid |
$2.28
|
| Rate for Payer: UHCCP Medicaid |
$2.71
|
| Rate for Payer: UHCCP Medicaid |
$2.99
|
| Rate for Payer: UHCCP Medicaid |
$3.35
|
| Rate for Payer: UHCCP Medicaid |
$2.56
|
| Rate for Payer: VA VA |
$3.19
|
| Rate for Payer: VA VA |
$4.75
|
| Rate for Payer: VA VA |
$3.62
|
| Rate for Payer: VA VA |
$4.24
|
| Rate for Payer: VA VA |
$5.46
|
| Rate for Payer: VA VA |
$3.23
|
| Rate for Payer: VA VA |
$3.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$12.32
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: BCBS Trust/PPO |
$18.03
|
| Rate for Payer: BCBS Trust/PPO |
$10.66
|
| Rate for Payer: BCBS Trust/PPO |
$15.69
|
| Rate for Payer: BCBS Trust/PPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$13.99
|
| Rate for Payer: BCBS Trust/PPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.69
|
| Rate for Payer: BCN Commercial |
$11.98
|
| Rate for Payer: BCN Commercial |
$15.69
|
| Rate for Payer: BCN Commercial |
$18.03
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: BCN Commercial |
$10.66
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: BCN Commercial |
$10.54
|
| Rate for Payer: Cash Price |
$11.60
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$12.47
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$13.05
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.32
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$10.46
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Nomi Health Commercial |
$15.58
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: Nomi Health Commercial |
$11.89
|
| Rate for Payer: Nomi Health Commercial |
$10.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.88
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: PHP Commercial |
$12.32
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.76
|
| Rate for Payer: UHC Core |
$10.65
|
| Rate for Payer: UHC Core |
$15.87
|
| Rate for Payer: UHC Core |
$10.78
|
| Rate for Payer: UHC Core |
$12.11
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.25
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$11.89
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: BCBS Trust/PPO |
$14.43
|
| Rate for Payer: BCBS Trust/PPO |
$19.16
|
| Rate for Payer: BCBS Trust/PPO |
$16.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.82
|
| Rate for Payer: BCBS Trust/PPO |
$21.09
|
| Rate for Payer: BCBS Trust/PPO |
$13.89
|
| Rate for Payer: BCBS Trust/PPO |
$19.64
|
| Rate for Payer: BCBS Trust/PPO |
$13.99
|
| Rate for Payer: BCN Commercial |
$13.99
|
| Rate for Payer: BCN Commercial |
$21.09
|
| Rate for Payer: BCN Commercial |
$13.89
|
| Rate for Payer: BCN Commercial |
$9.82
|
| Rate for Payer: BCN Commercial |
$11.74
|
| Rate for Payer: BCN Commercial |
$16.05
|
| Rate for Payer: BCN Commercial |
$19.16
|
| Rate for Payer: BCN Commercial |
$14.43
|
| Rate for Payer: BCN Commercial |
$19.64
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$12.79
|
| Rate for Payer: Healthscope Commercial |
$17.49
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Nomi Health Commercial |
$14.33
|
| Rate for Payer: Nomi Health Commercial |
$19.02
|
| Rate for Payer: Nomi Health Commercial |
$9.75
|
| Rate for Payer: Nomi Health Commercial |
$11.65
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: Nomi Health Commercial |
$15.93
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Nomi Health Commercial |
$19.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.15
|
| Rate for Payer: PHP Commercial |
$12.08
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.93
|
| Rate for Payer: UHC Core |
$16.22
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: UHC Core |
$21.32
|
| Rate for Payer: UHC Core |
$11.87
|
| Rate for Payer: UHC Core |
$14.04
|
| Rate for Payer: UHC Core |
$9.93
|
| Rate for Payer: UHC Core |
$19.37
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$11.89
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Aetna Medicare |
$5.05
|
| Rate for Payer: Aetna Medicare |
$4.37
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Aetna Medicare |
$4.54
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna Medicare |
$6.18
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.98
|
| Rate for Payer: BCBS Complete |
$3.60
|
| Rate for Payer: BCBS Complete |
$4.73
|
| Rate for Payer: BCBS Complete |
$2.63
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: BCBS Complete |
$3.11
|
| Rate for Payer: BCBS Complete |
$3.23
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS Complete |
$4.29
|
| Rate for Payer: BCBS MAPPO |
$4.24
|
| Rate for Payer: BCBS MAPPO |
$4.37
|
| Rate for Payer: BCBS MAPPO |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$5.80
