|
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
|
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 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 (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 |
$5.78
|
| 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 |
$5.78
|
| 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 |
$5.78
|
| 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 |
$5.78
|
| 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 |
$5.78
|
| 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 |
$5.78
|
| 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 |
$5.78
|
| 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 |
$5.78
|
| Rate for Payer: UHC Exchange |
$6.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.78
|
| 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 |
$5.78
|
| 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
|
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 %) 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
|
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 |
$5.78
|
| Rate for Payer: BCBS Trust/PPO |
$19.02
|
| Rate for Payer: BCN Commercial |
$17.99
|
| Rate for Payer: BCN Medicare Advantage |
$5.78
|
| 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 |
$5.78
|
| 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 |
$5.78
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Medicare Advantage |
$5.78
|
| 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 |
$5.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.36
|
| Rate for Payer: UHC Core |
$19.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.78
|
| Rate for Payer: UHC Exchange |
$5.78
|
| Rate for Payer: UHC Medicare Advantage |
$5.78
|
| Rate for Payer: VA VA |
$5.78
|
| 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
|
$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) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$12.98
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$11.68 |
| Rate for Payer: Aetna Commercial |
$11.03
|
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: BCBS Trust/PPO |
$18.46
|
| Rate for Payer: BCBS Trust/PPO |
$22.08
|
| Rate for Payer: BCBS Trust/PPO |
$20.69
|
| Rate for Payer: BCBS Trust/PPO |
$12.43
|
| Rate for Payer: BCBS Trust/PPO |
$10.60
|
| Rate for Payer: BCBS Trust/PPO |
$37.82
|
| Rate for Payer: BCBS Trust/PPO |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$22.73
|
| Rate for Payer: BCBS Trust/PPO |
$14.20
|
| Rate for Payer: BCN Commercial |
$13.45
|
| Rate for Payer: BCN Commercial |
$35.80
|
| Rate for Payer: BCN Commercial |
$12.40
|
| Rate for Payer: BCN Commercial |
$10.03
|
| Rate for Payer: BCN Commercial |
$11.77
|
| Rate for Payer: BCN Commercial |
$19.59
|
| Rate for Payer: BCN Commercial |
$20.90
|
| Rate for Payer: BCN Commercial |
$17.48
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Healthscope Commercial |
$11.68
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$41.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Nomi Health Commercial |
$18.55
|
| Rate for Payer: Nomi Health Commercial |
$22.18
|
| Rate for Payer: Nomi Health Commercial |
$10.64
|
| Rate for Payer: Nomi Health Commercial |
$12.49
|
| Rate for Payer: Nomi Health Commercial |
$14.27
|
| Rate for Payer: Nomi Health Commercial |
$20.79
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: Nomi Health Commercial |
$22.83
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$11.03
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health HMO/PPO |
$19.68
|
| Rate for Payer: Priority Health HMO/PPO |
$24.22
|
| Rate for Payer: Priority Health HMO/PPO |
$40.31
|
| Rate for Payer: Priority Health HMO/PPO |
$22.05
|
| Rate for Payer: Priority Health HMO/PPO |
$23.53
|
| Rate for Payer: Priority Health HMO/PPO |
$13.96
|
| Rate for Payer: Priority Health HMO/PPO |
$15.14
|
| Rate for Payer: Priority Health HMO/PPO |
$11.29
|
| Rate for Payer: Priority Health HMO/PPO |
$13.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.50
|
| Rate for Payer: UHC Core |
$21.17
|
| Rate for Payer: UHC Core |
$23.25
|
| Rate for Payer: UHC Core |
$38.69
|
| Rate for Payer: UHC Core |
$12.72
|
| Rate for Payer: UHC Core |
$13.40
|
| Rate for Payer: UHC Core |
$10.84
|
| Rate for Payer: UHC Core |
$22.59
|
| Rate for Payer: UHC Core |
