|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
OP
|
$107.59
|
|
|
Service Code
|
NDC 76329630005
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.81 |
| Max. Negotiated Rate |
$96.83 |
| Rate for Payer: Aetna American Axle |
$69.93
|
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: Aetna Medicare |
$53.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.93
|
| Rate for Payer: BCBS Complete |
$43.04
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cofinity Commercial |
$75.31
|
| Rate for Payer: Cofinity Commercial |
$92.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Healthscope Commercial |
$96.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: PHP Commercial |
$91.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.93
|
| Rate for Payer: Priority Health SBD |
$67.78
|
| Rate for Payer: UMR Bronson Commercial |
$39.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.69
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
IP
|
$107.59
|
|
|
Service Code
|
NDC 76329630005
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$96.83 |
| Rate for Payer: Aetna American Axle |
$69.93
|
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.93
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cofinity Commercial |
$75.31
|
| Rate for Payer: Cofinity Commercial |
$92.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$75.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Healthscope Commercial |
$96.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: PHP Commercial |
$91.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.93
|
| Rate for Payer: Priority Health SBD |
$67.78
|
| Rate for Payer: UMR Bronson Commercial |
$47.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.69
|
|
|
LIDOCAINE HCL 4 % LARYNGOTRACHEAL SOLUTION
|
Facility
|
OP
|
$3.68
|
|
|
Service Code
|
NDC 09900000915
|
| Hospital Charge Code |
43717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.31 |
| Rate for Payer: Aetna American Axle |
$2.39
|
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.39
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UMR Bronson Commercial |
$1.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.76
|
|
|
LIDOCAINE HCL (BULK) 100 % POWDER
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 51552010609
|
| Hospital Charge Code |
118597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.65 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
LIDOCAINE HCL (BULK) 100 % POWDER
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 51552010609
|
| Hospital Charge Code |
118597
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$40.50 |
| Rate for Payer: Aetna American Axle |
$29.25
|
| Rate for Payer: Aetna Commercial |
$38.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.25
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.00
|
| Rate for Payer: Healthscope Commercial |
$40.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.25
|
| Rate for Payer: PHP Commercial |
$38.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health SBD |
$28.35
|
| Rate for Payer: UMR Bronson Commercial |
$19.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.75
|
|
|
LIDOCAINE IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
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 Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| 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: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| 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 IN D5W (PF) 4 MG/ML (0.4 %) IV (CODE)
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J2001
|
| Hospital Charge Code |
163705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.21 |
| 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: Cash Price |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.54
|
| 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: PHP Commercial |
$18.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna American Axle |
$15.71
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: UMR Bronson Commercial |
$10.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4459
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna American Axle |
$15.71
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna Medicare |
$12.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: BCBS Complete |
$9.67
|
| Rate for Payer: BCBS Complete |
$9.26
|
| 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: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| 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 |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$23.14
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna Medicare |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: BCBS Complete |
$9.26
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UMR Bronson Commercial |
$8.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
OP
|
$24.17
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna American Axle |
$15.71
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna Medicare |
$12.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: BCBS Complete |
$9.67
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$23.14
|
|
|
Service Code
|
NDC 00409490334
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$20.83 |
| Rate for Payer: Aetna American Axle |
$15.04
|
| Rate for Payer: Aetna Commercial |
$19.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.04
|
| Rate for Payer: Cash Price |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.51
|
| Rate for Payer: Healthscope Commercial |
$20.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.67
|
| Rate for Payer: PHP Commercial |
$19.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health SBD |
$14.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.36
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRINGE (CODE)
|
Facility
|
IP
|
$24.17
|
|
|
Service Code
|
NDC 00409132305
|
| Hospital Charge Code |
163704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna American Axle |
$15.71
|
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.71
|
| Rate for Payer: Cash Price |
$19.34
|
| Rate for Payer: Cofinity Commercial |
$16.92
|
| Rate for Payer: Cofinity Commercial |
$20.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$21.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.54
|
| Rate for Payer: PHP Commercial |