|
| Rate for Payer: BCBS MAPPO |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$4.86
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS MAPPO |
$5.95
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$20.99
|
| Rate for Payer: BCBS Trust/PPO |
$15.97
|
| Rate for Payer: BCBS Trust/PPO |
$11.68
|
| Rate for Payer: BCBS Trust/PPO |
$13.93
|
| Rate for Payer: BCBS Trust/PPO |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$19.07
|
| Rate for Payer: BCBS Trust/PPO |
$19.55
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: BCN Commercial |
$11.68
|
| Rate for Payer: BCN Commercial |
$9.77
|
| Rate for Payer: BCN Commercial |
$14.36
|
| Rate for Payer: BCN Commercial |
$15.97
|
| Rate for Payer: BCN Commercial |
$20.99
|
| Rate for Payer: BCN Commercial |
$13.93
|
| Rate for Payer: BCN Commercial |
$13.83
|
| Rate for Payer: BCN Commercial |
$19.07
|
| Rate for Payer: BCN Medicare Advantage |
$3.55
|
| Rate for Payer: BCN Medicare Advantage |
$4.86
|
| Rate for Payer: BCN Medicare Advantage |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.95
|
| Rate for Payer: BCN Medicare Advantage |
$5.80
|
| Rate for Payer: BCN Medicare Advantage |
$4.21
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.24
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$17.49
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$12.79
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.71
|
| Rate for Payer: Mclaren Medicaid |
$2.97
|
| Rate for Payer: Mclaren Medicaid |
$4.19
|
| Rate for Payer: Mclaren Medicaid |
$2.99
|
| Rate for Payer: Mclaren Medicaid |
$4.50
|
| Rate for Payer: Mclaren Medicaid |
$3.43
|
| Rate for Payer: Mclaren Medicaid |
$2.10
|
| Rate for Payer: Mclaren Medicaid |
$2.51
|
| Rate for Payer: Mclaren Medicaid |
$3.08
|
| Rate for Payer: Mclaren Medicaid |
$4.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.42
|
| Rate for Payer: Meridian Medicaid |
$4.73
|
| Rate for Payer: Meridian Medicaid |
$3.60
|
| Rate for Payer: Meridian Medicaid |
$3.23
|
| Rate for Payer: Meridian Medicaid |
$2.63
|
| Rate for Payer: Meridian Medicaid |
$2.20
|
| Rate for Payer: Meridian Medicaid |
$4.29
|
| Rate for Payer: Meridian Medicaid |
$4.40
|
| Rate for Payer: Meridian Medicaid |
$3.11
|
| Rate for Payer: Meridian Medicaid |
$3.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Nomi Health Commercial |
$19.02
|
| Rate for Payer: Nomi Health Commercial |
$14.33
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Nomi Health Commercial |
$11.65
|
| Rate for Payer: Nomi Health Commercial |
$9.75
|
| Rate for Payer: Nomi Health Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$19.50
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: Nomi Health Commercial |
$15.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.57
|
| Rate for Payer: PACE Senior Care Partners |
$5.51
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE Senior Care Partners |
$4.15
|
| Rate for Payer: PACE Senior Care Partners |
$4.61
|
| Rate for Payer: PACE Senior Care Partners |
$3.37
|
| Rate for Payer: PACE Senior Care Partners |
$2.82
|
| Rate for Payer: PACE Senior Care Partners |
$4.02
|
| Rate for Payer: PACE Senior Care Partners |
$5.65
|
| Rate for Payer: PACE Senior Care Partners |
$3.99
|
| Rate for Payer: PACE SWMI |
$4.24
|
| Rate for Payer: PACE SWMI |
$5.80
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PACE SWMI |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.21
|
| Rate for Payer: PACE SWMI |
$5.95
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PACE SWMI |
$3.55
|
| Rate for Payer: PACE SWMI |
$4.86
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Commercial |
$16.52
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Commercial |
$12.08
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Medicare Advantage |
$4.86
|
| Rate for Payer: PHP Medicare Advantage |
$4.37
|
| Rate for Payer: PHP Medicare Advantage |
$3.55
|
| Rate for Payer: PHP Medicare Advantage |
$4.24
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: PHP Medicare Advantage |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.95
|
| Rate for Payer: PHP Medicare Advantage |
$5.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.34
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$4.91
|
| Rate for Payer: Priority Health Medicare |
$4.41
|
| Rate for Payer: Priority Health Medicare |
$5.86
|
| Rate for Payer: Priority Health Medicare |
$3.59
|
| Rate for Payer: Priority Health Medicare |
$6.00
|
| Rate for Payer: Priority Health Medicare |
$3.00
|
| Rate for Payer: Priority Health Medicare |
