|
LIDOCAINE 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION
|
Facility
|
OP
|
$22.91
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$20.62
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: Aetna Medicare |
$11.46
|
| Rate for Payer: ASR ASR |
$22.22
|
| Rate for Payer: ASR ASR |
$18.99
|
| Rate for Payer: ASR Commercial |
$18.99
|
| Rate for Payer: ASR Commercial |
$22.22
|
| Rate for Payer: BCBS Complete |
$9.16
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Trust/PPO |
$18.76
|
| Rate for Payer: BCBS Trust/PPO |
$16.03
|
| Rate for Payer: BCN Commercial |
$15.18
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cash Price |
$18.33
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Whirlpool |
$22.22
|
| Rate for Payer: Healthscope Whirlpool |
$18.99
|
| Rate for Payer: Mclaren Commercial |
$17.62
|
| Rate for Payer: Mclaren Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Nomi Health Commercial |
$18.79
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.16
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
OP
|
$15.90
|
|
|
Service Code
|
NDC 25021067376
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$15.90 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: ASR ASR |
$15.42
|
| Rate for Payer: ASR Commercial |
$15.42
|
| Rate for Payer: BCBS Complete |
$6.36
|
| Rate for Payer: BCBS Trust/PPO |
$13.02
|
| Rate for Payer: BCN Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cofinity Commercial |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Healthscope Whirlpool |
$15.42
|
| Rate for Payer: Mclaren Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Nomi Health Commercial |
$13.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.93
|
| Rate for Payer: Priority Health Narrow Network |
$11.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.99
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
IP
|
$15.90
|
|
|
Service Code
|
NDC 25021067376
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$15.90 |
| Rate for Payer: Aetna Commercial |
$14.31
|
| Rate for Payer: ASR ASR |
$15.42
|
| Rate for Payer: ASR Commercial |
$15.42
|
| Rate for Payer: BCBS Trust/PPO |
$12.96
|
| Rate for Payer: BCN Commercial |
$12.33
|
| Rate for Payer: Cash Price |
$12.72
|
| Rate for Payer: Cofinity Commercial |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.72
|
| Rate for Payer: Healthscope Commercial |
$15.90
|
| Rate for Payer: Healthscope Whirlpool |
$15.42
|
| Rate for Payer: Mclaren Commercial |
$14.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.52
|
| Rate for Payer: Nomi Health Commercial |
$13.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.99
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
OP
|
$21.85
|
|
|
Service Code
|
NDC 76329301205
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Medicare |
$10.92
|
| Rate for Payer: ASR ASR |
$21.19
|
| Rate for Payer: ASR Commercial |
$21.19
|
| Rate for Payer: BCBS Complete |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$17.89
|
| Rate for Payer: BCN Commercial |
$16.94
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$20.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Healthscope Whirlpool |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.14
|
| Rate for Payer: Priority Health Narrow Network |
$15.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.23
|
|
|
LIDOCAINE 2 % MUCOSAL JELLY IN APPLICATOR
|
Facility
|
IP
|
$21.85
|
|
|
Service Code
|
NDC 76329301205
|
| Hospital Charge Code |
118460
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: ASR ASR |
$21.19
|
| Rate for Payer: ASR Commercial |
$21.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.81
|
| Rate for Payer: BCN Commercial |
$16.94
|
| Rate for Payer: Cash Price |
$17.48
|
| Rate for Payer: Cofinity Commercial |
$20.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.48
|
| Rate for Payer: Healthscope Commercial |
$21.85
|
| Rate for Payer: Healthscope Whirlpool |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.57
|
| Rate for Payer: Nomi Health Commercial |
$17.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.23
|
|
|
LIDOCAINE 4 %-EPINEPHRINE 0.18 %-TETRACAINE 0.5 % TOPICAL GEL
|
Facility
|
IP
|
$29.92
|
|
|
Service Code
|
NDC 71266629001
|
| Hospital Charge Code |
196007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$29.92 |
| Rate for Payer: Aetna Commercial |
$26.93
|
| Rate for Payer: ASR ASR |
$29.02
|
| Rate for Payer: ASR Commercial |
$29.02
|
| Rate for Payer: BCBS Trust/PPO |
$24.38
|
| Rate for Payer: BCN Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$28.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$29.92
|
| Rate for Payer: Healthscope Whirlpool |
$29.02
|
| Rate for Payer: Mclaren Commercial |
$26.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.43
|
| Rate for Payer: Nomi Health Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.33
|
|
|
LIDOCAINE 4 %-EPINEPHRINE 0.18 %-TETRACAINE 0.5 % TOPICAL GEL
|
Facility
|
OP
|
$29.92
|
|
|
Service Code
|
NDC 71266629001
|
| Hospital Charge Code |
196007
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.97 |
| Max. Negotiated Rate |
$29.92 |
| Rate for Payer: Aetna Commercial |
$26.93
|
| Rate for Payer: Aetna Medicare |
$14.96
|
| Rate for Payer: ASR ASR |
$29.02
|
| Rate for Payer: ASR Commercial |
$29.02
|
| Rate for Payer: BCBS Complete |
$11.97
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCN Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$28.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.94
|
| Rate for Payer: Healthscope Commercial |
$29.92
|
| Rate for Payer: Healthscope Whirlpool |
$29.02
|
| Rate for Payer: Mclaren Commercial |
