|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$25.79
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna American Axle |
$16.76
|
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.76
|
| Rate for Payer: BCBS Complete |
$10.32
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Advantage |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: PHP Commercial |
$21.92
|
| Rate for Payer: Priority Health SBD |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.76
|
| Rate for Payer: UHC Core |
$13.44
|
| Rate for Payer: UHC Exchange |
$10.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.34
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$25.79
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.35 |
| Max. Negotiated Rate |
$23.21 |
| Rate for Payer: Aetna American Axle |
$16.76
|
| Rate for Payer: Aetna Commercial |
$21.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.76
|
| Rate for Payer: Cash Price |
$20.63
|
| Rate for Payer: Cofinity Advantage |
$18.05
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.63
|
| Rate for Payer: Healthscope Commercial |
$23.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.34
|
| Rate for Payer: PHP Commercial |
$21.92
|
| Rate for Payer: Priority Health SBD |
$16.25
|
| Rate for Payer: UMR Bronson Commercial |
$11.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.34
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$26.91
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$24.22 |
| Rate for Payer: Aetna American Axle |
$17.49
|
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Advantage |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: UMR Bronson Commercial |
$11.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$26.91
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$24.22 |
| Rate for Payer: Aetna American Axle |
$17.49
|
| Rate for Payer: Aetna Commercial |
$22.87
|
| Rate for Payer: Aetna Medicare |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.49
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: Cash Price |
$21.53
|
| Rate for Payer: Cofinity Advantage |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$23.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.53
|
| Rate for Payer: Healthscope Commercial |
$24.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.18
|
| Rate for Payer: PHP Commercial |
$22.87
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.49
|
| Rate for Payer: UHC Core |
$14.02
|
| Rate for Payer: UHC Exchange |
$10.58
|
| Rate for Payer: UMR Bronson Commercial |
$9.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$23.06
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna American Axle |
$16.48
|
| Rate for Payer: Aetna American Axle |
$20.66
|
| Rate for Payer: Aetna American Axle |
$9.29
|
| Rate for Payer: Aetna American Axle |
$10.60
|
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna American Axle |
$7.92
|
| Rate for Payer: Aetna American Axle |
$17.58
|
| Rate for Payer: Aetna American Axle |
$30.11
|
| Rate for Payer: Aetna American Axle |
$17.82
|
| Rate for Payer: Aetna American Axle |
$11.31
|
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna American Axle |
$9.90
|
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna American Axle |
$19.01
|
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$25.42
|
| Rate for Payer: Cash Price |
$23.39
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$18.93
|
| Rate for Payer: Cofinity Advantage |
$10.66
|
| Rate for Payer: Cofinity Advantage |
$22.25
|
| Rate for Payer: Cofinity Advantage |
$13.37
|
| Rate for Payer: Cofinity Advantage |
$12.18
|
| Rate for Payer: Cofinity Advantage |
$20.00
|
| Rate for Payer: Cofinity Advantage |
$8.53
|
| Rate for Payer: Cofinity Advantage |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$32.43
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Advantage |
$11.41
|
| Rate for Payer: Cofinity Advantage |
$20.47
|
| Rate for Payer: Cofinity Advantage |
$17.75
|
| Rate for Payer: Cofinity Advantage |
$12.59
|
| Rate for Payer: Cofinity Advantage |
$10.00
|
| Rate for Payer: Cofinity Advantage |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$10.47
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$25.15
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$27.33
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$12.86
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$28.60
|
| Rate for Payer: Healthscope Commercial |
$41.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.42
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$39.38
|
| Rate for Payer: PHP Commercial |
$12.15
|
| Rate for Payer: PHP Commercial |
$10.35
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$27.01
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: Priority Health SBD |
$10.27
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: Priority Health SBD |
$17.27
|
| Rate for Payer: Priority Health SBD |
$7.67
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$29.19
|
| Rate for Payer: Priority Health SBD |
$18.42
|
| Rate for Payer: Priority Health SBD |
$20.02
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$20.39
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: UMR Bronson Commercial |
$11.90
|
| Rate for Payer: UMR Bronson Commercial |
$7.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.06
|
| Rate for Payer: UMR Bronson Commercial |
$5.36
|
| Rate for Payer: UMR Bronson Commercial |
$11.15
|
| Rate for Payer: UMR Bronson Commercial |
$6.70
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: UMR Bronson Commercial |
$10.15
|
| Rate for Payer: UMR Bronson Commercial |
$7.91
|
| Rate for Payer: UMR Bronson Commercial |
$13.98
|
| Rate for Payer: UMR Bronson Commercial |
$12.87
|
| Rate for Payer: UMR Bronson Commercial |
$6.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$14.29
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Aetna American Axle |