$6.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.15
|
| Rate for Payer: Railroad Medicare Medicare |
$4.37
|
| Rate for Payer: Railroad Medicare Medicare |
$4.24
|
| Rate for Payer: Railroad Medicare Medicare |
$4.86
|
| Rate for Payer: Railroad Medicare Medicare |
$4.21
|
| Rate for Payer: Railroad Medicare Medicare |
$5.80
|
| Rate for Payer: Railroad Medicare Medicare |
$5.95
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: Railroad Medicare Medicare |
$3.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.37
|
| Rate for Payer: UHC Core |
$14.04
|
| Rate for Payer: UHC Core |
$9.93
|
| Rate for Payer: UHC Core |
$21.32
|
| Rate for Payer: UHC Core |
$11.87
|
| Rate for Payer: UHC Core |
$14.59
|
| Rate for Payer: UHC Core |
$19.37
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: UHC Core |
$16.22
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: UHC Exchange |
$5.80
|
| Rate for Payer: UHC Exchange |
$4.86
|
| Rate for Payer: UHC Exchange |
$5.95
|
| Rate for Payer: UHC Exchange |
$3.55
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UHC Exchange |
$4.21
|
| Rate for Payer: UHC Exchange |
$2.97
|
| Rate for Payer: UHC Exchange |
$4.24
|
| Rate for Payer: UHC Exchange |
$4.37
|
| Rate for Payer: UHC Medicaid |
$4.50
|
| Rate for Payer: UHC Medicaid |
$4.09
|
| Rate for Payer: UHC Medicaid |
$2.51
|
| Rate for Payer: UHC Medicaid |
$2.97
|
| Rate for Payer: UHC Medicaid |
$3.43
|
| Rate for Payer: UHC Medicaid |
$4.19
|
| Rate for Payer: UHC Medicaid |
$2.10
|
| Rate for Payer: UHC Medicaid |
$2.99
|
| Rate for Payer: UHC Medicaid |
$3.08
|
| Rate for Payer: UHC Medicare Advantage |
$3.55
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$5.95
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$4.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$4.37
|
| Rate for Payer: UHC Medicare Advantage |
$5.80
|
| Rate for Payer: UHC Medicare Advantage |
$4.21
|
| Rate for Payer: UHCCP Medicaid |
$4.09
|
| Rate for Payer: UHCCP Medicaid |
$2.51
|
| Rate for Payer: UHCCP Medicaid |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$4.19
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: UHCCP Medicaid |
$2.99
|
| Rate for Payer: UHCCP Medicaid |
$3.43
|
| Rate for Payer: UHCCP Medicaid |
$3.08
|
| Rate for Payer: UHCCP Medicaid |
$2.10
|
| Rate for Payer: VA VA |
$5.95
|
| Rate for Payer: VA VA |
$2.97
|
| Rate for Payer: VA VA |
$4.21
|
| Rate for Payer: VA VA |
$4.24
|
| Rate for Payer: VA VA |
$4.86
|
| Rate for Payer: VA VA |
$3.55
|
| Rate for Payer: VA VA |
$4.37
|
| Rate for Payer: VA VA |
$5.80
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$24.03
|
|
|
Service Code
|
NDC 00121495040
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$19.76
|
| Rate for Payer: BCN Commercial |
$19.76
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: Mclaren Medicaid |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$4.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: PACE Senior Care Partners |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.91
|
| Rate for Payer: Priority Health Medicare |
$6.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.72
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.15
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: UHC Exchange |
$6.01
|
| Rate for Payer: UHC Medicaid |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHCCP Medicaid |
$4.24
|
| Rate for Payer: VA VA |
$6.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$23.45
|
|
|
Service Code
|
NDC 50383077504
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.37
|
| Rate for Payer: BCN Commercial |
$19.37
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$20.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.93
|
| Rate for Payer: Nomi Health Commercial |
$19.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.59
|
| Rate for Payer: PHP Commercial |
$19.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.64
|
| Rate for Payer: UHC Core |
$19.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.59
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 09900000339
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.72
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS MAPPO |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$4.51
|
| Rate for Payer: BCN Commercial |
$4.51
|
| Rate for Payer: BCN Medicare Advantage |
$1.37
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.37
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Mclaren Medicaid |
$0.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.44
|
| Rate for Payer: Meridian Medicaid |
