|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$16.05
|
|
|
Service Code
|
NDC 0409-4713-32
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.05
|
|
|
Service Code
|
NDC 63323-492-57
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Aetna American Axle |
$17.58
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cofinity Commercial |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.99
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.94
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: UMR Bronson Commercial |
$11.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$10.65
|
|
|
Service Code
|
NDC 70756-640-25
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Healthscope Commercial |
$9.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.05
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.46
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$19.58
|
|
|
Service Code
|
NDC 70756-641-85
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna American Axle |
$12.73
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cofinity Commercial |
$13.71
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.64
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.71
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: UMR Bronson Commercial |
$8.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.68
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$10.65
|
|
|
Service Code
|
NDC 70756-640-82
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$9.58 |
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Healthscope Commercial |
$9.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.05
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.46
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$22.62
|
|
|
Service Code
|
NDC 0409-4279-02
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Aetna American Axle |
$14.70
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.70
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.23
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.83
|
| Rate for Payer: Priority Health SBD |
$14.25
|
| Rate for Payer: UMR Bronson Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$25.35
|
|
|
Service Code
|
NDC 63323-492-27
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna American Axle |
$16.48
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.55
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.74
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: UMR Bronson Commercial |
$9.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.05
|
|
|
Service Code
|
NDC 0409-4713-32
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.44
|
|
|
Service Code
|
NDC 71351-021-25
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.75 |
| Max. Negotiated Rate |
$22.00 |
| Rate for Payer: Aetna American Axle |
$15.89
|
| Rate for Payer: Aetna Commercial |
$20.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.89
|
| Rate for Payer: Cash Price |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$17.11
|
| Rate for Payer: Cofinity Commercial |
$21.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.55
|
| Rate for Payer: Healthscope Commercial |
$22.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.77
|
| Rate for Payer: PHP Commercial |
$20.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.11
|
| Rate for Payer: Priority Health SBD |
$15.40
|
| Rate for Payer: UMR Bronson Commercial |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.33
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.23
|
|
|
Service Code
|
NDC 55150-162-05
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$13.71 |
| Rate for Payer: Aetna American Axle |
$9.90
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.95
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.66
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: UMR Bronson Commercial |
$6.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$46.33
|
|
|
Service Code
|
NDC 63323-492-37
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$41.70 |
| Rate for Payer: Aetna American Axle |
$30.11
|
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.11
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cofinity Commercial |
$32.43
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Healthscope Commercial |
$41.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.38
|
| Rate for Payer: PHP Commercial |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.43
|
| Rate for Payer: Priority Health SBD |
$29.19
|
| Rate for Payer: UMR Bronson Commercial |
$20.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.75
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
NDC 72572-370-01
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.28
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$24.94
|
|
|
Service Code
|
NDC 0143-9595-01
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$22.45 |
| Rate for Payer: Aetna American Axle |
$16.21
|
| Rate for Payer: Aetna Commercial |
$21.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.21
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.95
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.20
|
| Rate for Payer: PHP Commercial |
$21.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.46
|
| Rate for Payer: Priority Health SBD |
$15.71
|
| Rate for Payer: UMR Bronson Commercial |
$10.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.70
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.05
|
|
|
Service Code
|
NDC 63323-492-09
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Aetna American Axle |
$17.58
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cofinity Commercial |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.99
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.94
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: UMR Bronson Commercial |
$11.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$22.62
|
|
|
Service Code
|
NDC 0409-4279-16
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$20.36 |
| Rate for Payer: Aetna American Axle |
$14.70
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.70
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.23
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.83
|
| Rate for Payer: Priority Health SBD |
$14.25
|
| Rate for Payer: UMR Bronson Commercial |
$9.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$29.24
|
|
|
Service Code
|
NDC 63323-492-31
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna American Axle |
$19.01
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.01
|
| Rate for Payer: Cash Price |
$23.39
|
| Rate for Payer: Cofinity Commercial |
$20.47
|
| Rate for Payer: Cofinity Commercial |
$25.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.39
|
| Rate for Payer: Healthscope Commercial |
$26.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.85
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.47
|
| Rate for Payer: Priority Health SBD |
$18.42
|
| Rate for Payer: UMR Bronson Commercial |
$12.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.93
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
NDC 72572-370-25
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.28
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.05
|
|
|
Service Code
|
NDC 0409-4713-42
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$14.44 |
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.64
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.24
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$31.78
|
|
|
Service Code
|
NDC 63323-492-45
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna American Axle |
$20.66
|
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.66
|
| Rate for Payer: Cash Price |
$25.42
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Cofinity Commercial |
$27.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.42
|
| Rate for Payer: Healthscope Commercial |
$28.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.01
|
| Rate for Payer: PHP Commercial |
$27.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.25
|
| Rate for Payer: Priority Health SBD |
$20.02
|
| Rate for Payer: UMR Bronson Commercial |
$13.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.84
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$25.35
|
|
|
Service Code
|
NDC 63323-492-27
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.15 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna American Axle |
$16.48
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.55
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.74
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: UMR Bronson Commercial |
$11.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
|
|
LIDOCAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.94
|
|
|
Service Code
|
NDC 63323-493-97
|
| Hospital Charge Code |
4453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$25.15 |
| Rate for Payer: Aetna American Axle |
$18.16
|
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.16
|
| Rate for Payer: Cash Price |
$22.35
|
| Rate for Payer: Cofinity Commercial |
$19.56
|
| Rate for Payer: Cofinity Commercial |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.35
|
| Rate for Payer: Healthscope Commercial |
$25.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.75
|
| Rate for Payer: PHP Commercial |
$23.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.56
|
| Rate for Payer: Priority Health SBD |
$17.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.96
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.99
|
|
|
Service Code
|
NDC 0409-4282-02
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$25.19 |
| Rate for Payer: Aetna American Axle |
$18.19
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cofinity Commercial |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.79
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.59
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: UMR Bronson Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.99
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
NDC 55150-165-05
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.16
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.19
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$5.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$28.42
|
|
|
Service Code
|
NDC 63323-495-04
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.50 |
| Max. Negotiated Rate |
$25.58 |
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.16
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.89
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: UMR Bronson Commercial |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.32
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$19.64
|
|
|
Service Code
|
NDC 55150-164-02
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$17.68 |
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.69
|
| Rate for Payer: PHP Commercial |
$16.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health SBD |
$12.37
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.73
|
|