$9.29
|
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna American Axle |
$19.01
|
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna American Axle |
$11.31
|
| Rate for Payer: Aetna American Axle |
$17.82
|
| Rate for Payer: Aetna American Axle |
$30.11
|
| Rate for Payer: Aetna American Axle |
$17.58
|
| Rate for Payer: Aetna American Axle |
$20.66
|
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna American Axle |
$12.41
|
| Rate for Payer: Aetna American Axle |
$10.60
|
| Rate for Payer: Aetna American Axle |
$18.57
|
| Rate for Payer: Aetna American Axle |
$9.90
|
| Rate for Payer: Aetna American Axle |
$16.48
|
| Rate for Payer: Aetna American Axle |
$7.92
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Commercial |
$13.86
|
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: Aetna Commercial |
$12.15
|
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Medicare |
$8.15
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna Medicare |
$14.29
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna Medicare |
$9.55
|
| Rate for Payer: Aetna Medicare |
$8.70
|
| Rate for Payer: Aetna Medicare |
$13.53
|
| Rate for Payer: Aetna Medicare |
$13.71
|
| Rate for Payer: Aetna Medicare |
$15.89
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: Aetna Medicare |
$23.16
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: Aetna Medicare |
$14.62
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.60
|
| Rate for Payer: BCBS Complete |
$4.87
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS Complete |
$11.43
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Complete |
$12.71
|
| Rate for Payer: BCBS Complete |
$18.53
|
| Rate for Payer: BCBS Complete |
$5.72
|
| Rate for Payer: BCBS Complete |
$7.64
|
| Rate for Payer: BCBS Complete |
$7.19
|
| 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: 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: 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: 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: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$25.42
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$23.39
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$22.86
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$23.39
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$25.42
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cofinity Advantage |
$10.00
|
| Rate for Payer: Cofinity Advantage |
$32.43
|
| Rate for Payer: Cofinity Advantage |
$17.75
|
| Rate for Payer: Cofinity Advantage |
$22.25
|
| Rate for Payer: Cofinity Advantage |
$18.93
|
| Rate for Payer: Cofinity Advantage |
$20.47
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Advantage |
$19.19
|
| Rate for Payer: Cofinity Advantage |
$12.59
|
| Rate for Payer: Cofinity Advantage |
$12.18
|
| Rate for Payer: Cofinity Advantage |
$11.41
|
| Rate for Payer: Cofinity Advantage |
$10.66
|
| Rate for Payer: Cofinity Advantage |
$8.53
|
| Rate for Payer: Cofinity Advantage |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$13.37
|
| Rate for Payer: Cofinity Advantage |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$10.47
|
| Rate for Payer: Cofinity Commercial |
$12.29
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Cofinity Commercial |
$27.33
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Cofinity Commercial |
$25.15
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.39
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$12.86
|
| Rate for Payer: Healthscope Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$25.71
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Healthscope Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$10.96
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$28.60
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.93
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$13.86
|
| Rate for Payer: PHP Commercial |
$12.15
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$10.35
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$39.38
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: PHP Commercial |
$27.01
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$7.67
|
| Rate for Payer: Priority Health SBD |
$18.42
|
| Rate for Payer: Priority Health SBD |
$20.02
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: Priority Health SBD |
$18.00
|
| Rate for Payer: Priority Health SBD |
$10.27
|
| Rate for Payer: Priority Health SBD |
$29.19
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: Priority Health SBD |
$17.27
|
| Rate for Payer: Priority Health SBD |
$9.00
|
| 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 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 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 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 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: 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: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$4.51
|
| Rate for Payer: UMR Bronson Commercial |
$10.82
|
| Rate for Payer: UMR Bronson Commercial |
$6.44
|
| Rate for Payer: UMR Bronson Commercial |
$6.03
|
| Rate for Payer: UMR Bronson Commercial |
$10.57
|
| Rate for Payer: UMR Bronson Commercial |
$10.14
|
| Rate for Payer: UMR Bronson Commercial |
$5.29
|
| Rate for Payer: UMR Bronson Commercial |
$5.64
|
| Rate for Payer: UMR Bronson Commercial |
$7.07
|
| Rate for Payer: UMR Bronson Commercial |
$10.01
|
| Rate for Payer: UMR Bronson Commercial |
$9.38
|
| Rate for Payer: UMR Bronson Commercial |
$11.76
|
| Rate for Payer: UMR Bronson Commercial |
$6.65
|
| Rate for Payer: UMR Bronson Commercial |
$3.94
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: UMR Bronson Commercial |
$17.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
|
|
LIDOCAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna American Axle |
$16.84
|