$1.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$4.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.12
|
| Rate for Payer: PACE Senior Care Partners |
$1.30
|
| Rate for Payer: PACE SWMI |
$1.37
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.78
|
| Rate for Payer: Priority Health Medicare |
$1.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Medicaid |
$0.97
|
| Rate for Payer: UHC Medicare Advantage |
$1.37
|
| Rate for Payer: UHCCP Medicaid |
$0.97
|
| Rate for Payer: VA VA |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$23.45
|
|
|
Service Code
|
NDC 50383077504
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.33
|
| Rate for Payer: BCBS Complete |
$4.34
|
| Rate for Payer: BCBS MAPPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$19.28
|
| Rate for Payer: BCN Commercial |
$19.28
|
| Rate for Payer: BCN Medicare Advantage |
$5.86
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$20.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.86
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: Mclaren Medicaid |
$4.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.16
|
| Rate for Payer: Meridian Medicaid |
$4.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.93
|
| Rate for Payer: Nomi Health Commercial |
$19.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.59
|
| Rate for Payer: PACE Senior Care Partners |
$5.57
|
| Rate for Payer: PACE SWMI |
$5.86
|
| Rate for Payer: PHP Commercial |
$19.93
|
| Rate for Payer: PHP Medicare Advantage |
$5.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.40
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.64
|
| Rate for Payer: UHC Core |
$19.58
|
| Rate for Payer: UHC Exchange |
$5.86
|
| Rate for Payer: UHC Medicaid |
$4.13
|
| Rate for Payer: UHC Medicare Advantage |
$5.86
|
| Rate for Payer: UHCCP Medicaid |
$4.13
|
| Rate for Payer: VA VA |
$5.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.59
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$24.03
|
|
|
Service Code
|
NDC 00121495015
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.15
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$24.03
|
|
|
Service Code
|
NDC 00121495040
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: BCBS Trust/PPO |
$19.85
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.15
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 00121090340
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 09900000339
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$4.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$24.03
|
|
|
Service Code
|
NDC 00121495015
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Medicare |
$6.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.51
|
| Rate for Payer: BCBS Complete |
$4.45
|
| Rate for Payer: BCBS MAPPO |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$19.76
|
| Rate for Payer: BCN Commercial |
$19.76
|
| Rate for Payer: BCN Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.01
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: Mclaren Medicaid |
$4.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.31
|
| Rate for Payer: Meridian Medicaid |
$4.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Nomi Health Commercial |
$19.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: PACE Senior Care Partners |
$5.71
|
| Rate for Payer: PACE SWMI |
$6.01
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: PHP Medicare Advantage |
$6.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.91
|
| Rate for Payer: Priority Health Medicare |
$6.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.72
|
| Rate for Payer: Railroad Medicare Medicare |
$6.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.15
|
| Rate for Payer: UHC Core |
$20.07
|
| Rate for Payer: UHC Exchange |
$6.01
|
| Rate for Payer: UHC Medicaid |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$6.01
|
| Rate for Payer: UHCCP Medicaid |
$4.24
|
| Rate for Payer: VA VA |
$6.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$15.06
|
|
|
Service Code
|
NDC 00121090340
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Medicare |
$3.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.71
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$3.77
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$12.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.77
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.77
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Mclaren Medicaid |
$2.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.95
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PACE Senior Care Partners |
$3.58
|
| Rate for Payer: PACE SWMI |
$3.77
