|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$38.05
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Aetna American Axle |
$24.73
|
| Rate for Payer: Aetna American Axle |
$34.45
|
| Rate for Payer: Aetna Commercial |
$45.05
|
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Medicare |
$19.02
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.45
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$15.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$45.58
|
| Rate for Payer: Cofinity Commercial |
$26.64
|
| Rate for Payer: Cofinity Commercial |
$37.10
|
| Rate for Payer: Cofinity Commercial |
$32.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.44
|
| Rate for Payer: Healthscope Commercial |
$47.70
|
| Rate for Payer: Healthscope Commercial |
$34.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: PHP Commercial |
$32.34
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health SBD |
$33.39
|
| Rate for Payer: Priority Health SBD |
$23.97
|
| Rate for Payer: UMR Bronson Commercial |
$14.08
|
| Rate for Payer: UMR Bronson Commercial |
$19.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.54
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$70.09
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15956
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$63.08 |
| Rate for Payer: Aetna American Axle |
$45.56
|
| Rate for Payer: Aetna American Axle |
$25.72
|
| Rate for Payer: Aetna American Axle |
$15.71
|
| Rate for Payer: Aetna American Axle |
$23.00
|
| Rate for Payer: Aetna Commercial |
$59.58
|
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna Medicare |
$19.78
|
| Rate for Payer: Aetna Medicare |
$17.69
|
| Rate for Payer: Aetna Medicare |
$12.08
|
| Rate for Payer: Aetna Medicare |
$35.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS Complete |
$9.67
|
| Rate for Payer: BCBS Complete |
$28.04
|
| Rate for Payer: BCBS Complete |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$27.70
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Cofinity Commercial |
$49.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$63.08
|
| Rate for Payer: Healthscope Commercial |
$35.61
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$59.58
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$33.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.72
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: Priority Health SBD |
$24.93
|
| Rate for Payer: Priority Health SBD |
$22.29
|
| Rate for Payer: Priority Health SBD |
$44.16
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: UMR Bronson Commercial |
$14.64
|
| Rate for Payer: UMR Bronson Commercial |
$25.93
|
| Rate for Payer: UMR Bronson Commercial |
$13.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.57
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15956
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$35.61 |
| Rate for Payer: Aetna American Axle |
$25.72
|
| Rate for Payer: Aetna American Axle |
$23.00
|
| Rate for Payer: Aetna American Axle |
$15.71
|
| Rate for Payer: Aetna American Axle |
$45.56
|
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna Commercial |
$59.58
|
| Rate for Payer: Aetna Commercial |
$30.07
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.72
|
| Rate for Payer: Cash Price |
$28.30
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$56.07
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$49.06
|
| Rate for Payer: Cofinity Commercial |
$27.70
|
| Rate for Payer: Cofinity Commercial |
$24.77
|
| Rate for Payer: Cofinity Commercial |
$30.43
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.30
|
| Rate for Payer: Healthscope Commercial |
$35.61
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$63.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: PHP Commercial |
$33.63
|
| Rate for Payer: PHP Commercial |
$59.58
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$30.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$44.16
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: Priority Health SBD |
$22.29
|
| Rate for Payer: Priority Health SBD |
$24.93
|
| Rate for Payer: UMR Bronson Commercial |
$17.41
|
| Rate for Payer: UMR Bronson Commercial |
$30.84
|
| Rate for Payer: UMR Bronson Commercial |
$15.57
|
| Rate for Payer: UMR Bronson Commercial |
$10.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.68
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.58
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna American Axle |
$13.38
|
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna American Axle |
$52.64
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$68.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$69.65
|
| Rate for Payer: Cofinity Commercial |
$56.69
|
| Rate for Payer: Cofinity Commercial |
$14.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Healthscope Commercial |
$72.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$68.84
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health SBD |
$51.02
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$12.97
|
| Rate for Payer: UMR Bronson Commercial |
$9.06
|
| Rate for Payer: UMR Bronson Commercial |
$35.64
|
