|
LICE AND NIT COMB
|
Facility
|
OP
|
$8.75
|
|
|
Service Code
|
NDC 64442650197
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna American Axle |
$5.69
|
| Rate for Payer: Aetna Commercial |
$7.44
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.69
|
| Rate for Payer: BCBS Complete |
$3.50
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cofinity Advantage |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.00
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.56
|
| Rate for Payer: PHP Commercial |
$7.44
|
| Rate for Payer: Priority Health SBD |
$5.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.69
|
| Rate for Payer: UHC Core |
$4.56
|
| Rate for Payer: UHC Exchange |
$3.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.56
|
|
|
LICE AND NIT COMB
|
Facility
|
IP
|
$8.75
|
|
|
Service Code
|
NDC 64442650197
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$7.88 |
| Rate for Payer: Aetna American Axle |
$5.69
|
| Rate for Payer: Aetna Commercial |
$7.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.69
|
| Rate for Payer: Cash Price |
$7.00
|
| Rate for Payer: Cofinity Advantage |
$6.12
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.00
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.56
|
| Rate for Payer: PHP Commercial |
$7.44
|
| Rate for Payer: Priority Health SBD |
$5.51
|
| Rate for Payer: UMR Bronson Commercial |
$3.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.56
|
|
|
LICE AND NIT COMB
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
NDC 55128270000
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
LICE AND NIT COMB
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 63736024793
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.76
|
| Rate for Payer: UHC Core |
$2.21
|
| Rate for Payer: UHC Exchange |
$1.67
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
LICE AND NIT COMB
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 63736024793
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna American Axle |
$2.76
|
| Rate for Payer: Aetna Commercial |
$3.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.76
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Advantage |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$3.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.19
|
| Rate for Payer: PHP Commercial |
$3.61
|
| Rate for Payer: Priority Health SBD |
$2.68
|
| Rate for Payer: UMR Bronson Commercial |
$1.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.19
|
|
|
LICE AND NIT COMB
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 07957310450
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna Medicare |
$2.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.32
|
| Rate for Payer: UHC Exchange |
$1.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
LICE AND NIT COMB
|
Facility
|
OP
|
$0.87
|
|
|
Service Code
|
NDC 25715067323
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna American Axle |
$0.57
|
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare |
$0.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.57
|
| Rate for Payer: BCBS Complete |
$0.35
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cofinity Advantage |
$0.61
|
| Rate for Payer: Cofinity Commercial |
$0.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.70
|
| Rate for Payer: Healthscope Commercial |
$0.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.65
|
| Rate for Payer: PHP Commercial |
$0.74
|
| Rate for Payer: Priority Health SBD |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.57
|
| Rate for Payer: UHC Core |
$0.45
|
| Rate for Payer: UHC Exchange |
$0.34
|
| Rate for Payer: UMR Bronson Commercial |
$0.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.65
|
|
|
LICE AND NIT COMB
|
Facility
|
IP
|
$0.87
|
|
|
Service Code
|
NDC 25715067323
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Aetna American Axle |
$0.57
|
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.57
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cofinity Advantage |
$0.61
|
| Rate for Payer: Cofinity Commercial |
$0.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.70
|
| Rate for Payer: Healthscope Commercial |
$0.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.65
|
| Rate for Payer: PHP Commercial |
$0.74
|
| Rate for Payer: Priority Health SBD |
$0.55
|
| Rate for Payer: UMR Bronson Commercial |
$0.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.65
|
|
|
LICE AND NIT COMB
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
NDC 55128270000
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna American Axle |
$2.57
|
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.97
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.97
|
|
|
LICE AND NIT COMB
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 07957310450
|
| Hospital Charge Code |
167001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna American Axle |
$2.89
|
| Rate for Payer: Aetna Commercial |
$3.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.89
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Advantage |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.34
|
| Rate for Payer: PHP Commercial |
$3.78
|
| Rate for Payer: Priority Health SBD |
$2.80
|
| Rate for Payer: UMR Bronson Commercial |
$1.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.34
