|
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 |
$449.87
|
| 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 |
$449.87
|
|
|
LIDOCAINE 4 % WITH EPINEPHRINE TOPICAL SOLUTION
|
Facility
|
OP
|
$599.82
|
|
|
Service Code
|
NDC 09900000211
|
| Hospital Charge Code |
155018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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 |
$449.87
|
| 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 |
$449.87
|
|
|
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
|
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
|
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
|
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
|
$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
|
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 |
$61.03
|
| 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 |
$61.03
|
|
|
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 |
$26.23
|
| 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 |
$26.23
|
|
|
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 |
$26.23
|
| 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 |
$26.23
|
|
|
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 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
|
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
|
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 |
$61.03
|
| 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 |
$61.03
|
|
|
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
|
|
|
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) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.58
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.89 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Medicare |
$5.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.43
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS MAPPO |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCN Commercial |
$16.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.14
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.49
|
| Rate for Payer: Nomi Health Commercial |
$16.88
|
| Rate for Payer: PACE Senior Care Partners |
$4.89
|
| Rate for Payer: PACE SWMI |
$5.14
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: PHP Medicare Advantage |
$5.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health HMO/PPO |
$17.90
|
| Rate for Payer: Priority Health Medicare |
$5.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.79
|
| Rate for Payer: Railroad Medicare Medicare |
$5.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.11
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.14
|
| Rate for Payer: UHC Exchange |
$5.14
|
| Rate for Payer: UHC Medicare Advantage |
$5.14
|
| Rate for Payer: VA VA |
$5.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.58
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: BCBS Trust/PPO |
$16.80
|
| Rate for Payer: BCN Commercial |
$15.90
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.49
|
| Rate for Payer: Nomi Health Commercial |
$16.88
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health HMO/PPO |
$17.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.11
|
| Rate for Payer: UHC Core |
$17.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
|
|
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 |
$14.19 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$9.37
|
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: BCBS Trust/PPO |
$17.82
|
| Rate for Payer: BCBS Trust/PPO |
$10.18
|
| Rate for Payer: BCBS Trust/PPO |
$15.51
|
| Rate for Payer: BCBS Trust/PPO |
$9.00
|
| Rate for Payer: BCBS Trust/PPO |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$10.54
|
| Rate for Payer: BCBS Trust/PPO |
$12.55
|
| Rate for Payer: BCN Commercial |
$9.98
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: BCN Commercial |
$16.87
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Commercial |
$11.88
|
| Rate for Payer: BCN Commercial |
$8.52
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$8.82
|
| 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 |
$9.98
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$9.48
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| 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 |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| 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 |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$9.92
|
| 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 |
$9.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| 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 |
$10.97
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| 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 |
$10.59
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: PHP Commercial |
$9.37
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: PHP Commercial |
$10.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health HMO/PPO |