| Rate for Payer: UMR Bronson Commercial |
$17.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$80.99
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$72.89 |
| Rate for Payer: Aetna American Axle |
$52.64
|
| Rate for Payer: Aetna American Axle |
$25.69
|
| Rate for Payer: Aetna American Axle |
$13.38
|
| Rate for Payer: Aetna Commercial |
$68.84
|
| Rate for Payer: Aetna Commercial |
$17.49
|
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Medicare |
$19.76
|
| Rate for Payer: Aetna Medicare |
$10.29
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.69
|
| Rate for Payer: BCBS Complete |
$15.81
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$8.23
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cofinity Commercial |
$33.99
|
| Rate for Payer: Cofinity Commercial |
$14.41
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$27.66
|
| Rate for Payer: Cofinity Commercial |
$56.69
|
| Rate for Payer: Cofinity Commercial |
$69.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$56.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.79
|
| Rate for Payer: Healthscope Commercial |
$72.89
|
| Rate for Payer: Healthscope Commercial |
$35.57
|
| Rate for Payer: Healthscope Commercial |
$18.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.84
|
| Rate for Payer: PHP Commercial |
$68.84
|
| Rate for Payer: PHP Commercial |
$17.49
|
| Rate for Payer: PHP Commercial |
$33.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health SBD |
$24.90
|
| Rate for Payer: Priority Health SBD |
$51.02
|
| Rate for Payer: Priority Health SBD |
$12.97
|
| Rate for Payer: UMR Bronson Commercial |
$29.97
|
| Rate for Payer: UMR Bronson Commercial |
$7.61
|
| Rate for Payer: UMR Bronson Commercial |
$14.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.74
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$16.94
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.45 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna American Axle |
$11.01
|
| Rate for Payer: Aetna American Axle |
$16.20
|
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna American Axle |
$15.87
|
| Rate for Payer: Aetna American Axle |
$12.35
|
| Rate for Payer: Aetna American Axle |
$15.83
|
| Rate for Payer: Aetna American Axle |
$14.19
|
| Rate for Payer: Aetna American Axle |
$8.11
|
| Rate for Payer: Aetna American Axle |
$8.29
|
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$20.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.35
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$11.86
|
| Rate for Payer: Cofinity Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$20.95
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$21.92
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: PHP Commercial |
$20.71
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.20
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: Priority Health SBD |
$11.97
|
| Rate for Payer: Priority Health SBD |
$10.67
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: Priority Health SBD |
$15.35
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: Priority Health SBD |
$8.04
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.61
|
| Rate for Payer: UMR Bronson Commercial |
$10.74
|
| Rate for Payer: UMR Bronson Commercial |
$10.96
|
| Rate for Payer: UMR Bronson Commercial |
$5.61
|
| Rate for Payer: UMR Bronson Commercial |
$6.76
|
| Rate for Payer: UMR Bronson Commercial |
$5.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.72
|
| Rate for Payer: UMR Bronson Commercial |
$7.45
|
| Rate for Payer: UMR Bronson Commercial |
$8.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.27
|
|
|
LIDOCAINE HCL 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$21.83
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Aetna American Axle |
$14.19
|
| Rate for Payer: Aetna American Axle |
$16.20
|
| Rate for Payer: Aetna American Axle |
$9.99
|
| Rate for Payer: Aetna American Axle |
$11.01
|
| Rate for Payer: Aetna American Axle |
$15.83
|
| Rate for Payer: Aetna American Axle |
$8.11
|
| Rate for Payer: Aetna American Axle |
$8.29
|
| Rate for Payer: Aetna American Axle |
$12.35
|
| Rate for Payer: Aetna American Axle |
$15.87
|
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Commercial |
$20.76
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$20.71
|
| Rate for Payer: Aetna Commercial |
$21.18
|
| Rate for Payer: Aetna Commercial |
$18.56
|
| Rate for Payer: Aetna Commercial |
$13.06
|
| Rate for Payer: Aetna Commercial |
$10.60
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Medicare |
$12.18
|
| Rate for Payer: Aetna Medicare |
$8.47
|
| Rate for Payer: Aetna Medicare |
$6.38
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna Medicare |
$7.68
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: Aetna Medicare |
$12.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.11
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS Complete |
$6.78
|
| Rate for Payer: BCBS Complete |
$9.74
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS Complete |
$9.97
|
| Rate for Payer: BCBS Complete |
$9.77
|
| Rate for Payer: BCBS Complete |
$6.15
|
| Rate for Payer: BCBS Complete |
$4.99
