|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
NDC 70000036601
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| 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: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$45.36
|
|
|
Service Code
|
NDC 41167005840
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.77 |
| 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 |
$18.14
|
| Rate for Payer: BCBS MAPPO |
$11.34
|
| Rate for Payer: BCBS Trust/PPO |
$37.29
|
| Rate for Payer: BCN Commercial |
$35.27
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$37.20
|
| 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 Cigna Priority Health |
$29.48
|
| Rate for Payer: Priority Health HMO/PPO |
$39.46
|
| Rate for Payer: Priority Health Medicare |
$11.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.39
|
| 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 Dual Complete DSNP |
$11.34
|
| Rate for Payer: UHC Exchange |
$11.34
|
| Rate for Payer: UHC Medicare Advantage |
$11.34
|
| Rate for Payer: VA VA |
$11.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.02
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
NDC 96295013458
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$14.47
|
| 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: Healthscope Commercial |
$16.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: PHP Commercial |
$15.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO |
$16.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.47
|
| Rate for Payer: UHC Core |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.04
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$30.05
|
|
|
Service Code
|
NDC 00536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$27.04 |
| Rate for Payer: Aetna Commercial |
$25.54
|
| Rate for Payer: BCBS Trust/PPO |
$24.53
|
| Rate for Payer: BCN Commercial |
$23.22
|
| Rate for Payer: Cash Price |
$24.04
|
| Rate for Payer: Cofinity Commercial |
$25.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.04
|
| Rate for Payer: Healthscope Commercial |
$27.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.54
|
| Rate for Payer: Nomi Health Commercial |
$24.64
|
| Rate for Payer: PHP Commercial |
$25.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: Priority Health HMO/PPO |
$26.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.44
|
| Rate for Payer: UHC Core |
$25.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.54
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$145.16
|
|
|
Service Code
|
NDC 00536120207
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.35 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: BCBS Trust/PPO |
$118.49
|
| Rate for Payer: BCN Commercial |
$112.18
|
| Rate for Payer: Cash Price |
$116.13
|
| Rate for Payer: Cofinity Commercial |
$124.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.13
|
| Rate for Payer: Healthscope Commercial |
$130.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.39
|
| Rate for Payer: Nomi Health Commercial |
$119.03
|
| Rate for Payer: PHP Commercial |
$123.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.35
|
| Rate for Payer: Priority Health HMO/PPO |
$126.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.74
|
| Rate for Payer: UHC Core |
$121.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.87
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$145.16
|
|
|
Service Code
|
NDC 00536120207
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.48 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: Aetna Medicare |
$37.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.36
|
| Rate for Payer: BCBS Complete |
$58.06
|
| Rate for Payer: BCBS MAPPO |
$36.29
|
| Rate for Payer: BCBS Trust/PPO |
$119.34
|
| Rate for Payer: BCN Commercial |
$112.86
|
| Rate for Payer: BCN Medicare Advantage |
$36.29
|
| Rate for Payer: Cash Price |
$116.13
|
| Rate for Payer: Cofinity Commercial |
$124.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$130.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.39
|
| Rate for Payer: Nomi Health Commercial |
$119.03
|
| Rate for Payer: PACE Senior Care Partners |
$34.48
|
| Rate for Payer: PACE SWMI |
$36.29
|
| Rate for Payer: PHP Commercial |
$123.39
|
| Rate for Payer: PHP Medicare Advantage |
$36.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.35
|
| Rate for Payer: Priority Health HMO/PPO |
$126.29
|
| Rate for Payer: Priority Health Medicare |
$36.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.26
|
| Rate for Payer: Railroad Medicare Medicare |
$36.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.74
|
| Rate for Payer: UHC Core |
$121.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.29
|
| Rate for Payer: UHC Exchange |
$36.29
|
| Rate for Payer: UHC Medicare Advantage |
$36.29
|
| Rate for Payer: VA VA |
$36.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.87
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$104.84
|
|
|
Service Code
|
NDC 00121097030
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.90 |
| 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 |
$41.94
|
| Rate for Payer: BCBS MAPPO |
$26.21
|
| Rate for Payer: BCBS Trust/PPO |
$86.19
|
| Rate for Payer: BCN Commercial |
$81.51
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.11
|
| Rate for Payer: Nomi Health Commercial |
$85.97
|
| 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 Cigna Priority Health |
$68.15
|
| Rate for Payer: Priority Health HMO/PPO |
$91.21
|
| Rate for Payer: Priority Health Medicare |
$26.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.24
|