$26.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.43
|
| Rate for Payer: Nomi Health Commercial |
$24.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.22
|
| Rate for Payer: Priority Health Narrow Network |
$20.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.33
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$45.36
|
|
|
Service Code
|
NDC 41167005840
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: ASR Commercial |
$44.00
|
| Rate for Payer: BCBS Trust/PPO |
$36.96
|
| Rate for Payer: BCN Commercial |
$35.17
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$42.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Healthscope Whirlpool |
$44.00
|
| Rate for Payer: Mclaren Commercial |
$40.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.92
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$30.05
|
|
|
Service Code
|
NDC 00536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna Commercial |
$27.04
|
| Rate for Payer: ASR ASR |
$29.15
|
| Rate for Payer: ASR Commercial |
$29.15
|
| Rate for Payer: BCBS Trust/PPO |
$24.49
|
| Rate for Payer: BCN Commercial |
$23.30
|
| Rate for Payer: Cash Price |
$24.04
|
| Rate for Payer: Cofinity Commercial |
$28.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.04
|
| Rate for Payer: Healthscope Commercial |
$30.05
|
| Rate for Payer: Healthscope Whirlpool |
$29.15
|
| Rate for Payer: Mclaren Commercial |
$27.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.54
|
| Rate for Payer: Nomi Health Commercial |
$24.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.44
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$3.71
|
|
|
Service Code
|
NDC 00121097001
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: ASR Commercial |
$3.60
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.25
|
| Rate for Payer: Priority Health Narrow Network |
$2.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$18.53
|
|
|
Service Code
|
NDC 00121097005
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$18.53 |
| Rate for Payer: Aetna Commercial |
$16.68
|
| Rate for Payer: ASR ASR |
$17.97
|
| Rate for Payer: ASR Commercial |
$17.97
|
| Rate for Payer: BCBS Trust/PPO |
$15.10
|
| Rate for Payer: BCN Commercial |
$14.37
|
| Rate for Payer: Cash Price |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.97
|
| Rate for Payer: Mclaren Commercial |
$16.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.75
|
| Rate for Payer: Nomi Health Commercial |
$15.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.31
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$3.71
|
|
|
Service Code
|
NDC 00121097001
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: ASR ASR |
$3.60
|
| Rate for Payer: ASR Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.97
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Healthscope Whirlpool |
$3.60
|
| Rate for Payer: Mclaren Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.15
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.26
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$27.36
|
|
|
Service Code
|
NDC 71399445605
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$27.36 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Aetna Medicare |
$13.68
|
| Rate for Payer: ASR ASR |
$26.54
|
| Rate for Payer: ASR Commercial |
$26.54
|
| Rate for Payer: BCBS Complete |
$10.94
|
| Rate for Payer: BCBS Trust/PPO |
$22.41
|
| Rate for Payer: BCN Commercial |
$21.21
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$25.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.89
|
| Rate for Payer: Healthscope Commercial |
$27.36
|
| Rate for Payer: Healthscope Whirlpool |
$26.54
|
| Rate for Payer: Mclaren Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.26
|
| Rate for Payer: Nomi Health Commercial |
$22.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.97
|
| Rate for Payer: Priority Health Narrow Network |
$19.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.08
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$5.47
|
|
|
Service Code
|
NDC 71399445601
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna Commercial |
$4.92
|
| Rate for Payer: ASR ASR |
$5.31
|
| Rate for Payer: ASR Commercial |
$5.31
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Healthscope Whirlpool |
$5.31
|
| Rate for Payer: Mclaren Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Nomi Health Commercial |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.81
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$18.53
|
|
|
Service Code
|
NDC 00121097005
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$18.53 |
| Rate for Payer: Aetna Commercial |
$16.68
|
| Rate for Payer: Aetna Medicare |
$9.26
|
| Rate for Payer: ASR ASR |
$17.97
|
| Rate for Payer: ASR Commercial |
$17.97
|
| Rate for Payer: BCBS Complete |
$7.41
|
| Rate for Payer: BCBS Trust/PPO |
$15.17
|
| Rate for Payer: BCN Commercial |
$14.37
|
| Rate for Payer: Cash Price |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$17.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.82
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.97
|
| Rate for Payer: Mclaren Commercial |
$16.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.75
|
| Rate for Payer: Nomi Health Commercial |
$15.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.24
|
| Rate for Payer: Priority Health Narrow Network |
$12.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.31
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$27.36
|
|
|
Service Code
|
NDC 71399445605
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.78 |
| Max. Negotiated Rate |
$27.36 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: ASR ASR |