|
|
|
LIDOCAINE 0.9 % BUFFERED WITH 8.4 % SODIUM BICARB (5 ML) INJ SYRINGE
|
Facility
|
IP
|
$139.20
|
|
|
Service Code
|
NDC 69374094750
|
| Hospital Charge Code |
152324
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Advantage |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UMR Bronson Commercial |
$61.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
LIDOCAINE 0.9 % BUFFERED WITH 8.4 % SODIUM BICARB (5 ML) INJ SYRINGE
|
Facility
|
OP
|
$139.20
|
|
|
Service Code
|
NDC 69374094750
|
| Hospital Charge Code |
152324
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$125.28 |
| Rate for Payer: Aetna American Axle |
$90.48
|
| Rate for Payer: Aetna Commercial |
$118.32
|
| Rate for Payer: Aetna Medicare |
$69.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.48
|
| Rate for Payer: BCBS Complete |
$55.68
|
| Rate for Payer: Cash Price |
$111.36
|
| Rate for Payer: Cofinity Advantage |
$97.44
|
| Rate for Payer: Cofinity Commercial |
$119.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.36
|
| Rate for Payer: Healthscope Commercial |
$125.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.40
|
| Rate for Payer: PHP Commercial |
$118.32
|
| Rate for Payer: Priority Health SBD |
$87.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.48
|
| Rate for Payer: UHC Core |
$72.52
|
| Rate for Payer: UHC Exchange |
$54.71
|
| Rate for Payer: UMR Bronson Commercial |
$51.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.40
|
|
|
LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$23.06
|
|
|
Service Code
|
NDC 00409427902
|
| Hospital Charge Code |
200046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: UMR Bronson Commercial |
$10.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$23.06
|
|
|
Service Code
|
NDC 00409427916
|
| Hospital Charge Code |
200046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.99
|
| Rate for Payer: UHC Core |
$12.01
|
| Rate for Payer: UHC Exchange |
$9.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$23.06
|
|
|
Service Code
|
NDC 00409427916
|
| Hospital Charge Code |
200046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: UMR Bronson Commercial |
$10.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
LIDOCAINE 10 MG/ML (1 %) INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$23.06
|
|
|
Service Code
|
NDC 00409427902
|
| Hospital Charge Code |
200046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.99
|
| Rate for Payer: UHC Core |
$12.01
|
| Rate for Payer: UHC Exchange |
$9.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
LIDOCAINE 1% AND BUPIVACAINE 0.25% AND HYALURONIDASE EYE BLOCK
|
Facility
|
OP
|
$165.63
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
158439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$149.07 |
| Rate for Payer: Aetna American Axle |
$107.66
|
| Rate for Payer: Aetna Commercial |
$140.79
|
| Rate for Payer: Aetna Medicare |
$82.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.66
|
| Rate for Payer: BCBS Complete |
$66.25
|
| Rate for Payer: BCBS Trust/PPO |
$1.15
|
| Rate for Payer: BCN Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cofinity Advantage |
$115.94
|
| Rate for Payer: Cofinity Commercial |
$142.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.50
|
| Rate for Payer: Healthscope Commercial |
$149.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.22
|
| Rate for Payer: PHP Commercial |
$140.79
|
| Rate for Payer: Priority Health SBD |
$104.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$61.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.22
|
|
|
LIDOCAINE 1% AND BUPIVACAINE 0.25% AND HYALURONIDASE EYE BLOCK
|
Facility
|
IP
|
$165.63
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
158439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$149.07 |
| Rate for Payer: Aetna American Axle |
$107.66
|
| Rate for Payer: Aetna Commercial |
$140.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.66
|
| Rate for Payer: Cash Price |
$132.50
|
| Rate for Payer: Cofinity Advantage |
$115.94
|
| Rate for Payer: Cofinity Commercial |
$142.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.50
|
| Rate for Payer: Healthscope Commercial |
$149.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.22
|
| Rate for Payer: PHP Commercial |
$140.79
|
| Rate for Payer: Priority Health SBD |
$104.35
|
| Rate for Payer: UMR Bronson Commercial |
$72.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.22
|
|
|
LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
OP
|
$24.20
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna American Axle |
$15.73
|
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna American Axle |
$11.50
|
| Rate for Payer: Aetna American Axle |
$12.50
|
| Rate for Payer: Aetna American Axle |
$13.27
|
| Rate for Payer: Aetna American Axle |
$10.10
|
| Rate for Payer: Aetna American Axle |
$11.31
|
| Rate for Payer: Aetna American Axle |
$29.22
|
| Rate for Payer: Aetna Commercial |
$15.04
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$17.35
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Medicare |
$8.85
|
| Rate for Payer: Aetna Medicare |
$8.70
|
| Rate for Payer: Aetna Medicare |
$12.10
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna Medicare |
$10.21
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: Aetna Medicare |
