|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION-DIALYSIS ONLY
|
Facility
|
IP
|
$15.37
|
|
|
Service Code
|
NDC 55150025110
|
| Hospital Charge Code |
300842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Advantage |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: UMR Bronson Commercial |
$6.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION-DIALYSIS ONLY
|
Facility
|
OP
|
$15.37
|
|
|
Service Code
|
NDC 55150025110
|
| Hospital Charge Code |
300842
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$13.83 |
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cofinity Advantage |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.53
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.99
|
| Rate for Payer: UHC Core |
$8.01
|
| Rate for Payer: UHC Exchange |
$6.04
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$27.38
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$24.64 |
| Rate for Payer: Aetna American Axle |
$17.80
|
| Rate for Payer: Aetna American Axle |
$7.73
|
| Rate for Payer: Aetna American Axle |
$15.46
|
| Rate for Payer: Aetna American Axle |
$16.59
|
| Rate for Payer: Aetna American Axle |
$11.36
|
| Rate for Payer: Aetna American Axle |
$20.25
|
| Rate for Payer: Aetna American Axle |
$18.76
|
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Medicare |
$5.95
|
| Rate for Payer: Aetna Medicare |
$15.57
|
| Rate for Payer: Aetna Medicare |
$13.69
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna Medicare |
$12.77
|
| Rate for Payer: Aetna Medicare |
$8.73
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: BCBS Complete |
$6.99
|
| Rate for Payer: BCBS Complete |
$12.46
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS Complete |
$10.95
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$4.76
|
| Rate for Payer: BCBS Complete |
$9.51
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cofinity Advantage |
$17.87
|
| Rate for Payer: Cofinity Advantage |
$16.65
|
| Rate for Payer: Cofinity Advantage |
$12.23
|
| Rate for Payer: Cofinity Advantage |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$19.17
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Advantage |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.92
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$14.98
|
| Rate for Payer: Priority Health SBD |
$17.25
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: Priority Health SBD |
$7.49
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: UMR Bronson Commercial |
$9.45
|
| Rate for Payer: UMR Bronson Commercial |
$6.46
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: UMR Bronson Commercial |
$11.53
|
| Rate for Payer: UMR Bronson Commercial |
$10.68
|
| Rate for Payer: UMR Bronson Commercial |
$10.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.15
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$11.89
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$10.70 |
| Rate for Payer: Aetna American Axle |
$7.73
|
| Rate for Payer: Aetna American Axle |
$15.46
|
| Rate for Payer: Aetna American Axle |
$16.59
|
| Rate for Payer: Aetna American Axle |
$20.25
|
| Rate for Payer: Aetna American Axle |
$18.76
|
| Rate for Payer: Aetna American Axle |
$17.80
|
| Rate for Payer: Aetna American Axle |
$11.36
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$14.85
|
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Advantage |
$20.20
|
| Rate for Payer: Cofinity Advantage |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$12.23
|
| Rate for Payer: Cofinity Advantage |
$17.87
|
| Rate for Payer: Cofinity Advantage |
$16.65
|
| Rate for Payer: Cofinity Advantage |
$19.17
|
| Rate for Payer: Cofinity Advantage |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$15.02
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.98
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$15.72
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.10
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: Priority Health SBD |
$7.49
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$17.25
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: Priority Health SBD |
$11.01
|
| Rate for Payer: Priority Health SBD |
$14.98
|
| Rate for Payer: UMR Bronson Commercial |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$11.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.69
|
| Rate for Payer: UMR Bronson Commercial |
$12.05
|
| Rate for Payer: UMR Bronson Commercial |
$12.70
|
| Rate for Payer: UMR Bronson Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.36
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 00121090340
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna American Axle |
$9.79
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.79
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$24.03
|
|
|
Service Code
|
NDC 00121495040
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna American Axle |
$15.62
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.62
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Advantage |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health SBD |
$15.14
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$5.49
|
|
|
Service Code
|
NDC 09900000339
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna American Axle |
$3.57
|
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Advantage |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health SBD |
$3.46
|
| Rate for Payer: UMR Bronson Commercial |
$2.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$15.06
|
|
|
Service Code
|
NDC 00121090315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna American Axle |
$9.79
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.79
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$6.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 50383036317
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna American Axle |
$2.75
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: BCBS Complete |
$1.69
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Advantage |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health SBD |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.75
|
| Rate for Payer: UHC Core |
$2.20
|
| Rate for Payer: UHC Exchange |
$1.66
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$23.45
|
|
|
Service Code
|
NDC 50383077504
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna American Axle |
$15.24
|
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: Aetna Medicare |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.24
|
| Rate for Payer: BCBS Complete |
$9.38
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cofinity Advantage |
$16.41
|
| Rate for Payer: Cofinity Commercial |
$20.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.59
|
| Rate for Payer: PHP Commercial |
$19.93
|
| Rate for Payer: Priority Health SBD |
$14.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.24
|
| Rate for Payer: UHC Core |
$12.22
|
| Rate for Payer: UHC Exchange |
$9.22
|
| Rate for Payer: UMR Bronson Commercial |
$8.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.59
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$5.49
|
|
|
Service Code
|
NDC 09900000339
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$4.94 |
| Rate for Payer: Aetna American Axle |
$3.57
|
| Rate for Payer: Aetna Commercial |
$4.67
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.57
|
| Rate for Payer: BCBS Complete |
$2.20
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cofinity Advantage |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.39
|
| Rate for Payer: Healthscope Commercial |
$4.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health SBD |
