|
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
|
|
|
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
|
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
|
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
|
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 |
$11.29
|
| 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 |
$11.29
|
|
|
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
|
$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
|
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
|
$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
|
$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 |
$3.77
|
| 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
|
|
|
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
|
$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 |
$11.29
|
| 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 |
$11.29
|
|
|
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
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
IP
|
$107.59
|
|
|
Service Code
|
NDC 76329630005
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.93 |
| Max. Negotiated Rate |
$96.83 |
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: BCBS Trust/PPO |
$87.83
|
| Rate for Payer: BCN Commercial |
$83.15
|
| 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: Healthscope Commercial |
$96.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: Nomi Health Commercial |
$88.22
|
| Rate for Payer: PHP Commercial |
$91.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.93
|
| Rate for Payer: Priority Health HMO/PPO |
$93.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.68
|
| Rate for Payer: UHC Core |
$89.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.69
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.43 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: BCBS Trust/PPO |
$18.12
|
| Rate for Payer: BCN Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.54
|
| Rate for Payer: UHC Core |
$18.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$5.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.94
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS MAPPO |
$5.55
|
| Rate for Payer: BCBS Trust/PPO |
$18.25
|
| Rate for Payer: BCN Commercial |
$17.26
|
| Rate for Payer: BCN Medicare Advantage |
$5.55
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.55
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: PACE Senior Care Partners |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.55
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Medicare Advantage |
$5.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Medicare |
$5.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.87
|
| Rate for Payer: Railroad Medicare Medicare |
$5.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.54
|
| Rate for Payer: UHC Core |
$18.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.55
|
| Rate for Payer: UHC Exchange |
$5.55
|
| Rate for Payer: UHC Medicare Advantage |
$5.55
|
| Rate for Payer: VA VA |
$5.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Commercial |
$23.23
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCBS Trust/PPO |
$18.89
|
| Rate for Payer: BCBS Trust/PPO |
$22.31
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: BCN Commercial |
$21.12
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.86
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$24.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.23
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$23.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health HMO/PPO |
$23.78
|
| Rate for Payer: Priority Health HMO/PPO |
$21.03
|
| Rate for Payer: Priority Health HMO/PPO |
$20.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.36
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Core |
$22.82
|
| Rate for Payer: UHC Core |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Commercial |
$23.23
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare |
$7.11
|
| Rate for Payer: Aetna Medicare |
$6.02
|
| Rate for Payer: Aetna Medicare |
$6.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.54
|
| Rate for Payer: BCBS Complete |
$9.67
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS Complete |
$10.93
|
| Rate for Payer: BCBS MAPPO |
$6.83
|
| Rate for Payer: BCBS MAPPO |
$5.79
|
| Rate for Payer: BCBS MAPPO |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCBS Trust/PPO |
$19.02
|
| Rate for Payer: BCBS Trust/PPO |
$22.47
|
| Rate for Payer: BCN Commercial |
$18.79
|
| Rate for Payer: BCN Commercial |
$21.25
|
| Rate for Payer: BCN Commercial |
$17.99
|
| Rate for Payer: BCN Medicare Advantage |
$5.79
|
| Rate for Payer: BCN Medicare Advantage |
$6.04
|
| Rate for Payer: BCN Medicare Advantage |
$6.83
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$21.86
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$23.50
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.79
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$24.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Nomi Health Commercial |
$22.41
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: PACE Senior Care Partners |
$6.49
|
| Rate for Payer: PACE Senior Care Partners |
$5.50
|
| Rate for Payer: PACE Senior Care Partners |
$5.74
|
| Rate for Payer: PACE SWMI |
$6.04
|
| Rate for Payer: PACE SWMI |
$5.79
|
| Rate for Payer: PACE SWMI |
$6.83
|
| Rate for Payer: PHP Commercial |
$23.23
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Medicare Advantage |
$6.04
|
| Rate for Payer: PHP Medicare Advantage |
$6.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health HMO/PPO |
$23.78
|
| Rate for Payer: Priority Health HMO/PPO |
$20.13
|
| Rate for Payer: Priority Health HMO/PPO |
$21.03
|
| Rate for Payer: Priority Health Medicare |
$5.84
|
| Rate for Payer: Priority Health Medicare |
$6.90
|
| Rate for Payer: Priority Health Medicare |
$6.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.50
|
| Rate for Payer: Railroad Medicare Medicare |
$6.04
|
| Rate for Payer: Railroad Medicare Medicare |
$6.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.36
|
| Rate for Payer: UHC Core |
$22.82
|
| Rate for Payer: UHC Core |
$20.18
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.04
|
| Rate for Payer: UHC Exchange |
$6.04
|
| Rate for Payer: UHC Exchange |
$5.79
|
| Rate for Payer: UHC Exchange |
$6.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.79
|
| Rate for Payer: UHC Medicare Advantage |
$6.04
|
| Rate for Payer: UHC Medicare Advantage |
$6.83
|
| Rate for Payer: VA VA |
$6.04
|
| Rate for Payer: VA VA |
$6.83
|
| Rate for Payer: VA VA |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$24.17
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare |
$6.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.55
|
| Rate for Payer: BCBS Complete |
$9.67
|
| Rate for Payer: BCBS MAPPO |
$6.04
|
| Rate for Payer: BCBS Trust/PPO |
$19.87
|
| Rate for Payer: BCN Commercial |
$18.79
|
| Rate for Payer: BCN Medicare Advantage |
$6.04
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.04
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: PACE Senior Care Partners |
$5.74
|
| Rate for Payer: PACE SWMI |
$6.04
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Medicare Advantage |
$6.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health HMO/PPO |
$21.03
|
| Rate for Payer: Priority Health Medicare |
$6.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.19
|
| Rate for Payer: Railroad Medicare Medicare |
$6.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.27
|
| Rate for Payer: UHC Core |
$20.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.04
|
| Rate for Payer: UHC Exchange |
$6.04
|
| Rate for Payer: UHC Medicare Advantage |
$6.04
|
| Rate for Payer: VA VA |
$6.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: BCBS Trust/PPO |
$18.89
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health HMO/PPO |
$20.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.36
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$24.17
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: BCBS Trust/PPO |
$19.73
|
| Rate for Payer: BCN Commercial |
$18.68
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Nomi Health Commercial |
$19.82
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health HMO/PPO |
$21.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.27
|
| Rate for Payer: UHC Core |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$6.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.23
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: BCBS MAPPO |
$5.79
|
| Rate for Payer: BCBS Trust/PPO |
$19.02
|
| Rate for Payer: BCN Commercial |
$17.99
|
| Rate for Payer: BCN Medicare Advantage |
$5.79
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.79
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Nomi Health Commercial |
$18.97
|
| Rate for Payer: PACE Senior Care Partners |
$5.50
|
| Rate for Payer: PACE SWMI |
$5.79
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health HMO/PPO |
$20.13
|
| Rate for Payer: Priority Health Medicare |
$5.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.50
|
| Rate for Payer: Railroad Medicare Medicare |
$5.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.36
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.79
|
| Rate for Payer: UHC Exchange |
$5.79
|
| Rate for Payer: UHC Medicare Advantage |
$5.79
|
| Rate for Payer: VA VA |
$5.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