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$9.98
|
| Rate for Payer: Cash Price |
$12.30
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cash Price |
$19.94
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$19.54
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cash Price |
$19.49
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$18.77
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$16.34
|
| Rate for Payer: Cofinity Commercial |
$20.95
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$21.00
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$21.43
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Commercial |
$13.30
|
| Rate for Payer: Cofinity Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$8.73
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Cofinity Commercial |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$8.93
|
| Rate for Payer: Cofinity Commercial |
$11.86
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.98
|
| Rate for Payer: Healthscope Commercial |
$21.92
|
| Rate for Payer: Healthscope Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$19.65
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Commercial |
$21.98
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$13.83
|
| Rate for Payer: Healthscope Commercial |
$11.22
|
| Rate for Payer: Healthscope Commercial |
$17.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.71
|
| Rate for Payer: PHP Commercial |
$14.40
|
| Rate for Payer: PHP Commercial |
$21.18
|
| Rate for Payer: PHP Commercial |
$20.71
|
| Rate for Payer: PHP Commercial |
$16.15
|
| Rate for Payer: PHP Commercial |
$20.76
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: PHP Commercial |
$10.60
|
| Rate for Payer: PHP Commercial |
$13.06
|
| Rate for Payer: PHP Commercial |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.11
|
| Rate for Payer: Priority Health SBD |
$11.97
|
| Rate for Payer: Priority Health SBD |
$10.67
|
| Rate for Payer: Priority Health SBD |
$13.75
|
| Rate for Payer: Priority Health SBD |
$7.86
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: Priority Health SBD |
$15.70
|
| Rate for Payer: Priority Health SBD |
$15.35
|
| Rate for Payer: Priority Health SBD |
$8.04
|
| Rate for Payer: Priority Health SBD |
$15.38
|
| Rate for Payer: UMR Bronson Commercial |
$9.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.01
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: UMR Bronson Commercial |
$4.61
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: UMR Bronson Commercial |
$6.27
|
| Rate for Payer: UMR Bronson Commercial |
$9.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.72
|
| Rate for Payer: UMR Bronson Commercial |
$7.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.25
|
|
|
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 Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.76
|
| 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: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| Rate for Payer: Priority Health SBD |
$9.68
|
| Rate for Payer: UMR Bronson Commercial |
$5.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.53
|
|
|
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 Commercial |
$10.76
|
| Rate for Payer: Cofinity Commercial |
$13.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.76
|
| 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: PHP Commercial |
$13.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.99
|
| 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 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: Healthscope Commercial |
$25.97
|
| Rate for Payer: Aetna American Axle |
$7.73
|
| Rate for Payer: Aetna American Axle |
$18.76
|
| Rate for Payer: Aetna American Axle |
$17.80
|
| Rate for Payer: Aetna American Axle |
$16.59
|
| Rate for Payer: Aetna American Axle |
$15.46
|
| Rate for Payer: Aetna American Axle |
$17.72
|
| Rate for Payer: Aetna American Axle |
$20.25
|
| Rate for Payer: Aetna Commercial |
$24.53
|
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Commercial |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| 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 |
$21.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.80
|
| 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 |
$20.54
|
| 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 |
$20.44
|
| 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 |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.53
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.80
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$14.98
|
| Rate for Payer: Priority Health SBD |
$7.49
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$17.25
|
| Rate for Payer: Priority Health SBD |
$17.17
|
| Rate for Payer: UMR Bronson Commercial |
$11.99
|
| Rate for Payer: UMR Bronson Commercial |
$13.71
|
| Rate for Payer: UMR Bronson Commercial |
$12.05
|
| Rate for Payer: UMR Bronson Commercial |
$12.70
|
| Rate for Payer: UMR Bronson Commercial |
$5.23
|
| Rate for Payer: UMR Bronson Commercial |
$11.23
|
| Rate for Payer: UMR Bronson Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