$14.53
|
| Rate for Payer: UHC Core |
$18.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$12.98
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$11.68 |
| Rate for Payer: Aetna Commercial |
$11.03
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: Aetna Medicare |
$3.37
|
| Rate for Payer: Aetna Medicare |
$4.17
|
| Rate for Payer: Aetna Medicare |
$7.24
|
| Rate for Payer: Aetna Medicare |
$7.03
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Aetna Medicare |
$6.59
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.07
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.48
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS Complete |
$5.19
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS Complete |
$9.05
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS Complete |
$18.53
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS MAPPO |
$4.35
|
| Rate for Payer: BCBS MAPPO |
$6.34
|
| Rate for Payer: BCBS MAPPO |
$5.66
|
| Rate for Payer: BCBS MAPPO |
$6.96
|
| Rate for Payer: BCBS MAPPO |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$6.76
|
| Rate for Payer: BCBS MAPPO |
$3.24
|
| Rate for Payer: BCBS MAPPO |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$11.58
|
| Rate for Payer: BCBS Trust/PPO |
$14.30
|
| Rate for Payer: BCBS Trust/PPO |
$22.24
|
| Rate for Payer: BCBS Trust/PPO |
$38.09
|
| Rate for Payer: BCBS Trust/PPO |
$10.67
|
| Rate for Payer: BCBS Trust/PPO |
$12.52
|
| Rate for Payer: BCBS Trust/PPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$20.84
|
| Rate for Payer: BCBS Trust/PPO |
$18.60
|
| Rate for Payer: BCBS Trust/PPO |
$22.89
|
| Rate for Payer: BCN Commercial |
$36.02
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$19.71
|
| Rate for Payer: BCN Commercial |
$17.59
|
| Rate for Payer: BCN Commercial |
$21.65
|
| Rate for Payer: BCN Commercial |
$10.09
|
| Rate for Payer: BCN Commercial |
$11.84
|
| Rate for Payer: BCN Commercial |
$21.03
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: BCN Medicare Advantage |
$6.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.01
|
| Rate for Payer: BCN Medicare Advantage |
$3.24
|
| Rate for Payer: BCN Medicare Advantage |
$5.66
|
| Rate for Payer: BCN Medicare Advantage |
$6.34
|
| Rate for Payer: BCN Medicare Advantage |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$11.58
|
| Rate for Payer: BCN Medicare Advantage |
$6.96
|
| Rate for Payer: BCN Medicare Advantage |
$3.81
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$11.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Nomi Health Commercial |
$22.18
|
| Rate for Payer: Nomi Health Commercial |
$20.79
|
| Rate for Payer: Nomi Health Commercial |
$14.27
|
| Rate for Payer: Nomi Health Commercial |
$12.49
|
| Rate for Payer: Nomi Health Commercial |
$10.64
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: Nomi Health Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$18.55
|
| Rate for Payer: Nomi Health Commercial |
$22.83
|
| Rate for Payer: PACE Senior Care Partners |
$11.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.13
|
| Rate for Payer: PACE Senior Care Partners |
$6.02
|
| Rate for Payer: PACE Senior Care Partners |
$5.37
|
| Rate for Payer: PACE Senior Care Partners |
$3.81
|
| Rate for Payer: PACE Senior Care Partners |
$6.42
|
| Rate for Payer: PACE Senior Care Partners |
$3.62
|
| Rate for Payer: PACE Senior Care Partners |
$3.08
|
| Rate for Payer: PACE Senior Care Partners |
$6.61
|
| Rate for Payer: PACE SWMI |
$6.34
|
| Rate for Payer: PACE SWMI |
$3.81
|
| Rate for Payer: PACE SWMI |
$3.24
|
| Rate for Payer: PACE SWMI |
$6.76
|
| Rate for Payer: PACE SWMI |
$4.01
|
| Rate for Payer: PACE SWMI |
$5.66
|
| Rate for Payer: PACE SWMI |
$4.35
|
| Rate for Payer: PACE SWMI |
$11.58
|
| Rate for Payer: PACE SWMI |
$6.96
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: PHP Commercial |
$39.38
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$11.03
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$11.58
|
| Rate for Payer: PHP Medicare Advantage |
$3.24
|
| Rate for Payer: PHP Medicare Advantage |
$6.96
|
| Rate for Payer: PHP Medicare Advantage |
$6.76
|
| Rate for Payer: PHP Medicare Advantage |
$3.81
|
| Rate for Payer: PHP Medicare Advantage |
$6.34
|
| Rate for Payer: PHP Medicare Advantage |
$5.66
|