$22.48
|
| Rate for Payer: Aetna Medicare |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.27
|
| Rate for Payer: BCBS Complete |
$17.98
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: BCBS Complete |
$7.69
|
| Rate for Payer: BCBS Complete |
$6.22
|
| Rate for Payer: BCBS Complete |
$7.08
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS Complete |
$9.68
|
| Rate for Payer: BCBS Complete |
$8.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cash Price |
$16.33
|
| Rate for Payer: Cash Price |
$16.33
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cash Price |
$35.96
|
| Rate for Payer: Cash Price |
$35.96
|
| Rate for Payer: Cofinity Advantage |
$16.63
|
| Rate for Payer: Cofinity Advantage |
$31.46
|
| Rate for Payer: Cofinity Advantage |
$12.38
|
| Rate for Payer: Cofinity Advantage |
$14.29
|
| Rate for Payer: Cofinity Advantage |
$16.94
|
| Rate for Payer: Cofinity Advantage |
$13.46
|
| Rate for Payer: Cofinity Advantage |
$10.88
|
| Rate for Payer: Cofinity Advantage |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Commercial |
$38.66
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$17.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.36
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$40.45
|
| Rate for Payer: Healthscope Commercial |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$21.78
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$18.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.27
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$20.20
|
| Rate for Payer: PHP Commercial |
$15.04
|
| Rate for Payer: PHP Commercial |
$38.21
|
| Rate for Payer: PHP Commercial |
$20.57
|
| Rate for Payer: PHP Commercial |
$17.35
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$28.32
|
| Rate for Payer: Priority Health SBD |
$9.79
|
| Rate for Payer: Priority Health SBD |
$14.97
|
| Rate for Payer: Priority Health SBD |
$15.25
|
| Rate for Payer: Priority Health SBD |
$11.14
|
| Rate for Payer: Priority Health SBD |
$12.11
|
| Rate for Payer: Priority Health SBD |
$12.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$8.95
|
| Rate for Payer: UMR Bronson Commercial |
$16.63
|
| Rate for Payer: UMR Bronson Commercial |
$7.55
|
| Rate for Payer: UMR Bronson Commercial |
$6.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$5.75
|
| Rate for Payer: UMR Bronson Commercial |
$6.44
|
| Rate for Payer: UMR Bronson Commercial |
$7.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.15
|
|
|
LIDOCAINE 1 %-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
IP
|
$19.23
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10427
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$17.31 |
| Rate for Payer: Aetna American Axle |
$12.50
|
| Rate for Payer: Aetna American Axle |
$15.44
|
| Rate for Payer: Aetna American Axle |
$15.73
|
| Rate for Payer: Aetna American Axle |
$10.10
|
| Rate for Payer: Aetna American Axle |
$11.50
|
| Rate for Payer: Aetna American Axle |
$11.31
|
| Rate for Payer: Aetna American Axle |
$29.22
|
| Rate for Payer: Aetna American Axle |
$13.27
|
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Commercial |
$15.04
|
| Rate for Payer: Aetna Commercial |
$17.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.44
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$35.96
|
| Rate for Payer: Cash Price |
$15.38
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$14.15
|
| Rate for Payer: Cash Price |
$16.33
|
| Rate for Payer: Cash Price |
$19.01
|
| Rate for Payer: Cash Price |
$19.36
|
| Rate for Payer: Cofinity Advantage |
$31.46
|
| Rate for Payer: Cofinity Advantage |
$12.18
|
| Rate for Payer: Cofinity Advantage |
$13.46
|
| Rate for Payer: Cofinity Advantage |
$12.38
|
| Rate for Payer: Cofinity Advantage |
$10.88
|
| Rate for Payer: Cofinity Advantage |
$16.63
|
| Rate for Payer: Cofinity Advantage |
$16.94
|
| Rate for Payer: Cofinity Advantage |
$14.29
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$15.21
|
| Rate for Payer: Cofinity Commercial |
$16.54
|
| Rate for Payer: Cofinity Commercial |
$38.66
|
| Rate for Payer: Cofinity Commercial |
$17.55
|
| Rate for Payer: Cofinity Commercial |
$20.81
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Healthscope Commercial |
$18.37
|
| Rate for Payer: Healthscope Commercial |
$17.31
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$40.45
|
| Rate for Payer: Healthscope Commercial |
$21.78
|
| Rate for Payer: Healthscope Commercial |
$15.92
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.71
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$17.35
|
| Rate for Payer: PHP Commercial |
$38.21
|
| Rate for Payer: PHP Commercial |
$15.04
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$20.20
|
| Rate for Payer: PHP Commercial |
$20.57
|
| Rate for Payer: Priority Health SBD |
$14.97
|
| Rate for Payer: Priority Health SBD |
$15.25
|
| Rate for Payer: Priority Health SBD |
$28.32
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$9.79
|
| Rate for Payer: Priority Health SBD |
$11.14
|
| Rate for Payer: Priority Health SBD |
$12.11
|
| Rate for Payer: Priority Health SBD |
$12.86
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: UMR Bronson Commercial |
$8.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.78
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.46
