|
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-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 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 |
$2.76
|
| 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 |
$2.76
|
| 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 |
$2.76
|
| 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 |
$8.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| 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 |
$2.76
|
| 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 |
$2.76
|
| 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 |
$2.76
|
| 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 |
$15.86
|
| 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 |
$2.76
|
| 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 |
$2.76
|
| Rate for Payer: UHC Exchange |
$4.24
|
| Rate for Payer: UHC Medicare Advantage |
$5.46
|
| Rate for Payer: UHC Medicare Advantage |
$2.76
|
| 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 |
$2.76
|
| 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 |
$8.26
|
| 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 |
$12.70
|
|
|
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 |
$12.70
|
| 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 |
$8.26
|
| 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 |
$15.86
|
| 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 |
$8.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.25
|
|
|
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 |
$20.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| 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 |
$12.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
| 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 |
$5.94
|
| 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 |
$5.94
|
| 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 |
$5.94
|
| 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 |
$20.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| 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 |
$5.94
|
| 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 |
$5.94
|
| 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 |
$5.94
|
| 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 |
$5.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.80
|
| Rate for Payer: UHC Exchange |
$5.94
|
| 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 |
$5.94
|
| 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 |
$5.94
|
| 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 |
$20.44
|
| 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 |
$12.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50383077515
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 50383077515
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: PACE Senior Care Partners |
$1.00
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3.68
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50383077517
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.27
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$19.31
|
|
|
Service Code
|
NDC 00121495040
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$15.76
|
| Rate for Payer: BCN Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Cofinity Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.45
|
| Rate for Payer: Healthscope Commercial |
$17.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.41
|
| Rate for Payer: Nomi Health Commercial |
$15.83
|
| Rate for Payer: PHP Commercial |
$16.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.55
|
| Rate for Payer: Priority Health HMO/PPO |
$16.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.99
|
| Rate for Payer: UHC Core |
$16.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.48
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$19.31
|
|
|
Service Code
|
NDC 00121495040
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$16.41
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.03
|
| Rate for Payer: BCBS Complete |
$7.72
|
| Rate for Payer: BCBS MAPPO |
$4.83
|
| Rate for Payer: BCBS Trust/PPO |
$15.87
|
| Rate for Payer: BCN Commercial |
$15.01
|
| Rate for Payer: BCN Medicare Advantage |
$4.83
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Cofinity Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$17.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.41
|
| Rate for Payer: Nomi Health Commercial |
$15.83
|
| Rate for Payer: PACE Senior Care Partners |
$4.59
|
| Rate for Payer: PACE SWMI |
$4.83
|
| Rate for Payer: PHP Commercial |
$16.41
|
| Rate for Payer: PHP Medicare Advantage |
$4.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.55
|
| Rate for Payer: Priority Health HMO/PPO |
$16.80
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.99
|
| Rate for Payer: UHC Core |
$16.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Medicare Advantage |
$4.83
|
| Rate for Payer: VA VA |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.48
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$19.31
|
|
|
Service Code
|
NDC 00121495015
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.55 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$16.41
|
| Rate for Payer: BCBS Trust/PPO |
$15.76
|
| Rate for Payer: BCN Commercial |
$14.92
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Cofinity Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.45
|
| Rate for Payer: Healthscope Commercial |
$17.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.41
|
| Rate for Payer: Nomi Health Commercial |
$15.83
|
| Rate for Payer: PHP Commercial |
$16.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.55
|
| Rate for Payer: Priority Health HMO/PPO |
$16.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.99
|
| Rate for Payer: UHC Core |
$16.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.48
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 09900000339
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.72
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: BCBS MAPPO |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$4.51
|
| Rate for Payer: BCN Commercial |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$1.37
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.37
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$4.50
|
| Rate for Payer: PACE Senior Care Partners |
$1.30
|
| Rate for Payer: PACE SWMI |
$1.37
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health HMO/PPO |
$4.78
|
| Rate for Payer: Priority Health Medicare |
$1.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.37
|
| Rate for Payer: UHC Exchange |
$1.37
|
| Rate for Payer: UHC Medicare Advantage |
$1.37
|
| Rate for Payer: VA VA |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$15.06
|
|
|
Service Code
|
NDC 00121090340
|
| 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 |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: BCN Medicare Advantage |
$3.76
|
| 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 |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| 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 |
$3.76
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$3.76
|
| 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 |
$3.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.76
|
| Rate for Payer: UHC Exchange |
$3.76
|
| Rate for Payer: UHC Medicare Advantage |
$3.76
|
| Rate for Payer: VA VA |
$3.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 09900000339
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: BCBS Trust/PPO |
$4.48
|
| Rate for Payer: BCN Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Nomi Health Commercial |
$4.50
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health HMO/PPO |