$10.85
|
| Rate for Payer: Priority Health HMO/PPO |
$14.74
|
| Rate for Payer: Priority Health HMO/PPO |
$18.99
|
| Rate for Payer: Priority Health HMO/PPO |
$11.23
|
| Rate for Payer: Priority Health HMO/PPO |
$13.37
|
| Rate for Payer: Priority Health HMO/PPO |
$9.59
|
| Rate for Payer: Priority Health HMO/PPO |
$16.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.70
|
| 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) |
$10.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.36
|
| Rate for Payer: UHC Core |
$9.20
|
| Rate for Payer: UHC Core |
$15.87
|
| Rate for Payer: UHC Core |
$10.41
|
| Rate for Payer: UHC Core |
$10.78
|
| 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 |
$9.35
|
| 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 |
$9.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.25
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$16.94
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Commercial |
$9.37
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Medicare |
$3.24
|
| Rate for Payer: Aetna Medicare |
$2.87
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Aetna Medicare |
$5.68
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: Aetna Medicare |
$3.36
|
| 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: Allen County Amish Medical Aid Commercial |
$4.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.80
|
| 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 |
$5.29
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS Complete |
$4.41
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS MAPPO |
$4.24
|
| Rate for Payer: BCBS MAPPO |
$5.46
|
| Rate for Payer: BCBS MAPPO |
$4.75
|
| Rate for Payer: BCBS MAPPO |
$3.84
|
| Rate for Payer: BCBS MAPPO |
$3.12
|
| Rate for Payer: BCBS MAPPO |
$2.75
|
| Rate for Payer: BCBS MAPPO |
$3.23
|
| Rate for Payer: BCBS Trust/PPO |
$9.06
|
| Rate for Payer: BCBS Trust/PPO |
$10.25
|
| Rate for Payer: BCBS Trust/PPO |
$17.95
|
| Rate for Payer: BCBS Trust/PPO |
$15.62
|
| Rate for Payer: BCBS Trust/PPO |
$10.61
|
| Rate for Payer: BCBS Trust/PPO |
$13.93
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCN Commercial |
$11.95
|
| Rate for Payer: BCN Commercial |
$8.57
|
| Rate for Payer: BCN Commercial |
$10.04
|
| Rate for Payer: BCN Commercial |
$9.70
|
| Rate for Payer: BCN Commercial |
$14.77
|
| Rate for Payer: BCN Commercial |
$13.17
|
| Rate for Payer: BCN Commercial |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$5.46
|
| Rate for Payer: BCN Medicare Advantage |
$4.24
|
| Rate for Payer: BCN Medicare Advantage |
$4.75
|
| Rate for Payer: BCN Medicare Advantage |
$3.23
|
| Rate for Payer: BCN Medicare Advantage |
$2.75
|
| Rate for Payer: BCN Medicare Advantage |
$3.12
|
| Rate for Payer: BCN Medicare Advantage |
$3.84
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cofinity Commercial |
$11.10
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$9.48
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| 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 |
$4.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.84
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$9.92
|
| Rate for Payer: Healthscope Commercial |
$11.62
|
| 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 |
$9.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.27
|
| 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 |
$4.03
|
| 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 |
$4.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| 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 |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| Rate for Payer: Nomi Health Commercial |
$15.58
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$10.23
|
| Rate for Payer: Nomi Health Commercial |
$17.90
|
| Rate for Payer: Nomi Health Commercial |
$12.60
|
| Rate for Payer: Nomi Health Commercial |
$10.59
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: PACE Senior Care Partners |
$4.02
|
| Rate for Payer: PACE Senior Care Partners |
$5.18
|
| Rate for Payer: PACE Senior Care Partners |
$3.65
|
| Rate for Payer: PACE Senior Care Partners |
$2.96
|
| Rate for Payer: PACE Senior Care Partners |
$2.62
|
| Rate for Payer: PACE Senior Care Partners |
$3.07
|
| Rate for Payer: PACE Senior Care Partners |
$4.51
|
| Rate for Payer: PACE SWMI |
$4.75
|
| Rate for Payer: PACE SWMI |
$3.23
|
| Rate for Payer: PACE SWMI |
$4.24
|
| Rate for Payer: PACE SWMI |
$2.75
|
| Rate for Payer: PACE SWMI |
$3.84
|
| Rate for Payer: PACE SWMI |
$3.12
|
| Rate for Payer: PACE SWMI |
$5.46
|
| 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 |
$18.56
|
| Rate for Payer: PHP Commercial |
$9.37
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Medicare Advantage |
$2.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.84
|
| Rate for Payer: PHP Medicare Advantage |
$3.23
|
| Rate for Payer: PHP Medicare Advantage |