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: UMR Bronson Commercial |
$10.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.15
|
|
|
LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna American Axle |
$12.68
|
| Rate for Payer: Aetna American Axle |
$23.72
|
| Rate for Payer: Aetna American Axle |
$11.80
|
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: Aetna Commercial |
$16.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.80
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$13.65
|
| Rate for Payer: Cofinity Advantage |
$12.71
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Advantage |
$25.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.60
|
| Rate for Payer: Healthscope Commercial |
$17.55
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.62
|
| Rate for Payer: PHP Commercial |
$15.44
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$16.57
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: Priority Health SBD |
$22.99
|
| Rate for Payer: Priority Health SBD |
$11.44
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: Priority Health SBD |
$12.29
|
| Rate for Payer: UMR Bronson Commercial |
$8.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.99
|
| Rate for Payer: UMR Bronson Commercial |
$16.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
|
|
LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
OP
|
$36.49
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Aetna American Axle |
$23.72
|
| Rate for Payer: Aetna American Axle |
$11.80
|
| Rate for Payer: Aetna American Axle |
$12.68
|
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Commercial |
$15.44
|
| Rate for Payer: Aetna Commercial |
$16.57
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna Medicare |
$9.75
|
| Rate for Payer: Aetna Medicare |
$18.25
|
| Rate for Payer: Aetna Medicare |
$9.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: BCBS Complete |
$7.26
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Complete |
$14.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Cofinity Advantage |
$25.54
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Advantage |
$13.65
|
| Rate for Payer: Cofinity Advantage |
$12.71
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Cofinity Commercial |
$15.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.53
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$17.55
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.37
|
| Rate for Payer: PHP Commercial |
$15.44
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: PHP Commercial |
$16.57
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: Priority Health SBD |
$11.44
|
| Rate for Payer: Priority Health SBD |
$12.29
|
| Rate for Payer: Priority Health SBD |
$22.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$13.50
|
| Rate for Payer: UMR Bronson Commercial |
$6.72
|
| Rate for Payer: UMR Bronson Commercial |
$7.21
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
|
|
LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
118255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna American Axle |
$4.59
|
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.59
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cofinity Advantage |
$4.94
|
| Rate for Payer: Cofinity Commercial |
$6.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$6.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$6.00
|
| Rate for Payer: Priority Health SBD |
$4.45
|
| Rate for Payer: UMR Bronson Commercial |
$3.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
LIDOCAINE 2 %-EPINEPHRINE BITARTRATE 1:100,000 INJECTION CARTRIDGE
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
118255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: Aetna American Axle |
$4.59
|
| Rate for Payer: Aetna Commercial |
$6.00
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.59
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$0.06
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cash Price |
$5.65
|
| Rate for Payer: Cofinity Advantage |
$4.94
|
| Rate for Payer: Cofinity Commercial |
$6.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$6.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.29
|
| Rate for Payer: PHP Commercial |
$6.00
|
| Rate for Payer: Priority Health SBD |
$4.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$2.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.29
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
OP
|
$15.21
|
|
|
Service Code
|
NDC 25021067376
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$13.69 |
| Rate for Payer: Aetna American Axle |
$9.89
|
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.89
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: Cash Price |
$12.17
|
| Rate for Payer: Cofinity Advantage |
$10.65
|
| Rate for Payer: Cofinity Commercial |
$13.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.17
|
| Rate for Payer: Healthscope Commercial |
$13.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.41
|
| Rate for Payer: PHP Commercial |
$12.93
|
| Rate for Payer: Priority Health SBD |
$9.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.89
|
| Rate for Payer: UHC Core |
$7.92
|
| Rate for Payer: UHC Exchange |
$5.98
|
| Rate for Payer: UMR Bronson Commercial |
$5.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.41
|
|