$4.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.83
|
| Rate for Payer: UHC Core |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$23.45
|
|
|
Service Code
|
NDC 50383077504
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$21.10 |
| 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 |
$21.10
|
| 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
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 00121090315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.29
|
| Rate for Payer: BCN Commercial |
$11.64
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.35
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.79
|
| Rate for Payer: Priority Health HMO/PPO |
$13.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 50383077517
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.29
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: PACE Senior Care Partners |
$1.00
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3.68
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.06
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$19.31
|
|
|
Service Code
|
NDC 00121495015
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$16.41
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.03
|
| Rate for Payer: BCBS Complete |
$7.72
|
| Rate for Payer: BCBS MAPPO |
$4.83
|
| Rate for Payer: BCBS Trust/PPO |
$15.87
|
| Rate for Payer: BCN Commercial |
$15.01
|
| Rate for Payer: BCN Medicare Advantage |
$4.83
|
| Rate for Payer: Cash Price |
$15.45
|
| Rate for Payer: Cofinity Commercial |
$16.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.83
|
| Rate for Payer: Healthscope Commercial |
$17.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.41
|
| Rate for Payer: Nomi Health Commercial |
$15.83
|
| Rate for Payer: PACE Senior Care Partners |
$4.59
|
| Rate for Payer: PACE SWMI |
$4.83
|
| Rate for Payer: PHP Commercial |
$16.41
|
| Rate for Payer: PHP Medicare Advantage |
$4.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.55
|
| Rate for Payer: Priority Health HMO/PPO |
$16.80
|
| Rate for Payer: Priority Health Medicare |
$4.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.99
|
| Rate for Payer: UHC Core |
$16.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.83
|
| Rate for Payer: UHC Exchange |
$4.83
|
| Rate for Payer: UHC Medicare Advantage |
$4.83
|
| Rate for Payer: VA VA |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.48
|
|
|
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 |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$12.38
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: BCN Medicare Advantage |
$3.76
|
| 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 |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| 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 |
$3.76
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: PHP Medicare Advantage |
$3.76
|
| 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 |
$3.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.76
|
| Rate for Payer: UHC Exchange |
$3.76
|
| Rate for Payer: UHC Medicare Advantage |
$3.76
|
| Rate for Payer: VA VA |
$3.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
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 |
$21.10 |
| 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 |
$21.10
|
| 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
|
$15.06
|
|
|
Service Code
|
NDC 00121090340
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$12.29
|
| Rate for Payer: BCN Commercial |
$11.64
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Nomi Health Commercial |
$12.35
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.79
|
| Rate for Payer: Priority Health HMO/PPO |
$13.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.25
|
| Rate for Payer: UHC Core |
$12.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
NDC 00054350547
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.59 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Medicare |
$34.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41.56
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$33.25
|
| Rate for Payer: BCBS Trust/PPO |
$109.34
|
| Rate for Payer: BCN Commercial |
$103.41
|
| Rate for Payer: BCN Medicare Advantage |
$33.25
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$114.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.25
|
| Rate for Payer: Healthscope Commercial |
$119.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Nomi Health Commercial |
$109.06
|
| Rate for Payer: PACE Senior Care Partners |
$31.59
|
| Rate for Payer: PACE SWMI |
$33.25
|
| Rate for Payer: PHP Commercial |
$113.05
|
| Rate for Payer: PHP Medicare Advantage |
$33.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health HMO/PPO |
$115.71
|
| Rate for Payer: Priority Health Medicare |
$33.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.11
|
| Rate for Payer: Railroad Medicare Medicare |
$33.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.04
|
| Rate for Payer: UHC Core |
$111.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.25
|
| Rate for Payer: UHC Exchange |
$33.25
|
| Rate for Payer: UHC Medicare Advantage |
$33.25
|
| Rate for Payer: VA VA |
$33.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.75
|
|
|
LIDOCAINE HCL 4 % (40 MG/ML) MUCOSAL SOLUTION
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
NDC 00054350547
|
| Hospital Charge Code |
4450
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.45 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$108.57
|
| Rate for Payer: BCN Commercial |
$102.78
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$114.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.40
|
| Rate for Payer: Healthscope Commercial |
$119.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.05
|
| Rate for Payer: Nomi Health Commercial |
$109.06
|
| Rate for Payer: PHP Commercial |
$113.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health HMO/PPO |
$115.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.04
|
| Rate for Payer: UHC Core |
$111.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.75
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
OP
|
$107.59
|
|
|
Service Code
|
NDC 76329630005
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.55 |
| Max. Negotiated Rate |
$96.83 |
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: Aetna Medicare |
$27.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.62
|
| Rate for Payer: BCBS Complete |
$43.04
|
| Rate for Payer: BCBS MAPPO |
$26.90
|
| Rate for Payer: BCBS Trust/PPO |
$88.45
|
| Rate for Payer: BCN Commercial |
$83.65
|
| Rate for Payer: BCN Medicare Advantage |
$26.90
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cofinity Commercial |
$92.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.90
|
| Rate for Payer: Healthscope Commercial |
$96.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: Nomi Health Commercial |
$88.22
|
| Rate for Payer: PACE Senior Care Partners |
$25.55
|
| Rate for Payer: PACE SWMI |
$26.90
|
| Rate for Payer: PHP Commercial |
$91.45
|
| Rate for Payer: PHP Medicare Advantage |
$26.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.93
|
| Rate for Payer: Priority Health HMO/PPO |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$27.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.09
|
| Rate for Payer: Railroad Medicare Medicare |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.68
|
| Rate for Payer: UHC Core |
$89.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.90
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicare Advantage |
$26.90
|
| Rate for Payer: VA VA |
$26.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.69
|
|