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$3.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.10
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: UHC Exchange |
$3.77
|
| Rate for Payer: UHC Medicaid |
$2.66
|
| Rate for Payer: UHC Medicare Advantage |
$3.77
|
| Rate for Payer: UHCCP Medicaid |
$2.66
|
| Rate for Payer: VA VA |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 00121090315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.44
|
| Rate for Payer: BCN Commercial |
$12.44
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$15.06
|
|
|
Service Code
|
NDC 00121090315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Medicare |
$3.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.71
|
| Rate for Payer: BCBS Complete |
$2.79
|
| Rate for Payer: BCBS MAPPO |
$3.77
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$12.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.77
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.77
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Mclaren Medicaid |
$2.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.95
|
| Rate for Payer: Meridian Medicaid |
$2.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PACE Senior Care Partners |
$3.58
|
| Rate for Payer: PACE SWMI |
$3.77
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$3.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.10
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: UHC Exchange |
$3.77
|
| Rate for Payer: UHC Medicaid |
$2.66
|
| Rate for Payer: UHC Medicare Advantage |
$3.77
|
| Rate for Payer: UHCCP Medicaid |
$2.66
|
| Rate for Payer: VA VA |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 00054350547
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.62 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: BCBS Trust/PPO |
$107.53
|
| Rate for Payer: BCN Commercial |
$107.53
|
| Rate for Payer: Cash Price |
$104.16
|
| 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: Lakeland Regional Health Systems Commercial |
$97.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Nomi Health Commercial |
$106.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.58
|
| Rate for Payer: UHC Core |
$108.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.65
|
|
|
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 |
$22.95 |
| Max. Negotiated Rate |
$117.18 |
| Rate for Payer: Aetna Commercial |
$110.67
|
| Rate for Payer: Aetna Medicare |
$33.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.69
|
| Rate for Payer: BCBS Complete |
$24.10
|
| Rate for Payer: BCBS MAPPO |
$32.55
|
| Rate for Payer: BCBS Trust/PPO |
$107.04
|
| Rate for Payer: BCN Commercial |
$107.04
|
| Rate for Payer: BCN Medicare Advantage |
$32.55
|
| Rate for Payer: Cash Price |
$104.16
|
| Rate for Payer: Cofinity Commercial |
$111.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.55
|
| Rate for Payer: Healthscope Commercial |
$117.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.65
|
| Rate for Payer: Mclaren Medicaid |
$22.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.18
|
| Rate for Payer: Meridian Medicaid |
$24.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.67
|
| Rate for Payer: Nomi Health Commercial |
$106.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.65
|
| Rate for Payer: PACE Senior Care Partners |
$30.92
|
| Rate for Payer: PACE SWMI |
$32.55
|
| Rate for Payer: PHP Commercial |
$110.67
|
| Rate for Payer: PHP Medicare Advantage |
$32.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.27
|
| Rate for Payer: Priority Health Medicare |
$32.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.62
|
| Rate for Payer: Railroad Medicare Medicare |
$32.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.58
|
| Rate for Payer: UHC Core |
$108.72
|
| Rate for Payer: UHC Exchange |
$32.55
|
| Rate for Payer: UHC Medicaid |
$22.95
|
| Rate for Payer: UHC Medicare Advantage |
$32.55
|
| Rate for Payer: UHCCP Medicaid |
$22.95
|
| Rate for Payer: VA VA |
$32.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.65
|
|
|
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 |
$13.55 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.01
|
| Rate for Payer: BCBS Complete |
$14.22
|
| Rate for Payer: BCBS MAPPO |
$19.21
|
| Rate for Payer: BCBS Trust/PPO |
$63.16
|
| Rate for Payer: BCN Commercial |
$63.16
|
| Rate for Payer: BCN Medicare Advantage |
$19.21
|
| Rate for Payer: Cash Price |
$61.46
|
| Rate for Payer: Cofinity Commercial |
$66.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.21
|
| Rate for Payer: Healthscope Commercial |
$69.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.62