| 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 Dual Complete DSNP |
$26.21
|
| Rate for Payer: UHC Exchange |
$26.21
|
| Rate for Payer: UHC Medicare Advantage |
$26.21
|
| Rate for Payer: VA VA |
$26.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.63
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$3.64
|
|
|
Service Code
|
NDC 00121097001
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.81
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO |
$3.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.73
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$3.64
|
|
|
Service Code
|
NDC 00121097001
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$3.28 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.14
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.83
|
| Rate for Payer: BCN Medicare Advantage |
$0.91
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.91
|
| Rate for Payer: Healthscope Commercial |
$3.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: PACE Senior Care Partners |
$0.86
|
| Rate for Payer: PACE SWMI |
$0.91
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health HMO/PPO |
$3.17
|
| Rate for Payer: Priority Health Medicare |
$0.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.44
|
| Rate for Payer: Railroad Medicare Medicare |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.20
|
| Rate for Payer: UHC Core |
$3.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.91
|
| Rate for Payer: UHC Exchange |
$0.91
|
| Rate for Payer: UHC Medicare Advantage |
$0.91
|
| Rate for Payer: VA VA |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.73
|
|
|
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 |
$142.46 |
| 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 |
$239.93
|
| Rate for Payer: BCBS MAPPO |
$149.96
|
| Rate for Payer: BCBS Trust/PPO |
$493.11
|
| Rate for Payer: BCN Commercial |
$466.36
|
| 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 |
$449.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$509.85
|
| Rate for Payer: Nomi Health Commercial |
$491.85
|
| 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 Cigna Priority Health |
$389.88
|
| Rate for Payer: Priority Health HMO/PPO |
$521.84
|
| Rate for Payer: Priority Health Medicare |
$151.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.88
|
| 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 Dual Complete DSNP |
$149.96
|
| Rate for Payer: UHC Exchange |
$149.96
|
| Rate for Payer: UHC Medicare Advantage |
$149.96
|
| Rate for Payer: VA VA |
$149.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$449.86
|
|
|
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 |
$389.88 |
| Max. Negotiated Rate |
$539.84 |
| Rate for Payer: Aetna Commercial |
$509.85
|
| Rate for Payer: BCBS Trust/PPO |
$489.63
|
| Rate for Payer: BCN Commercial |
$463.54
|
| 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 |
$449.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$509.85
|
| Rate for Payer: Nomi Health Commercial |
$491.85
|
| Rate for Payer: PHP Commercial |
$509.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.88
|
| Rate for Payer: Priority Health HMO/PPO |
$521.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$401.88
|
| 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 |
$449.86
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$34.36
|
|
|
Service Code
|
NDC 52565000814
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.33 |
| Max. Negotiated Rate |
$30.92 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: BCBS Trust/PPO |
$28.05
|
| Rate for Payer: BCN Commercial |
$26.55
|
| Rate for Payer: Cash Price |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$29.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.49
|
| Rate for Payer: Healthscope Commercial |
$30.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.21
|
| Rate for Payer: Nomi Health Commercial |
$28.18
|
| Rate for Payer: PHP Commercial |
$29.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.33
|
| Rate for Payer: Priority Health HMO/PPO |
$29.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.24
|
| Rate for Payer: UHC Core |
$28.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.77
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$34.98
|
|
|
Service Code
|
NDC 33342040535
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.74 |
| Max. Negotiated Rate |
$31.48 |
| Rate for Payer: Aetna Commercial |
$29.73
|
| Rate for Payer: BCBS Trust/PPO |
$28.55
|
| Rate for Payer: BCN Commercial |
$27.03
|
| Rate for Payer: Cash Price |
$27.98
|
| Rate for Payer: Cofinity Commercial |
$30.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.98
|
| Rate for Payer: Healthscope Commercial |
$31.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.73
|
| Rate for Payer: Nomi Health Commercial |
$28.68
|
| Rate for Payer: PHP Commercial |
$29.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.74
|
| Rate for Payer: Priority Health HMO/PPO |
$30.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.78
|
| Rate for Payer: UHC Core |
$29.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.24
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$89.69
|
|
|
Service Code
|
NDC 68462041820
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$80.72 |
| Rate for Payer: Aetna Commercial |
$76.24
|
| Rate for Payer: BCBS Trust/PPO |
$73.21
|
| Rate for Payer: BCN Commercial |
$69.31
|
| 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: PHP Commercial |
$76.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.30
|
| Rate for Payer: Priority Health HMO/PPO |
$78.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.09
|