| Rate for Payer: Aetna Commercial |
$22.02
|
| Rate for Payer: Aetna Medicare |
$12.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.84
|
| Rate for Payer: BCBS Complete |
$10.36
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$20.72
|
| 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: MI Amish Medical Board Commercial |
$20.72
|
| 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: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.43
|
|
|
LIDOCAINE (PF) 15 MG/ML (1.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4453
|
|
Hospital Revenue Code
|
636
|
| 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 (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$28.84
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.69 |
| Max. Negotiated Rate |
$25.96 |
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna American Axle |
$14.46
|
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna American Axle |
$12.40
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$16.21
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cofinity Advantage |
$15.57
|
| Rate for Payer: Cofinity Advantage |
$13.35
|
| Rate for Payer: Cofinity Advantage |
$9.19
|
| Rate for Payer: Cofinity Advantage |
$19.89
|
| Rate for Payer: Cofinity Advantage |
$13.75
|
| Rate for Payer: Cofinity Advantage |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$17.16
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.73
|
| Rate for Payer: PHP Commercial |
$16.69
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$16.21
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Priority Health SBD |
$12.01
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: Priority Health SBD |
$12.37
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: UMR Bronson Commercial |
$12.50
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: UMR Bronson Commercial |
$8.39
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: UMR Bronson Commercial |
$5.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.73
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$19.07
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna American Axle |
$12.40
|
| Rate for Payer: Aetna American Axle |
$14.46
|
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$16.21
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Aetna Medicare |
$14.21
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS Complete |
$7.63
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$11.37
|
| Rate for Payer: BCBS Complete |
$11.54
|
| 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: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Advantage |
$15.57
|
| Rate for Payer: Cofinity Advantage |
$13.75
|
| Rate for Payer: Cofinity Advantage |
$20.19
|
| Rate for Payer: Cofinity Advantage |
$9.19
|
| Rate for Payer: Cofinity Advantage |
$13.35
|
| Rate for Payer: Cofinity Advantage |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Healthscope Commercial |
$17.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.73
|
| Rate for Payer: PHP Commercial |
$16.21
|
| Rate for Payer: PHP Commercial |
$16.69
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: Priority Health SBD |
$12.01
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$12.37
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| 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 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 |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$10.52
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.67
|
| Rate for Payer: UMR Bronson Commercial |
$7.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.30
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.88
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Aetna American Axle |
$13.57
|
| Rate for Payer: Aetna Commercial |
$17.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$18.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.66
|
| Rate for Payer: PHP Commercial |
$17.75
|
| Rate for Payer: Priority Health SBD |
$13.15
|
| Rate for Payer: UMR Bronson Commercial |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.66
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.88
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$18.79 |
| Rate for Payer: Aetna American Axle |
$13.57
|
| Rate for Payer: Aetna Commercial |
$17.75
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$17.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$18.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.66
|
| Rate for Payer: PHP Commercial |
$17.75
|
| Rate for Payer: Priority Health SBD |
$13.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.66
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.10
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Core |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Medicare |
$10.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: BCBS Complete |
$8.50
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.81
|
| Rate for Payer: UHC Core |
$11.07
|
| Rate for Payer: UHC Exchange |
$8.35
|
| Rate for Payer: UMR Bronson Commercial |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Aetna American Axle |
$13.81
|
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.81
|
| Rate for Payer: Cash Price |
$16.99
|
| Rate for Payer: Cofinity Advantage |
$14.87
|
| Rate for Payer: Cofinity Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$19.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.93
|
| Rate for Payer: PHP Commercial |
$18.05
|
| Rate for Payer: Priority Health SBD |
$13.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.93
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
14868
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION (ANES ANALGESIA)
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
301050
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 4 MG/ML (0.4 %) IN 5 % DEXTROSE INTRAVENOUS SOLUTION (ANES ANALGESIA)