| Rate for Payer: PHP Medicare Advantage |
$4.01
|
| Rate for Payer: PHP Medicare Advantage |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health HMO/PPO |
$40.31
|
| Rate for Payer: Priority Health HMO/PPO |
$24.22
|
| Rate for Payer: Priority Health HMO/PPO |
$13.25
|
| Rate for Payer: Priority Health HMO/PPO |
$11.29
|
| Rate for Payer: Priority Health HMO/PPO |
$13.96
|
| Rate for Payer: Priority Health HMO/PPO |
$15.14
|
| Rate for Payer: Priority Health HMO/PPO |
$19.68
|
| Rate for Payer: Priority Health HMO/PPO |
$23.53
|
| Rate for Payer: Priority Health HMO/PPO |
$22.05
|
| Rate for Payer: Priority Health Medicare |
$6.40
|
| Rate for Payer: Priority Health Medicare |
$5.71
|
| Rate for Payer: Priority Health Medicare |
$4.39
|
| Rate for Payer: Priority Health Medicare |
$4.05
|
| Rate for Payer: Priority Health Medicare |
$6.83
|
| Rate for Payer: Priority Health Medicare |
$7.03
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Medicare |
$3.85
|
| Rate for Payer: Priority Health Medicare |
$11.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.66
|
| Rate for Payer: Railroad Medicare Medicare |
$4.01
|
| Rate for Payer: Railroad Medicare Medicare |
$4.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6.76
|
| Rate for Payer: Railroad Medicare Medicare |
$3.81
|
| Rate for Payer: Railroad Medicare Medicare |
$3.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.91
|
| Rate for Payer: UHC Core |
$18.89
|
| Rate for Payer: UHC Core |
$14.53
|
| Rate for Payer: UHC Core |
$38.69
|
| Rate for Payer: UHC Core |
$13.40
|
| Rate for Payer: UHC Core |
$23.25
|
| Rate for Payer: UHC Core |
$21.17
|
| Rate for Payer: UHC Core |
$22.59
|
| Rate for Payer: UHC Core |
$12.72
|
| Rate for Payer: UHC Core |
$10.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.01
|
| Rate for Payer: UHC Exchange |
$4.01
|
| Rate for Payer: UHC Exchange |
$11.58
|
| Rate for Payer: UHC Exchange |
$4.35
|
| Rate for Payer: UHC Exchange |
$3.24
|
| Rate for Payer: UHC Exchange |
$3.81
|
| Rate for Payer: UHC Exchange |
$5.66
|
| Rate for Payer: UHC Exchange |
$6.96
|
| Rate for Payer: UHC Exchange |
$6.76
|
| Rate for Payer: UHC Exchange |
$6.34
|
| Rate for Payer: UHC Medicare Advantage |
$3.24
|
| Rate for Payer: UHC Medicare Advantage |
$3.81
|
| Rate for Payer: UHC Medicare Advantage |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$6.96
|
| Rate for Payer: UHC Medicare Advantage |
$6.76
|
| Rate for Payer: UHC Medicare Advantage |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$6.34
|
| Rate for Payer: UHC Medicare Advantage |
$5.66
|
| Rate for Payer: VA VA |
$3.81
|
| Rate for Payer: VA VA |
$4.35
|
| Rate for Payer: VA VA |
$6.96
|
| Rate for Payer: VA VA |
$6.76
|
| Rate for Payer: VA VA |
$5.66
|
| Rate for Payer: VA VA |
$3.24
|
| Rate for Payer: VA VA |
$6.34
|
| Rate for Payer: VA VA |
$11.58
|
| Rate for Payer: VA VA |
$4.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.66
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$14.09 |
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCBS Trust/PPO |
$23.20
|
| Rate for Payer: BCBS Trust/PPO |
$10.72
|
| Rate for Payer: BCBS Trust/PPO |
$9.89
|
| Rate for Payer: BCN Commercial |
$12.10
|
| Rate for Payer: BCN Commercial |
$9.36
|
| Rate for Payer: BCN Commercial |
$21.96
|
| Rate for Payer: BCN Commercial |
$10.15
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Nomi Health Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$10.77
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Nomi Health Commercial |
$12.84
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.18
|
| Rate for Payer: Priority Health HMO/PPO |
$13.62
|
| Rate for Payer: Priority Health HMO/PPO |
$24.73
|
| Rate for Payer: Priority Health HMO/PPO |
$10.54
|
| Rate for Payer: Priority Health HMO/PPO |
$11.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.78
|
| Rate for Payer: UHC Core |
$13.08
|
| Rate for Payer: UHC Core |
$23.73
|
| Rate for Payer: UHC Core |
$10.96
|
| Rate for Payer: UHC Core |
$10.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$12.11
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$13.31
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Aetna Medicare |
$4.07
|
| Rate for Payer: Aetna Medicare |
$7.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.78