| 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 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$28.29
|
|
|
Service Code
|
NDC 70752011303
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna Commercial |
$24.05
|
| Rate for Payer: Aetna Medicare |
$7.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.84
|
| Rate for Payer: BCBS Complete |
$11.32
|
| Rate for Payer: BCBS MAPPO |
$7.07
|
| Rate for Payer: BCBS Trust/PPO |
$23.26
|
| Rate for Payer: BCN Commercial |
$22.00
|
| Rate for Payer: BCN Medicare Advantage |
$7.07
|
| Rate for Payer: Cash Price |
$22.63
|
| Rate for Payer: Cofinity Commercial |
$24.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.07
|
| Rate for Payer: Healthscope Commercial |
$25.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Nomi Health Commercial |
$23.20
|
| Rate for Payer: PACE Senior Care Partners |
$6.72
|
| Rate for Payer: PACE SWMI |
$7.07
|
| Rate for Payer: PHP Commercial |
$24.05
|
| Rate for Payer: PHP Medicare Advantage |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.39
|
| Rate for Payer: Priority Health HMO/PPO |
$24.61
|
| Rate for Payer: Priority Health Medicare |
$7.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.95
|
| Rate for Payer: Railroad Medicare Medicare |
$7.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.90
|
| Rate for Payer: UHC Core |
$23.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.07
|
| Rate for Payer: UHC Exchange |
$7.07
|
| Rate for Payer: UHC Medicare Advantage |
$7.07
|
| Rate for Payer: VA VA |
$7.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.22
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$81.38
|
|
|
Service Code
|
NDC 51672302009
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.33 |
| 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 |
$32.55
|
| Rate for Payer: BCBS MAPPO |
$20.34
|
| Rate for Payer: BCBS Trust/PPO |
$66.90
|
| Rate for Payer: BCN Commercial |
$63.27
|
| 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 |
$61.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.17
|
| Rate for Payer: Nomi Health Commercial |
$66.73
|
| 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 Cigna Priority Health |
$52.90
|
| Rate for Payer: Priority Health HMO/PPO |
$70.80
|
| Rate for Payer: Priority Health Medicare |
$20.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.52
|
| 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 Dual Complete DSNP |
$20.34
|
| Rate for Payer: UHC Exchange |
$20.34
|
| Rate for Payer: UHC Medicare Advantage |
$20.34
|
| Rate for Payer: VA VA |
$20.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.04
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$28.29
|
|
|
Service Code
|
NDC 70752011303
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna Commercial |
$24.05
|
| Rate for Payer: BCBS Trust/PPO |
$23.09
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: Cash Price |
$22.63
|
| Rate for Payer: Cofinity Commercial |
$24.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.63
|
| Rate for Payer: Healthscope Commercial |
$25.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Nomi Health Commercial |
$23.20
|
| Rate for Payer: PHP Commercial |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.39
|
| Rate for Payer: Priority Health HMO/PPO |
$24.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.90
|
| Rate for Payer: UHC Core |
$23.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.22
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$737.67
|
|
|
Service Code
|
NDC 00168020437
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$479.49 |
| Max. Negotiated Rate |
$663.90 |
| Rate for Payer: Aetna Commercial |
$627.02
|
| Rate for Payer: BCBS Trust/PPO |
$602.16
|
| Rate for Payer: BCN Commercial |
$570.07
|
| 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: PHP Commercial |
$627.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.49
|
| Rate for Payer: Priority Health HMO/PPO |
$641.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.24
|
| 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
|
OP
|
$34.36
|
|
|
Service Code
|
NDC 52565000814
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$30.92 |
| Rate for Payer: Aetna Commercial |
$29.21
|
| Rate for Payer: Aetna Medicare |
$8.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.74
|
| Rate for Payer: BCBS Complete |
$13.74
|
| Rate for Payer: BCBS MAPPO |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$28.25
|
| Rate for Payer: BCN Commercial |
$26.71
|
| Rate for Payer: BCN Medicare Advantage |
$8.59
|
| Rate for Payer: Cash Price |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$29.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.59
|
| Rate for Payer: Healthscope Commercial |
$30.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.21
|
| Rate for Payer: Nomi Health Commercial |
$28.18
|
| Rate for Payer: PACE Senior Care Partners |
$8.16
|
| Rate for Payer: PACE SWMI |
$8.59
|
| Rate for Payer: PHP Commercial |
$29.21
|
| Rate for Payer: PHP Medicare Advantage |
$8.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.33
|
| Rate for Payer: Priority Health HMO/PPO |
$29.89
|
| Rate for Payer: Priority Health Medicare |
$8.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.02
|
| Rate for Payer: Railroad Medicare Medicare |
$8.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.24
|
| Rate for Payer: UHC Core |
$28.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.59
|
| Rate for Payer: UHC Exchange |
$8.59
|
| Rate for Payer: UHC Medicare Advantage |
$8.59
|
| Rate for Payer: VA VA |
$8.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.77