|
| Rate for Payer: Mclaren Medicaid |
$13.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.17
|
| Rate for Payer: Meridian Medicaid |
$14.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Nomi Health Commercial |
$63.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: PACE Senior Care Partners |
$18.25
|
| Rate for Payer: PACE SWMI |
$19.21
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: PHP Medicare Advantage |
$19.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.84
|
| Rate for Payer: Priority Health Medicare |
$19.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.47
|
| Rate for Payer: Railroad Medicare Medicare |
$19.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.61
|
| Rate for Payer: UHC Core |
$64.15
|
| Rate for Payer: UHC Exchange |
$19.21
|
| Rate for Payer: UHC Medicaid |
$13.55
|
| Rate for Payer: UHC Medicare Advantage |
$19.21
|
| Rate for Payer: UHCCP Medicaid |
$13.55
|
| Rate for Payer: VA VA |
$19.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.62
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$76.83
|
|
|
Service Code
|
NDC 00527600480
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.47 |
| Max. Negotiated Rate |
$69.15 |
| Rate for Payer: Aetna Commercial |
$65.31
|
| Rate for Payer: BCBS Trust/PPO |
$63.45
|
| Rate for Payer: BCN Commercial |
$63.45
|
| Rate for Payer: Cash Price |
$61.46
|
| 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: Lakeland Regional Health Systems Commercial |
$57.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.31
|
| Rate for Payer: Nomi Health Commercial |
$63.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.62
|
| Rate for Payer: PHP Commercial |
$65.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$66.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.61
|
| Rate for Payer: UHC Core |
$64.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.62
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
IP
|
$125.11
|
|
|
Service Code
|
NDC 76329630005
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.08 |
| Max. Negotiated Rate |
$112.60 |
| Rate for Payer: Aetna Commercial |
$106.34
|
| Rate for Payer: BCBS Trust/PPO |
$103.33
|
| Rate for Payer: BCN Commercial |
$103.33
|
| Rate for Payer: Cash Price |
$100.09
|
| 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: Lakeland Regional Health Systems Commercial |
$93.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.34
|
| Rate for Payer: Nomi Health Commercial |
$102.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.83
|
| Rate for Payer: PHP Commercial |
$106.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.10
|
| Rate for Payer: UHC Core |
$104.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.83
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
OP
|
$125.11
|
|
|
Service Code
|
NDC 76329630005
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$112.60 |
| Rate for Payer: Aetna Commercial |
$106.34
|
| Rate for Payer: Aetna Medicare |
$32.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39.10
|
| Rate for Payer: BCBS Complete |
$23.16
|
| Rate for Payer: BCBS MAPPO |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$102.85
|
| Rate for Payer: BCN Commercial |
$102.85
|
| Rate for Payer: BCN Medicare Advantage |
$31.28
|
| Rate for Payer: Cash Price |
$100.09
|
| Rate for Payer: Cofinity Commercial |
$107.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.28
|
| Rate for Payer: Healthscope Commercial |
$112.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.83
|
| Rate for Payer: Mclaren Medicaid |
$22.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.84
|
| Rate for Payer: Meridian Medicaid |
$23.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.34
|
| Rate for Payer: Nomi Health Commercial |
$102.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.83
|
| Rate for Payer: PACE Senior Care Partners |
$29.71
|
| Rate for Payer: PACE SWMI |
$31.28
|
| Rate for Payer: PHP Commercial |
$106.34
|
| Rate for Payer: PHP Medicare Advantage |
$31.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$108.85
|
| Rate for Payer: Priority Health Medicare |
$31.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.08
|
| Rate for Payer: Railroad Medicare Medicare |
$31.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.10
|
| Rate for Payer: UHC Core |
$104.47
|
| Rate for Payer: UHC Exchange |
$31.28
|
| Rate for Payer: UHC Medicaid |
$22.06
|
| Rate for Payer: UHC Medicare Advantage |
$31.28
|
| Rate for Payer: UHCCP Medicaid |
$22.06
|
| Rate for Payer: VA VA |
$31.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.83
|
|