$20.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.71
|
| Rate for Payer: Priority Health SBD |
$15.23
|
| Rate for Payer: UMR Bronson Commercial |
$10.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.13
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
OP
|
$27.05
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Aetna American Axle |
$17.58
|
| Rate for Payer: Aetna American Axle |
$20.66
|
| Rate for Payer: Aetna American Axle |
$10.13
|
| Rate for Payer: Aetna American Axle |
$14.70
|
| Rate for Payer: Aetna American Axle |
$18.10
|
| Rate for Payer: Aetna American Axle |
$16.48
|
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna American Axle |
$30.11
|
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna American Axle |
$9.90
|
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna American Axle |
$8.44
|
| Rate for Payer: Aetna American Axle |
$19.01
|
| Rate for Payer: Aetna American Axle |
$17.48
|
| Rate for Payer: Aetna American Axle |
$11.31
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna Commercial |
$11.03
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Commercial |
$13.25
|
| Rate for Payer: Aetna Commercial |
$22.86
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: Aetna Medicare |
$13.45
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna Medicare |
$13.52
|
| Rate for Payer: Aetna Medicare |
$8.02
|
| Rate for Payer: Aetna Medicare |
$14.62
|
| Rate for Payer: Aetna Medicare |
$13.92
|
| Rate for Payer: Aetna Medicare |
$23.16
|
| Rate for Payer: Aetna Medicare |
$11.31
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna Medicare |
$12.68
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Aetna Medicare |
$6.49
|
| Rate for Payer: Aetna Medicare |
$8.70
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna Medicare |
$15.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: BCBS Complete |
$11.70
|
| Rate for Payer: BCBS Complete |
$10.82
|
| Rate for Payer: BCBS Complete |
$6.96
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS Complete |
$9.05
|
| Rate for Payer: BCBS Complete |
$10.14
|
| Rate for Payer: BCBS Complete |
$5.19
|
| Rate for Payer: BCBS Complete |
$18.53
|
| Rate for Payer: BCBS Complete |
$12.71
|
| Rate for Payer: BCBS Complete |
$7.19
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS Complete |
$6.24
|
| Rate for Payer: BCBS Complete |
$10.76
|
| Rate for Payer: BCBS Complete |
$6.42
|
| 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: 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: 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 |
$37.06
|
| Rate for Payer: Cash Price |
$37.06
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$23.39
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$23.39
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$25.42
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$25.42
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$19.49
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$13.41
|
| Rate for Payer: Cofinity Commercial |
$10.91
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$20.47
|
| Rate for Payer: Cofinity Commercial |
$25.15
|
| Rate for Payer: Cofinity Commercial |
$23.13
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Cofinity Commercial |
$27.33
|
| Rate for Payer: Cofinity Commercial |
$32.43
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$9.09
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$18.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$11.68
|
| Rate for Payer: Healthscope Commercial |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$24.21
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$28.60
|
| Rate for Payer: Healthscope Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Healthscope Commercial |
$26.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.24
|
| 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 |
$32.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.85
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$22.86
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$39.38
|
| Rate for Payer: PHP Commercial |
$13.25
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: PHP Commercial |
$11.03
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$27.01
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health SBD |
$9.82
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: Priority Health SBD |
$14.25
|
| Rate for Payer: Priority Health SBD |
$17.54
|
| Rate for Payer: Priority Health SBD |
$18.42
|
| Rate for Payer: Priority Health SBD |
$8.18
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: Priority Health SBD |
$29.19
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: Priority Health SBD |
$20.02
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: UMR Bronson Commercial |
$9.38
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: UMR Bronson Commercial |
$4.80
|
| Rate for Payer: UMR Bronson Commercial |
$6.65
|
| Rate for Payer: UMR Bronson Commercial |
$10.82
|
| Rate for Payer: UMR Bronson Commercial |
$5.77
|
| Rate for Payer: UMR Bronson Commercial |
$11.76
|
| Rate for Payer: UMR Bronson Commercial |
$10.30
|
| Rate for Payer: UMR Bronson Commercial |
$8.37
|
| Rate for Payer: UMR Bronson Commercial |
$9.95
|
| Rate for Payer: UMR Bronson Commercial |
$10.01
|
| Rate for Payer: UMR Bronson Commercial |
$6.44
|
| Rate for Payer: UMR Bronson Commercial |
$17.14
|
| Rate for Payer: UMR Bronson Commercial |
$5.64
|
| Rate for Payer: UMR Bronson Commercial |
$3.94
|
| 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 |
$16.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| 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 |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.74
|
|
|
LIDOCAINE (PF) 10 MG/ML (1 %) INJECTION SOLUTION
|
Facility
|
IP
|
$27.05
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$24.34 |
| Rate for Payer: Aetna American Axle |
$17.58
|
| Rate for Payer: Aetna American Axle |
$9.90
|
| Rate for Payer: Aetna American Axle |
$16.48
|
| Rate for Payer: Aetna American Axle |
$14.70
|
| Rate for Payer: Aetna American Axle |
$20.66
|
| Rate for Payer: Aetna American Axle |
$19.01
|
| Rate for Payer: Aetna American Axle |
$17.48
|
| Rate for Payer: Aetna American Axle |
$30.11
|
| Rate for Payer: Aetna American Axle |
$11.31
|
| Rate for Payer: Aetna American Axle |