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2002
|
| Hospital Charge Code |
301050
|
|
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 Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$55.10
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$49.59 |
| Rate for Payer: Aetna American Axle |
$35.81
|
| Rate for Payer: Aetna American Axle |
$53.59
|
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Aetna Medicare |
$27.55
|
| Rate for Payer: Aetna Medicare |
$41.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.59
|
| Rate for Payer: BCBS Complete |
$32.98
|
| Rate for Payer: BCBS Complete |
$22.04
|
| 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: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$65.95
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$65.95
|
| Rate for Payer: Cofinity Advantage |
$38.57
|
| Rate for Payer: Cofinity Advantage |
$57.71
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Cofinity Commercial |
$70.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.95
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Healthscope Commercial |
$74.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.33
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$70.07
|
| Rate for Payer: Priority Health SBD |
$34.71
|
| Rate for Payer: Priority Health SBD |
$51.94
|
| 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 Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$20.39
|
| Rate for Payer: UMR Bronson Commercial |
$30.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.83
|
|
|
LIDOCAINE (PF) 50 MG/5 ML (1 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$55.10
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.24 |
| Max. Negotiated Rate |
$49.59 |
| Rate for Payer: Aetna American Axle |
$35.81
|
| Rate for Payer: Aetna American Axle |
$53.59
|
| Rate for Payer: Aetna Commercial |
$46.84
|
| Rate for Payer: Aetna Commercial |
$70.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.59
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: Cash Price |
$65.95
|
| Rate for Payer: Cofinity Advantage |
$57.71
|
| Rate for Payer: Cofinity Advantage |
$38.57
|
| Rate for Payer: Cofinity Commercial |
$70.90
|
| Rate for Payer: Cofinity Commercial |
$47.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.95
|
| Rate for Payer: Healthscope Commercial |
$49.59
|
| Rate for Payer: Healthscope Commercial |
$74.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.83
|
| Rate for Payer: PHP Commercial |
$46.84
|
| Rate for Payer: PHP Commercial |
$70.07
|
| Rate for Payer: Priority Health SBD |
$51.94
|
| Rate for Payer: Priority Health SBD |
$34.71
|
| Rate for Payer: UMR Bronson Commercial |
$24.24
|
| Rate for Payer: UMR Bronson Commercial |
$36.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.83
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$37.02
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna Medicare |
$7.96
|
| Rate for Payer: Aetna Medicare |
$28.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.02
|
| Rate for Payer: BCBS Complete |
$22.78
|
| Rate for Payer: BCBS Complete |
$6.36
|
| 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: Cash Price |
$12.73
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Advantage |
$39.87
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Cofinity Commercial |
$48.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Healthscope Commercial |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$48.42
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: Priority Health SBD |
$35.88
|
| 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 Exchange |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$5.89
|
| Rate for Payer: UMR Bronson Commercial |
$21.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.72
|
|
|
LIDOCAINE (PF) 5 MG/ML (0.5 %) INJECTION SOLUTION
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
105635
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$14.32 |
| Rate for Payer: Aetna American Axle |
$10.34
|
| Rate for Payer: Aetna American Axle |
$37.02
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$48.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.02
|
| Rate for Payer: Cash Price |
$12.73
|
| Rate for Payer: Cash Price |
$45.57
|
| Rate for Payer: Cofinity Advantage |
$39.87
|
| Rate for Payer: Cofinity Advantage |
$11.14
|
| Rate for Payer: Cofinity Commercial |
$48.99
|
| Rate for Payer: Cofinity Commercial |
$13.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.57
|
| Rate for Payer: Healthscope Commercial |
$14.32
|
| Rate for Payer: Healthscope Commercial |
$51.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.72
|
| Rate for Payer: PHP Commercial |
$13.52
|
| Rate for Payer: PHP Commercial |
$48.42
|
| Rate for Payer: Priority Health SBD |
$35.88
|
| Rate for Payer: Priority Health SBD |
$10.02
|
| Rate for Payer: UMR Bronson Commercial |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$25.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.72
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOPICAL KIT
|
Facility
|
IP
|
$10.40
|
|
|
Service Code
|
NDC 00496088205
|
| Hospital Charge Code |
30183
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.58 |
| Max. Negotiated Rate |
$9.36 |
| Rate for Payer: Aetna American Axle |
$6.76
|
| Rate for Payer: Aetna Commercial |
$8.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.76
|
| Rate for Payer: Cash Price |
$8.32
|
| Rate for Payer: Cofinity Advantage |
$7.28
|
| Rate for Payer: Cofinity Commercial |
$8.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.32
|
| Rate for Payer: Healthscope Commercial |
$9.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.80
|
| Rate for Payer: PHP Commercial |
$8.84
|
| Rate for Payer: Priority Health SBD |
$6.55
|
| Rate for Payer: UMR Bronson Commercial |
$4.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.80
|
|