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: BCBS Complete |
$11.37
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS MAPPO |
$3.03
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS MAPPO |
$7.10
|
| Rate for Payer: BCBS MAPPO |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$9.96
|
| Rate for Payer: BCBS Trust/PPO |
$23.36
|
| Rate for Payer: BCBS Trust/PPO |
$10.79
|
| Rate for Payer: BCBS Trust/PPO |
$12.87
|
| Rate for Payer: BCN Commercial |
$9.42
|
| Rate for Payer: BCN Commercial |
$12.18
|
| Rate for Payer: BCN Commercial |
$10.21
|
| Rate for Payer: BCN Commercial |
$22.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: BCN Medicare Advantage |
$7.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.03
|
| Rate for Payer: BCN Medicare Advantage |
$3.92
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$12.53
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.92
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$14.09
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.31
|
| Rate for Payer: Nomi Health Commercial |
$12.84
|
| Rate for Payer: Nomi Health Commercial |
$23.30
|
| Rate for Payer: Nomi Health Commercial |
$9.93
|
| Rate for Payer: Nomi Health Commercial |
$10.77
|
| Rate for Payer: PACE Senior Care Partners |
$2.88
|
| Rate for Payer: PACE Senior Care Partners |
$3.72
|
| Rate for Payer: PACE Senior Care Partners |
$6.75
|
| Rate for Payer: PACE Senior Care Partners |
$3.12
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PACE SWMI |
$3.03
|
| Rate for Payer: PACE SWMI |
$3.92
|
| Rate for Payer: PACE SWMI |
$7.10
|
| Rate for Payer: PHP Commercial |
$13.31
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: PHP Medicare Advantage |
$3.03
|
| Rate for Payer: PHP Medicare Advantage |
$7.10
|
| Rate for Payer: PHP Medicare Advantage |
$3.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: Priority Health HMO/PPO |
$11.42
|
| Rate for Payer: Priority Health HMO/PPO |
$24.73
|
| Rate for Payer: Priority Health HMO/PPO |
$13.62
|
| Rate for Payer: Priority Health HMO/PPO |
$10.54
|
| Rate for Payer: Priority Health Medicare |
$3.95
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Medicare |
$3.32
|
| Rate for Payer: Priority Health Medicare |
$7.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.11
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: Railroad Medicare Medicare |
$3.92
|
| Rate for Payer: Railroad Medicare Medicare |
$3.03
|
| Rate for Payer: Railroad Medicare Medicare |
$7.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.55
|
| Rate for Payer: UHC Core |
$10.11
|
| Rate for Payer: UHC Core |
$23.73
|
| Rate for Payer: UHC Core |
$10.96
|
| Rate for Payer: UHC Core |
$13.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Exchange |
$7.10
|
| Rate for Payer: UHC Exchange |
$3.28
|
| Rate for Payer: UHC Exchange |
$3.03
|
| Rate for Payer: UHC Exchange |
$3.92
|
| Rate for Payer: UHC Medicare Advantage |
$7.10
|
| Rate for Payer: UHC Medicare Advantage |
$3.03
|
| Rate for Payer: UHC Medicare Advantage |
$3.92
|
| Rate for Payer: UHC Medicare Advantage |
$3.28
|
| Rate for Payer: VA VA |
$3.28
|
| Rate for Payer: VA VA |
$7.10
|
| Rate for Payer: VA VA |
$3.92
|
| Rate for Payer: VA VA |
$3.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.74
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCN Commercial |
$16.19
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: Nomi Health Commercial |
$17.18
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health HMO/PPO |
$18.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
OP
|
$20.95
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.55
|
| Rate for Payer: BCBS Complete |
$8.38
|
| Rate for Payer: BCBS MAPPO |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$17.22
|
| Rate for Payer: BCN Commercial |
$16.29
|
| Rate for Payer: BCN Medicare Advantage |
$5.24
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.24
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: Nomi Health Commercial |
$17.18
|
| Rate for Payer: PACE Senior Care Partners |
$4.98
|
| Rate for Payer: PACE SWMI |
$5.24
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: PHP Medicare Advantage |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health HMO/PPO |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$5.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.04