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$89.69
|
|
|
Service Code
|
NDC 68462041820
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.30 |
| 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 |
$35.88
|
| Rate for Payer: BCBS MAPPO |
$22.42
|
| Rate for Payer: BCBS Trust/PPO |
$73.73
|
| Rate for Payer: BCN Commercial |
$69.73
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.24
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| 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 Cigna Priority Health |
$58.30
|
| Rate for Payer: Priority Health HMO/PPO |
$78.03
|
| Rate for Payer: Priority Health Medicare |
$22.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.09
|
| 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 Dual Complete DSNP |
$22.42
|
| Rate for Payer: UHC Exchange |
$22.42
|
| Rate for Payer: UHC Medicare Advantage |
$22.42
|
| Rate for Payer: VA VA |
$22.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.27
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$34.98
|
|
|
Service Code
|
NDC 33342040535
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$31.48 |
| Rate for Payer: Aetna Commercial |
$29.73
|
| Rate for Payer: Aetna Medicare |
$9.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.93
|
| Rate for Payer: BCBS Complete |
$13.99
|
| Rate for Payer: BCBS MAPPO |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$28.76
|
| Rate for Payer: BCN Commercial |
$27.20
|
| Rate for Payer: BCN Medicare Advantage |
$8.74
|
| Rate for Payer: Cash Price |
$27.98
|
| Rate for Payer: Cofinity Commercial |
$30.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.74
|
| Rate for Payer: Healthscope Commercial |
$31.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.73
|
| Rate for Payer: Nomi Health Commercial |
$28.68
|
| Rate for Payer: PACE Senior Care Partners |
$8.31
|
| Rate for Payer: PACE SWMI |
$8.74
|
| Rate for Payer: PHP Commercial |
$29.73
|
| Rate for Payer: PHP Medicare Advantage |
$8.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.74
|
| Rate for Payer: Priority Health HMO/PPO |
$30.43
|
| Rate for Payer: Priority Health Medicare |
$8.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.44
|
| Rate for Payer: Railroad Medicare Medicare |
$8.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.78
|
| Rate for Payer: UHC Core |
$29.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.74
|
| Rate for Payer: UHC Exchange |
$8.74
|
| Rate for Payer: UHC Medicare Advantage |
$8.74
|
| Rate for Payer: VA VA |
$8.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.24
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$81.38
|
|
|
Service Code
|
NDC 51672302009
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.90 |
| Max. Negotiated Rate |
$73.24 |
| Rate for Payer: Aetna Commercial |
$69.17
|
| Rate for Payer: BCBS Trust/PPO |
$66.43
|
| Rate for Payer: BCN Commercial |
$62.89
|
| 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 |
$61.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.17
|
| Rate for Payer: Nomi Health Commercial |
$66.73
|
| Rate for Payer: PHP Commercial |
$69.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.90
|
| Rate for Payer: Priority Health HMO/PPO |
$70.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.52
|
| 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 |
$61.04
|
|
|
LIDOCAINE 5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$737.67
|
|
|
Service Code
|
NDC 00168020437
|
| Hospital Charge Code |
159107
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.20 |
| 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 |
$295.07
|
| Rate for Payer: BCBS MAPPO |
$184.42
|
| Rate for Payer: BCBS Trust/PPO |
$606.44
|
| Rate for Payer: BCN Commercial |
$573.54
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$627.02
|
| Rate for Payer: Nomi Health Commercial |
$604.89
|
| 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 Cigna Priority Health |
$479.49
|
| Rate for Payer: Priority Health HMO/PPO |
$641.77
|
| Rate for Payer: Priority Health Medicare |
$186.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$494.24
|
| 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 Dual Complete DSNP |
$184.42
|
| Rate for Payer: UHC Exchange |
$184.42
|
| Rate for Payer: UHC Medicare Advantage |
$184.42
|
| Rate for Payer: VA VA |
$184.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$553.25
|
|
|
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 |
$12.59 |
| 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 |
$21.20
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$43.57
|
| Rate for Payer: BCN Commercial |
$41.21
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Nomi Health Commercial |
$43.46
|
| 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 Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO |
$46.11
|
| Rate for Payer: Priority Health Medicare |
$13.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.51
|
| 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 Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Exchange |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: VA VA |
$13.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.75
|
|
|
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 |
$34.45 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: BCBS Trust/PPO |
$43.26
|
| Rate for Payer: BCN Commercial |
$40.96
|
| 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: PHP Commercial |
$45.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO |
$46.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.51
|
| 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
|
|