| 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 |
$23.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.92
|
|
|
LIDOCAINE HCL 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$11.89
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4454
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| 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 |
$18.76
|
| Rate for Payer: Aetna American Axle |
$20.25
|
| Rate for Payer: Aetna American Axle |
$16.59
|
| Rate for Payer: Aetna American Axle |
$17.80
|
| Rate for Payer: Aetna American Axle |
$17.72
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| 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 Commercial |
$21.70
|
| Rate for Payer: Aetna Commercial |
$10.11
|
| Rate for Payer: Aetna Commercial |
$20.21
|
| Rate for Payer: Aetna Medicare |
$13.63
|
| Rate for Payer: Aetna Medicare |
$13.69
|
| Rate for Payer: Aetna Medicare |
$11.89
|
| Rate for Payer: Aetna Medicare |
$14.43
|
| Rate for Payer: Aetna Medicare |
$12.76
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Aetna Medicare |
$15.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.76
|
| Rate for Payer: BCBS Complete |
$10.95
|
| Rate for Payer: BCBS Complete |
$9.51
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS Complete |
$4.76
|
| Rate for Payer: BCBS Complete |
$12.46
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cash Price |
$9.51
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$23.09
|
| Rate for Payer: Cash Price |
$24.92
|
| Rate for Payer: Cofinity Commercial |
$16.65
|
| Rate for Payer: Cofinity Commercial |
$26.79
|
| Rate for Payer: Cofinity Commercial |
$19.17
|
| Rate for Payer: Cofinity Commercial |
$8.32
|
| Rate for Payer: Cofinity Commercial |
$21.96
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$10.23
|
| Rate for Payer: Cofinity Commercial |
$23.55
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Commercial |
$24.82
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$20.45
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$28.04
|
| Rate for Payer: Healthscope Commercial |
$24.64
|
| Rate for Payer: Healthscope Commercial |
$10.70
|
| Rate for Payer: Healthscope Commercial |
$21.40
|
| Rate for Payer: Healthscope Commercial |
$22.98
|
| Rate for Payer: Healthscope Commercial |
$25.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.17
|
| 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 |
$23.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.48
|
| Rate for Payer: PHP Commercial |
$20.21
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: PHP Commercial |
$26.48
|
| Rate for Payer: PHP Commercial |
$21.70
|
| Rate for Payer: PHP Commercial |
$10.11
|
| Rate for Payer: PHP Commercial |
$23.27
|
| Rate for Payer: PHP Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.25
|
| Rate for Payer: Priority Health SBD |
$17.17
|
| Rate for Payer: Priority Health SBD |
$17.25
|
| Rate for Payer: Priority Health SBD |
$19.62
|
| Rate for Payer: Priority Health SBD |
$18.18
|
| Rate for Payer: Priority Health SBD |
$14.98
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$7.49
|
| Rate for Payer: UMR Bronson Commercial |
$10.13
|
| Rate for Payer: UMR Bronson Commercial |
$9.45
|
| Rate for Payer: UMR Bronson Commercial |
$4.40
|
| Rate for Payer: UMR Bronson Commercial |
$8.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.09
|
| Rate for Payer: UMR Bronson Commercial |
$10.68
|
| Rate for Payer: UMR Bronson Commercial |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
| 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 |
$23.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.64
|
|
|
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 Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.13
|
| 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 |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| 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 |
$19.42
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
IP
|
$33.95
|
|
|
Service Code
|
NDC 00121095003
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.94 |
| Max. Negotiated Rate |
$30.56 |
| Rate for Payer: Aetna American Axle |
$22.07
|
| Rate for Payer: Aetna Commercial |
$28.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.07
|
| Rate for Payer: Cash Price |
$27.16
|
| Rate for Payer: Cofinity Commercial |
$23.76
|
| Rate for Payer: Cofinity Commercial |
$29.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.16
|
| Rate for Payer: Healthscope Commercial |
$30.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.86
|
| Rate for Payer: PHP Commercial |
$28.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.07
|
| Rate for Payer: Priority Health SBD |
$21.39
|
| Rate for Payer: UMR Bronson Commercial |
$14.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.46
|
|
|
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 Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.54
|
| 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 |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.79
|
| 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 |
$11.30
|
|
|