$10.43
|
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna American Axle |
$10.13
|
| Rate for Payer: Aetna American Axle |
$8.44
|
| Rate for Payer: Aetna American Axle |
$18.10
|
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$11.03
|
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Commercial |
$13.25
|
| Rate for Payer: Aetna Commercial |
$14.79
|
| Rate for Payer: Aetna Commercial |
$22.86
|
| Rate for Payer: Aetna Commercial |
$13.64
|
| Rate for Payer: Aetna Commercial |
$19.23
|
| Rate for Payer: Aetna Commercial |
$39.38
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| 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) |
$10.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$21.52
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$12.47
|
| 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 |
$22.27
|
| Rate for Payer: Cash Price |
$21.64
|
| Rate for Payer: Cash Price |
$12.84
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$13.92
|
| Rate for Payer: Cash Price |
$20.28
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$23.26
|
| Rate for Payer: Cofinity Commercial |
$18.94
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$22.25
|
| Rate for Payer: Cofinity Commercial |
$27.33
|
| Rate for Payer: Cofinity Commercial |
$17.74
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$9.09
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$14.96
|
| Rate for Payer: Cofinity Commercial |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$10.91
|
| Rate for Payer: Cofinity Commercial |
$13.41
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$19.49
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Cofinity Commercial |
$20.47
|
| Rate for Payer: Cofinity Commercial |
$25.15
|
| Rate for Payer: Cofinity Commercial |
$32.43
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$23.13
|
| Rate for Payer: Cofinity Commercial |
$18.83
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$21.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.06
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$14.44
|
| Rate for Payer: Healthscope Commercial |
$24.21
|
| Rate for Payer: Healthscope Commercial |
$28.60
|
| Rate for Payer: Healthscope Commercial |
$41.70
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Commercial |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$14.03
|
| Rate for Payer: Healthscope Commercial |
$24.34
|
| Rate for Payer: Healthscope Commercial |
$11.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$13.64
|
| Rate for Payer: PHP Commercial |
$22.86
|
| Rate for Payer: PHP Commercial |
$27.01
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$21.55
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$13.25
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$14.79
|
| Rate for Payer: PHP Commercial |
$11.03
|
| Rate for Payer: PHP Commercial |
$22.99
|
| Rate for Payer: PHP Commercial |
$39.38
|
| Rate for Payer: PHP Commercial |
$19.23
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health SBD |
$16.95
|
| Rate for Payer: Priority Health SBD |
$29.19
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: Priority Health SBD |
$20.02
|
| Rate for Payer: Priority Health SBD |
$15.97
|
| Rate for Payer: Priority Health SBD |
$10.11
|
| Rate for Payer: Priority Health SBD |
$14.25
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: Priority Health SBD |
$18.42
|
| Rate for Payer: Priority Health SBD |
$10.96
|
| Rate for Payer: Priority Health SBD |
$8.18
|
| Rate for Payer: Priority Health SBD |
$9.82
|
| Rate for Payer: Priority Health SBD |
$17.04
|
| Rate for Payer: Priority Health SBD |
$17.54
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: UMR Bronson Commercial |
$11.90
|
| Rate for Payer: UMR Bronson Commercial |
$5.71
|
| Rate for Payer: UMR Bronson Commercial |
$11.84
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: UMR Bronson Commercial |
$12.87
|
| Rate for Payer: UMR Bronson Commercial |
$7.91
|
| Rate for Payer: UMR Bronson Commercial |
$11.15
|
| Rate for Payer: UMR Bronson Commercial |
$20.39
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$13.98
|
| Rate for Payer: UMR Bronson Commercial |
$9.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: UMR Bronson Commercial |
$6.70
|
| Rate for Payer: UMR Bronson Commercial |
$6.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.18
|
|
|
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 |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$20.72
|
| 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 (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 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 (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
OP
|
$13.13
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna American Axle |
$12.40
|
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna American Axle |
$18.19
|
| Rate for Payer: Aetna American Axle |
$14.46
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| 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 |
$16.21
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: Aetna Medicare |
$9.54
|
| Rate for Payer: Aetna Medicare |
$14.21
|
| Rate for Payer: Aetna Medicare |
$9.82
|
| Rate for Payer: Aetna Medicare |
$6.56
|
| Rate for Payer: Aetna Medicare |
$14.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS Complete |
$7.63
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: BCBS Complete |
$11.54
|
| Rate for Payer: BCBS Complete |
$11.37
|
| Rate for Payer: BCBS Complete |
$8.90
|
| 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 |
$23.07
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| 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 |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.71
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$25.96
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$17.16
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.59
|
| 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 |
$14.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.63
|
| 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 |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$16.21
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$16.69
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Priority Health SBD |
$12.01
|
| Rate for Payer: Priority Health SBD |