|
| Rate for Payer: Railroad Medicare Medicare |
$5.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.24
|
| Rate for Payer: UHC Exchange |
$5.24
|
| Rate for Payer: UHC Medicare Advantage |
$5.24
|
| Rate for Payer: VA VA |
$5.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
OP
|
$20.95
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna Medicare |
$5.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.55
|
| Rate for Payer: BCBS Complete |
$8.38
|
| Rate for Payer: BCBS MAPPO |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$17.22
|
| Rate for Payer: BCN Commercial |
$16.29
|
| Rate for Payer: BCN Medicare Advantage |
$5.24
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.24
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: Nomi Health Commercial |
$17.18
|
| Rate for Payer: PACE Senior Care Partners |
$4.98
|
| Rate for Payer: PACE SWMI |
$5.24
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: PHP Medicare Advantage |
$5.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health HMO/PPO |
$18.23
|
| Rate for Payer: Priority Health Medicare |
$5.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.04
|
| Rate for Payer: Railroad Medicare Medicare |
$5.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.24
|
| Rate for Payer: UHC Exchange |
$5.24
|
| Rate for Payer: UHC Medicare Advantage |
$5.24
|
| Rate for Payer: VA VA |
$5.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.62 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCN Commercial |
$16.19
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: Nomi Health Commercial |
$17.18
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health HMO/PPO |
$18.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.44
|
| Rate for Payer: UHC Core |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
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 (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
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 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) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION
|
Facility
|
IP
|
$32.26
|
|
|
Service Code
|
NDC 00409471201
|
| Hospital Charge Code |
27396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$29.03 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: BCBS Trust/PPO |
$26.33
|
| Rate for Payer: BCN Commercial |
$24.93
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$27.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$29.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.42
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: PHP Commercial |
$27.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.97
|
| Rate for Payer: Priority Health HMO/PPO |
$28.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.39
|
| Rate for Payer: UHC Core |
$26.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.20
|
|
|
LIDOCAINE (PF) 50 MG/ML (5 %) IN 7.5 % DEXTROSE INTRATHECAL SOLUTION
|
Facility
|
OP
|
$32.26
|
|
|
Service Code
|
NDC 00409471201
|
| Hospital Charge Code |
27396
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$29.03 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.08
|
| Rate for Payer: BCBS Complete |
$12.90
|
| Rate for Payer: BCBS MAPPO |
$8.06
|
| Rate for Payer: BCBS Trust/PPO |
$26.52
|
| Rate for Payer: BCN Commercial |
$25.08
|
| Rate for Payer: BCN Medicare Advantage |
$8.06
|
| Rate for Payer: Cash Price |
$25.81
|
| Rate for Payer: Cofinity Commercial |
$27.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$29.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.42
|
| Rate for Payer: Nomi Health Commercial |
$26.45
|
| Rate for Payer: PACE Senior Care Partners |
$7.66
|
| Rate for Payer: PACE SWMI |
$8.06
|
| Rate for Payer: PHP Commercial |
$27.42
|
| Rate for Payer: PHP Medicare Advantage |
$8.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.97
|
| Rate for Payer: Priority Health HMO/PPO |
$28.07
|
| Rate for Payer: Priority Health Medicare |
$8.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.61
|
| Rate for Payer: Railroad Medicare Medicare |
$8.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.39
|
| Rate for Payer: UHC Core |
$26.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.06
|
| Rate for Payer: UHC Exchange |
$8.06
|
| Rate for Payer: UHC Medicare Advantage |