$4.24
|
| Rate for Payer: PHP Medicare Advantage |
$4.75
|
| Rate for Payer: PHP Medicare Advantage |
$3.12
|
| Rate for Payer: PHP Medicare Advantage |
$5.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.16
|
| Rate for Payer: Priority Health HMO/PPO |
$10.85
|
| Rate for Payer: Priority Health HMO/PPO |
$13.37
|
| Rate for Payer: Priority Health HMO/PPO |
$14.74
|
| Rate for Payer: Priority Health HMO/PPO |
$16.53
|
| Rate for Payer: Priority Health HMO/PPO |
$11.23
|
| Rate for Payer: Priority Health HMO/PPO |
$18.99
|
| Rate for Payer: Priority Health HMO/PPO |
$9.59
|
| Rate for Payer: Priority Health Medicare |
$3.15
|
| Rate for Payer: Priority Health Medicare |
$3.88
|
| Rate for Payer: Priority Health Medicare |
$3.26
|
| Rate for Payer: Priority Health Medicare |
$2.78
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$4.80
|
| Rate for Payer: Priority Health Medicare |
$5.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.30
|
| Rate for Payer: Railroad Medicare Medicare |
$5.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2.75
|
| Rate for Payer: Railroad Medicare Medicare |
$4.75
|
| Rate for Payer: Railroad Medicare Medicare |
$3.84
|
| Rate for Payer: Railroad Medicare Medicare |
$3.23
|
| Rate for Payer: Railroad Medicare Medicare |
$3.12
|
| Rate for Payer: Railroad Medicare Medicare |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.53
|
| 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) |
$9.70
|
| Rate for Payer: UHC Core |
$10.41
|
| Rate for Payer: UHC Core |
$15.87
|
| Rate for Payer: UHC Core |
$9.20
|
| Rate for Payer: UHC Core |
$12.83
|
| Rate for Payer: UHC Core |
$10.78
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: UHC Core |
$18.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.46
|
| Rate for Payer: UHC Exchange |
$3.84
|
| Rate for Payer: UHC Exchange |
$4.75
|
| Rate for Payer: UHC Exchange |
$5.46
|
| Rate for Payer: UHC Exchange |
$3.12
|
| Rate for Payer: UHC Exchange |
$3.23
|
| Rate for Payer: UHC Exchange |
$2.75
|
| Rate for Payer: UHC Exchange |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$5.46
|
| Rate for Payer: UHC Medicare Advantage |
$2.75
|
| Rate for Payer: UHC Medicare Advantage |
$3.23
|
| Rate for Payer: UHC Medicare Advantage |
$3.84
|
| Rate for Payer: UHC Medicare Advantage |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$4.75
|
| Rate for Payer: UHC Medicare Advantage |
$3.12
|
| Rate for Payer: VA VA |
$3.23
|
| Rate for Payer: VA VA |
$3.84
|
| Rate for Payer: VA VA |
$3.12
|
| Rate for Payer: VA VA |
$5.46
|
| Rate for Payer: VA VA |
$2.75
|
| Rate for Payer: VA VA |
$4.24
|
| Rate for Payer: VA VA |
$4.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.71
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$23.78
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$21.40 |
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Commercial |
$11.71
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: BCBS Trust/PPO |
$20.84
|
| Rate for Payer: BCBS Trust/PPO |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCBS Trust/PPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$22.25
|
| Rate for Payer: BCBS Trust/PPO |
$11.25
|
| Rate for Payer: BCBS Trust/PPO |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$11.60
|
| Rate for Payer: BCN Commercial |
$10.98
|
| Rate for Payer: BCN Commercial |
$9.19
|
| Rate for Payer: BCN Commercial |
$13.09
|
| Rate for Payer: BCN Commercial |
$10.65
|
| Rate for Payer: BCN Commercial |
$18.38
|
| Rate for Payer: BCN Commercial |
$21.07
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: BCN Commercial |
$19.73
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$11.85
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| 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 |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.02
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$12.40
|
| Rate for Payer: Healthscope Commercial |
$12.79
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Nomi Health Commercial |
$19.02
|
| Rate for Payer: Nomi Health Commercial |
$19.50
|
| Rate for Payer: Nomi Health Commercial |
$22.35
|
| Rate for Payer: Nomi Health Commercial |
$9.75
|
| Rate for Payer: Nomi Health Commercial |
$11.30
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: Nomi Health Commercial |
$11.65
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Commercial |
$12.08
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$11.71
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$20.69
|
| Rate for Payer: Priority Health HMO/PPO |
$11.99
|
| Rate for Payer: Priority Health HMO/PPO |
$10.34
|
| Rate for Payer: Priority Health HMO/PPO |
$14.74
|
| Rate for Payer: Priority Health HMO/PPO |
$22.21
|
| Rate for Payer: Priority Health HMO/PPO |
$12.36
|
| Rate for Payer: Priority Health HMO/PPO |
$23.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.93
|