$3.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.57
|
| Rate for Payer: UHC Core |
$2.86
|
| Rate for Payer: UHC Exchange |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$2.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.12
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$24.03
|
|
|
Service Code
|
NDC 00121495015
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna American Axle |
$15.62
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.62
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Advantage |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health SBD |
$15.14
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$15.06
|
|
|
Service Code
|
NDC 00121090315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna American Axle |
$9.79
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Medicare |
$7.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.79
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.79
|
| Rate for Payer: UHC Core |
$7.85
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$24.03
|
|
|
Service Code
|
NDC 00121495040
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna American Axle |
$15.62
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.62
|
| Rate for Payer: BCBS Complete |
$9.61
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Advantage |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health SBD |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.62
|
| Rate for Payer: UHC Core |
$12.52
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UMR Bronson Commercial |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50383036315
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna American Axle |
$2.75
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Advantage |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health SBD |
$2.66
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
NDC 17856139302
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Advantage |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UMR Bronson Commercial |
$5.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
NDC 72888012526
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$32.13 |
| Rate for Payer: Aetna American Axle |
$23.20
|
| Rate for Payer: Aetna Commercial |
$30.34
|
| Rate for Payer: Aetna Medicare |
$17.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.20
|
| Rate for Payer: BCBS Complete |
$14.28
|
| Rate for Payer: Cash Price |
$28.56
|
| Rate for Payer: Cofinity Advantage |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.56
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.77
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.20
|
| Rate for Payer: UHC Core |
$18.60
|
| Rate for Payer: UHC Exchange |
$14.03
|
| Rate for Payer: UMR Bronson Commercial |
$13.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.77
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
NDC 60432046400
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Advantage |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.43
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$11.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
NDC 17856139302
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Aetna American Axle |
$7.80
|
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Advantage |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
| Rate for Payer: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.80
|
| Rate for Payer: UHC Core |
$6.25
|
| Rate for Payer: UHC Exchange |
$4.72
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.00
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$15.06
|
|
|
Service Code
|
NDC 00121090340
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna American Axle |
$9.79
|
| Rate for Payer: Aetna Commercial |
$12.80
|
| Rate for Payer: Aetna Medicare |
$7.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.79
|
| Rate for Payer: BCBS Complete |
$6.02
|
| Rate for Payer: Cash Price |
$12.05
|
| Rate for Payer: Cofinity Advantage |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$13.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.29
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.79
|
| Rate for Payer: UHC Core |
$7.85
|
| Rate for Payer: UHC Exchange |
$5.92
|
| Rate for Payer: UMR Bronson Commercial |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.29
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$35.35
|
|
|
Service Code
|
NDC 00054350049
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$31.82 |
| Rate for Payer: Aetna American Axle |
$22.98
|
| Rate for Payer: Aetna Commercial |
$30.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.98
|
| Rate for Payer: Cash Price |
$28.28
|
| Rate for Payer: Cofinity Advantage |
$24.75
|
| Rate for Payer: Cofinity Commercial |
$30.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.51
|
| Rate for Payer: PHP Commercial |
$30.05
|
| Rate for Payer: Priority Health SBD |
$22.27
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.51
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$35.35
|
|
|
Service Code
|
NDC 00054350049
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$31.82 |
| Rate for Payer: Aetna American Axle |
$22.98
|
| Rate for Payer: Aetna Commercial |
$30.05
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.98
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: Cash Price |
$28.28
|
| Rate for Payer: Cofinity Advantage |
$24.75
|
| Rate for Payer: Cofinity Commercial |
$30.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.51
|
| Rate for Payer: PHP Commercial |
$30.05
|
| Rate for Payer: Priority Health SBD |
$22.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.98
|
| Rate for Payer: UHC Core |
$18.42
|
| Rate for Payer: UHC Exchange |
$13.89
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.51
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 50383036317
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna American Axle |
$2.75
|
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.75
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Advantage |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health SBD |
$2.66
|
| Rate for Payer: UMR Bronson Commercial |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$23.45
|
|
|
Service Code
|
NDC 50383077504
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Aetna American Axle |
$15.24
|
| Rate for Payer: Aetna Commercial |
$19.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.24
|
| Rate for Payer: Cash Price |
$18.76
|
| Rate for Payer: Cofinity Advantage |
$16.41
|
| Rate for Payer: Cofinity Commercial |
$20.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$21.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.59
|
| Rate for Payer: PHP Commercial |
$19.93
|
| Rate for Payer: Priority Health SBD |
$14.77
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.59
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$24.03
|
|
|
Service Code
|
NDC 00121495015
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$21.63 |
| Rate for Payer: Aetna American Axle |
$15.62
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.62
|
| Rate for Payer: BCBS Complete |
$9.61
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cofinity Advantage |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$21.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.02
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health SBD |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.62
|
| Rate for Payer: UHC Core |
$12.52
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UMR Bronson Commercial |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.02
|
|