$12.37
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.27
|
| Rate for Payer: UMR Bronson Commercial |
$4.86
|
| Rate for Payer: UMR Bronson Commercial |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.23
|
| Rate for Payer: UMR Bronson Commercial |
$10.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.99
|
| 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
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.32
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INJECTION SOLUTION
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
103889
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna American Axle |
$18.47
|
| Rate for Payer: Aetna American Axle |
$18.19
|
| Rate for Payer: Aetna American Axle |
$12.77
|
| Rate for Payer: Aetna American Axle |
$12.40
|
| Rate for Payer: Aetna American Axle |
$14.46
|
| Rate for Payer: Aetna American Axle |
$18.75
|
| Rate for Payer: Aetna Commercial |
$24.16
|
| Rate for Payer: Aetna Commercial |
$16.21
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: Aetna Commercial |
$24.51
|
| Rate for Payer: Aetna Commercial |
$16.69
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| 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) |
$14.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.47
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$15.26
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$15.71
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$13.75
|
| Rate for Payer: Cofinity Commercial |
$13.35
|
| Rate for Payer: Cofinity Commercial |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$16.89
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Cofinity Commercial |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$19.89
|
| Rate for Payer: Cofinity Commercial |
$20.19
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.26
|
| 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: Healthscope Commercial |
$25.96
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$17.16
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Healthscope Commercial |
$25.58
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$15.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.99
|
| 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 |
$21.63
|
| 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 |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.16
|
| Rate for Payer: PHP Commercial |
$23.79
|
| 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 |
$16.21
|
| Rate for Payer: PHP Commercial |
$24.51
|
| Rate for Payer: PHP Commercial |
$24.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.19
|
| Rate for Payer: Priority Health SBD |
$12.37
|
| Rate for Payer: Priority Health SBD |
$12.01
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: Priority Health SBD |
$18.17
|
| Rate for Payer: Priority Health SBD |
$17.90
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: UMR Bronson Commercial |
$9.79
|
| Rate for Payer: UMR Bronson Commercial |
$12.69
|
| Rate for Payer: UMR Bronson Commercial |
$12.32
|
| Rate for Payer: UMR Bronson Commercial |
$12.50
|
| Rate for Payer: UMR Bronson Commercial |
$5.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.64
|
| Rate for Payer: UMR Bronson Commercial |
$8.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.30
|
| 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 |
$14.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.03
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna American Axle |
$13.67
|
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Medicare |
$10.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.67
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.67
|
| Rate for Payer: Priority Health SBD |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$7.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.77
|
|
|
LIDOCAINE (PF) 20 MG/ML (2 %) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.03
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
116451
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$18.93 |
| Rate for Payer: Aetna American Axle |
$13.67
|
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.67
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cofinity Commercial |
$14.72
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.67
|
| Rate for Payer: Priority Health SBD |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$9.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.77
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna American Axle |
$13.62
|
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.62
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$13.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) INJECTION SOLUTION
|
Facility
|
OP
|
$20.95
|
|
|
Service Code
|
HCPCS J2003
|
| Hospital Charge Code |
4455
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna American Axle |
$13.62
|
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna Medicare |
$10.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.62
|
| Rate for Payer: BCBS Complete |
$8.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$13.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
OP
|
$20.95
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna American Axle |
$13.62
|
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna Medicare |
$10.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.62
|
| Rate for Payer: BCBS Complete |
$8.38
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$13.20
|
| Rate for Payer: UMR Bronson Commercial |
$7.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
|
LIDOCAINE (PF) 40 MG/ML (4 %) NEBULIZED SOLUTION
|
Facility
|
IP
|
$20.95
|
|
|
Service Code
|
NDC 00409428301
|
| Hospital Charge Code |
168979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.22 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna American Axle |
$13.62
|
| Rate for Payer: Aetna Commercial |
$17.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.62
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$18.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$18.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.81
|
| Rate for Payer: PHP Commercial |
$17.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.62
|
| Rate for Payer: Priority Health SBD |
$13.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.71
|
|