| 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) |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.13
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: UHC Core |
$9.93
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: UHC Core |
$11.51
|
| Rate for Payer: UHC Core |
$19.37
|
| Rate for Payer: UHC Core |
$22.76
|
| Rate for Payer: UHC Core |
$21.32
|
| Rate for Payer: UHC Core |
$11.87
|
| 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 |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.34
|
| 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 |
$2.82 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Commercial |
$11.71
|
| Rate for Payer: Aetna Commercial |
$12.08
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$19.72
|
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Medicare |
$6.18
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Aetna Medicare |
$7.09
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: Aetna Medicare |
$4.40
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.44
|
| Rate for Payer: BCBS Complete |
$9.28
|
| Rate for Payer: BCBS Complete |
$5.51
|
| Rate for Payer: BCBS Complete |
$5.68
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS Complete |
$4.76
|
| Rate for Payer: BCBS Complete |
$9.51
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: BCBS MAPPO |
$3.44
|
| Rate for Payer: BCBS MAPPO |
$5.80
|
| Rate for Payer: BCBS MAPPO |
$5.95
|
| Rate for Payer: BCBS MAPPO |
$3.55
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS MAPPO |
$4.24
|
| Rate for Payer: BCBS MAPPO |
$2.97
|
| Rate for Payer: BCBS MAPPO |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$11.68
|
| Rate for Payer: BCBS Trust/PPO |
$13.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$19.55
|
| Rate for Payer: BCBS Trust/PPO |
$19.07
|
| Rate for Payer: BCBS Trust/PPO |
$9.77
|
| Rate for Payer: BCBS Trust/PPO |
$11.33
|
| Rate for Payer: BCBS Trust/PPO |
$20.99
|
| Rate for Payer: BCN Commercial |
$21.19
|
| Rate for Payer: BCN Commercial |
$13.17
|
| Rate for Payer: BCN Commercial |
$10.71
|
| Rate for Payer: BCN Commercial |
$18.49
|
| Rate for Payer: BCN Commercial |
$18.04
|
| Rate for Payer: BCN Commercial |
$19.85
|
| Rate for Payer: BCN Commercial |
$9.24
|
| Rate for Payer: BCN Commercial |
$11.05
|
| Rate for Payer: BCN Medicare Advantage |
$5.80
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: BCN Medicare Advantage |
$3.55
|
| Rate for Payer: BCN Medicare Advantage |
$2.97
|
| Rate for Payer: BCN Medicare Advantage |
$6.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.95
|
| Rate for Payer: BCN Medicare Advantage |
$4.24
|
| Rate for Payer: BCN Medicare Advantage |
$3.44
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cash Price |
$18.56
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cofinity Commercial |
$11.85
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Cofinity Commercial |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Cofinity Commercial |
$12.22
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| 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 |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.82
|
| Rate for Payer: Healthscope Commercial |
$12.79
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$12.40
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.40
|
| 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 |
$7.16
|
| 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 |
$3.62
|
| 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 |
$6.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.96
|
| 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 |
$6.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.11
|
| Rate for Payer: Nomi Health Commercial |
$11.30
|
| Rate for Payer: Nomi Health Commercial |
$19.50
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: Nomi Health Commercial |
$11.65
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Nomi Health Commercial |
$22.35
|
| Rate for Payer: Nomi Health Commercial |
$9.75
|
| Rate for Payer: Nomi Health Commercial |
$19.02
|
| Rate for Payer: PACE Senior Care Partners |
$6.47
|
| 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 |
$5.51
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE Senior Care Partners |
$3.37
|
| Rate for Payer: PACE Senior Care Partners |
$3.27
|
| Rate for Payer: PACE SWMI |
$5.80
|
| Rate for Payer: PACE SWMI |
$2.97
|
| Rate for Payer: PACE SWMI |
$3.55
|
| Rate for Payer: PACE SWMI |
$4.24
|
| Rate for Payer: PACE SWMI |
$3.44
|
| Rate for Payer: PACE SWMI |
$5.95
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PACE SWMI |
$6.82
|
| Rate for Payer: PHP Commercial |
$12.08
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Commercial |
$19.72
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Commercial |
$11.71
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: PHP Medicare Advantage |
$4.24
|
| Rate for Payer: PHP Medicare Advantage |