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 Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| 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 |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.05
|
| Rate for Payer: PHP Commercial |
$30.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.98
|
| 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
|
$35.70
|
|
|
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 Commercial |
$24.99
|
| Rate for Payer: Cofinity Commercial |
$30.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.99
|
| 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 |
$26.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.34
|
| Rate for Payer: PHP Commercial |
$30.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.20
|
| Rate for Payer: Priority Health SBD |
$22.49
|
| Rate for Payer: UMR Bronson Commercial |
$13.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
NDC 60432046400
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.58 |
| 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: Cash Price |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$18.13
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.13
|
| 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 |
$19.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.02
|
| Rate for Payer: PHP Commercial |
$22.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.84
|
| Rate for Payer: Priority Health SBD |
$16.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.42
|
|
|
LIDOCAINE HCL 2 % MUCOSAL VISCOUS SOLUTION
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 50383077517
|
| 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 Commercial |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.96
|
| 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: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.75
|
| Rate for Payer: Priority Health SBD |
$2.66
|
| 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
|
$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 Commercial |
$10.54
|
| Rate for Payer: Cofinity Commercial |
$12.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.54
|
| 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 |
$11.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.80
|
| Rate for Payer: PHP Commercial |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.79
|
| Rate for Payer: Priority Health SBD |
$9.49
|
| Rate for Payer: UMR Bronson Commercial |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.30
|
|
|
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 Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.84
|
| 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: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| 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
|
$32.55
|
|
|
Service Code
|
NDC 00527600274
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna American Axle |
$21.16
|
| Rate for Payer: Aetna Commercial |
$27.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.16
|
| Rate for Payer: Cash Price |
$26.04
|
| Rate for Payer: Cofinity Commercial |
$22.78
|
| Rate for Payer: Cofinity Commercial |
$27.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$29.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.67
|
| Rate for Payer: PHP Commercial |
$27.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.16
|
| Rate for Payer: Priority Health SBD |
$20.51
|
| Rate for Payer: UMR Bronson Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.41
|
|
|
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 Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.40
|
| 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: PHP Commercial |
$10.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health SBD |
$7.56
|
| 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
|
$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 Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| 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 |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.05
|
| Rate for Payer: PHP Commercial |
$30.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.98
|
| Rate for Payer: Priority Health SBD |
$22.27
|
| 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
|
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 |
$2.74
|
| 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 Commercial |
$3.84
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.84
|
| 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: PHP Commercial |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.57
|
| Rate for Payer: Priority Health SBD |
$3.46
|
| 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
|
$23.45
|
|
|
Service Code
|
NDC 50383077504
|
| Hospital Charge Code |
109454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$21.10 |
| 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 Commercial |
$16.42
|
| Rate for Payer: Cofinity Commercial |
$20.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$21.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.93
|
| Rate for Payer: PHP Commercial |
$19.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.24
|
| 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
|
|