$8.06
|
| Rate for Payer: VA VA |
$8.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.20
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.54
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: BCBS Trust/PPO |
$12.69
|
| Rate for Payer: BCBS Trust/PPO |
$46.50
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: BCN Commercial |
$44.02
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cofinity Commercial |
$48.99
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.42
|
| Rate for Payer: Nomi Health Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$46.71
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$48.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health HMO/PPO |
$49.56
|
| Rate for Payer: Priority Health HMO/PPO |
$13.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Core |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.72
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$56.96
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$51.26 |
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Medicare |
$14.81
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.86
|
| Rate for Payer: BCBS Complete |
$6.22
|
| Rate for Payer: BCBS Complete |
$22.78
|
| Rate for Payer: BCBS MAPPO |
$3.88
|
| Rate for Payer: BCBS MAPPO |
$14.24
|
| Rate for Payer: BCBS Trust/PPO |
$46.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCN Commercial |
$44.29
|
| Rate for Payer: BCN Commercial |
$12.08
|
| Rate for Payer: BCN Medicare Advantage |
$14.24
|
| Rate for Payer: BCN Medicare Advantage |
$3.88
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$48.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.24
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Nomi Health Commercial |
$46.71
|
| Rate for Payer: Nomi Health Commercial |
$12.74
|
| Rate for Payer: PACE Senior Care Partners |
$13.53
|
| Rate for Payer: PACE Senior Care Partners |
$3.69
|
| Rate for Payer: PACE SWMI |
$14.24
|
| Rate for Payer: PACE SWMI |
$3.88
|
| Rate for Payer: PHP Commercial |
$48.42
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Medicare Advantage |
$3.88
|
| Rate for Payer: PHP Medicare Advantage |
$14.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health HMO/PPO |
$13.52
|
| Rate for Payer: Priority Health HMO/PPO |
$49.56
|
| Rate for Payer: Priority Health Medicare |
$14.38
|
| Rate for Payer: Priority Health Medicare |
$3.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.41
|
| Rate for Payer: Railroad Medicare Medicare |
$3.88
|
| Rate for Payer: Railroad Medicare Medicare |
$14.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.12
|
| Rate for Payer: UHC Core |
$47.56
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.88
|
| Rate for Payer: UHC Exchange |
$3.88
|
| Rate for Payer: UHC Exchange |
$14.24
|
| Rate for Payer: UHC Medicare Advantage |
$3.88
|
| Rate for Payer: UHC Medicare Advantage |
$14.24
|
| Rate for Payer: VA VA |
$3.88
|
| Rate for Payer: VA VA |
$14.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.66
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
OP
|
$10.40
|
|
|
Service Code
|
NDC 00496088205
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna Medicare |
$2.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.25
|
| Rate for Payer: BCBS Complete |
$4.16
|
| Rate for Payer: BCBS MAPPO |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.09
|
| Rate for Payer: BCN Medicare Advantage |
$2.60
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PACE Senior Care Partners |
$2.47
|
| Rate for Payer: PACE SWMI |
$2.60
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$2.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: Railroad Medicare Medicare |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.60
|
| Rate for Payer: UHC Exchange |
$2.60
|
| Rate for Payer: UHC Medicare Advantage |
$2.60
|
| Rate for Payer: VA VA |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
NDC 00496088205
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCN Commercial |
$8.04
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Nomi Health Commercial |
$8.53
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health HMO/PPO |
$9.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.15
|
| Rate for Payer: UHC Core |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