$3.44
|
| Rate for Payer: PHP Medicare Advantage |
$5.80
|
| Rate for Payer: PHP Medicare Advantage |
$3.55
|
| Rate for Payer: PHP Medicare Advantage |
$6.82
|
| Rate for Payer: PHP Medicare Advantage |
$5.95
|
| Rate for Payer: PHP Medicare Advantage |
$2.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health HMO/PPO |
$23.72
|
| Rate for Payer: Priority Health HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health HMO/PPO |
$14.74
|
| Rate for Payer: Priority Health HMO/PPO |
$20.69
|
| Rate for Payer: Priority Health HMO/PPO |
$10.34
|
| Rate for Payer: Priority Health HMO/PPO |
$11.99
|
| Rate for Payer: Priority Health HMO/PPO |
$22.21
|
| Rate for Payer: Priority Health HMO/PPO |
$12.36
|
| Rate for Payer: Priority Health Medicare |
$6.88
|
| Rate for Payer: Priority Health Medicare |
$5.86
|
| Rate for Payer: Priority Health Medicare |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: Priority Health Medicare |
$3.00
|
| Rate for Payer: Priority Health Medicare |
$6.00
|
| Rate for Payer: Priority Health Medicare |
$6.45
|
| Rate for Payer: Priority Health Medicare |
$3.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.11
|
| Rate for Payer: Railroad Medicare Medicare |
$3.55
|
| Rate for Payer: Railroad Medicare Medicare |
$5.95
|
| Rate for Payer: Railroad Medicare Medicare |
$3.44
|
| Rate for Payer: Railroad Medicare Medicare |
$2.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: Railroad Medicare Medicare |
$6.82
|
| Rate for Payer: Railroad Medicare Medicare |
$4.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.99
|
| Rate for Payer: UHC Core |
$19.37
|
| Rate for Payer: UHC Core |
$11.51
|
| Rate for Payer: UHC Core |
$19.86
|
| Rate for Payer: UHC Core |
$9.93
|
| Rate for Payer: UHC Core |
$11.87
|
| Rate for Payer: UHC Core |
$14.14
|
| Rate for Payer: UHC Core |
$22.76
|
| Rate for Payer: UHC Core |
$21.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.80
|
| 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 |
$3.44
|
| Rate for Payer: UHC Exchange |
$2.97
|
| Rate for Payer: UHC Exchange |
$5.80
|
| Rate for Payer: UHC Exchange |
$4.24
|
| Rate for Payer: UHC Exchange |
$6.82
|
| Rate for Payer: UHC Medicare Advantage |
$3.44
|
| Rate for Payer: UHC Medicare Advantage |
$5.95
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: UHC Medicare Advantage |
$5.80
|
| Rate for Payer: UHC Medicare Advantage |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$3.55
|
| Rate for Payer: UHC Medicare Advantage |
$6.82
|
| Rate for Payer: UHC Medicare Advantage |
$2.97
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: VA VA |
$5.80
|
| Rate for Payer: VA VA |
$3.44
|
| Rate for Payer: VA VA |
$4.24
|
| Rate for Payer: VA VA |
$2.97
|
| Rate for Payer: VA VA |
$6.82
|
| Rate for Payer: VA VA |
$5.95
|
| Rate for Payer: VA VA |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
|
|
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 |
$5.57 |
| 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 |
$9.38
|
| Rate for Payer: BCBS MAPPO |
$5.86
|
| Rate for Payer: BCBS Trust/PPO |
$19.28
|
| Rate for Payer: BCN Commercial |
$18.23
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.93
|
| Rate for Payer: Nomi Health Commercial |
$19.23
|
| 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 Cigna Priority Health |
$15.24
|
| Rate for Payer: Priority Health HMO/PPO |
$20.40
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.71
|
| 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 Dual Complete DSNP |
$5.86
|
| Rate for Payer: UHC Exchange |
$5.86
|
| Rate for Payer: UHC Medicare Advantage |
$5.86
|
| 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
|
$23.45
|
|
|
Service Code
|
NDC 50383077504
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: BCBS Trust/PPO |
$19.14
|
| Rate for Payer: BCN Commercial |
$18.12
|
| 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: PHP Commercial |
$19.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.24
|
| Rate for Payer: Priority Health HMO/PPO |
$20.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.71
|
| 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
|
$15.06
|
|
|
Service Code
|
NDC 00121090315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.58 |
| 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 |
$6.02
|
| Rate for Payer: BCBS MAPPO |
$3.77
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$11.71
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.35
|
| 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 Cigna Priority Health |
$9.79
|
| Rate for Payer: Priority Health HMO/PPO |
$13.10
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.09
|
| 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 Dual Complete DSNP |
$3.77
|
| Rate for Payer: UHC Exchange |
$3.77
|
| Rate for Payer: UHC Medicare Advantage |
$3.77
|
| Rate for Payer: VA VA |
$3.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