$26.54
|
| Rate for Payer: ASR Commercial |
$26.54
|
| Rate for Payer: BCBS Trust/PPO |
$22.30
|
| Rate for Payer: BCN Commercial |
$21.21
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$25.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.89
|
| Rate for Payer: Healthscope Commercial |
$27.36
|
| Rate for Payer: Healthscope Whirlpool |
$26.54
|
| Rate for Payer: Mclaren Commercial |
$24.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.26
|
| Rate for Payer: Nomi Health Commercial |
$22.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.08
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$45.36
|
|
|
Service Code
|
NDC 41167005840
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$40.82
|
| Rate for Payer: Aetna Medicare |
$22.68
|
| Rate for Payer: ASR ASR |
$44.00
|
| Rate for Payer: ASR Commercial |
$44.00
|
| Rate for Payer: BCBS Complete |
$18.14
|
| Rate for Payer: BCBS Trust/PPO |
$37.15
|
| Rate for Payer: BCN Commercial |
$35.17
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cofinity Commercial |
$42.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.29
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Healthscope Whirlpool |
$44.00
|
| Rate for Payer: Mclaren Commercial |
$40.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.56
|
| Rate for Payer: Nomi Health Commercial |
$37.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.74
|
| Rate for Payer: Priority Health Narrow Network |
$31.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.92
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$5.47
|
|
|
Service Code
|
NDC 71399445601
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.47 |
| Rate for Payer: Aetna Commercial |
$4.92
|
| Rate for Payer: Aetna Medicare |
$2.74
|
| Rate for Payer: ASR ASR |
$5.31
|
| Rate for Payer: ASR Commercial |
$5.31
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$4.48
|
| Rate for Payer: BCN Commercial |
$4.24
|
| Rate for Payer: Cash Price |
$4.38
|
| Rate for Payer: Cofinity Commercial |
$5.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$5.47
|
| Rate for Payer: Healthscope Whirlpool |
$5.31
|
| Rate for Payer: Mclaren Commercial |
$4.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.65
|
| Rate for Payer: Nomi Health Commercial |
$4.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.79
|
| Rate for Payer: Priority Health Narrow Network |
$3.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.81
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$30.05
|
|
|
Service Code
|
NDC 00536120215
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.02 |
| Max. Negotiated Rate |
$30.05 |
| Rate for Payer: Aetna Commercial |
$27.04
|
| Rate for Payer: Aetna Medicare |
$15.02
|
| Rate for Payer: ASR ASR |
$29.15
|
| Rate for Payer: ASR Commercial |
$29.15
|
| Rate for Payer: BCBS Complete |
$12.02
|
| Rate for Payer: BCBS Trust/PPO |
$24.61
|
| Rate for Payer: BCN Commercial |
$23.30
|
| Rate for Payer: Cash Price |
$24.04
|
| Rate for Payer: Cofinity Commercial |
$28.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.04
|
| Rate for Payer: Healthscope Commercial |
$30.05
|
| Rate for Payer: Healthscope Whirlpool |
$29.15
|
| Rate for Payer: Mclaren Commercial |
$27.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.54
|
| Rate for Payer: Nomi Health Commercial |
$24.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.33
|
| Rate for Payer: Priority Health Narrow Network |
$21.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.44
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
IP
|
$18.72
|
|
|
Service Code
|
NDC 96295013458
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Trust/PPO |
$15.25
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
LIDOCAINE 4 % TOPICAL PATCH
|
Facility
|
OP
|
$18.72
|
|
|
Service Code
|
NDC 96295013458
|
| Hospital Charge Code |
108212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.72 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: ASR ASR |
$18.16
|
| Rate for Payer: ASR Commercial |
$18.16
|
| Rate for Payer: BCBS Complete |
$7.49
|
| Rate for Payer: BCBS Trust/PPO |
$15.33
|
| Rate for Payer: BCN Commercial |
$14.51
|
| Rate for Payer: Cash Price |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$17.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.98
|
| Rate for Payer: Healthscope Commercial |
$18.72
|
| Rate for Payer: Healthscope Whirlpool |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.91
|
| Rate for Payer: Nomi Health Commercial |
$15.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.40
|
| Rate for Payer: Priority Health Narrow Network |
$13.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.47
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.87
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$20.87 |
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: Aetna Medicare |
$19.04
|
| Rate for Payer: ASR ASR |
$36.95
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: ASR ASR |
$51.41
|
| Rate for Payer: ASR Commercial |
$36.95
|
| Rate for Payer: ASR Commercial |
$20.24
|
| Rate for Payer: ASR Commercial |
$51.41
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: BCBS Complete |
$15.24
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Trust/PPO |
$43.40
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCBS Trust/PPO |
$31.19
|
| Rate for Payer: BCN Commercial |
$29.53
|
| Rate for Payer: BCN Commercial |
$41.09
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.47
|
| Rate for Payer: Healthscope Commercial |
$53.00
|
| Rate for Payer: Healthscope Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Healthscope Whirlpool |
$51.41
|
| Rate for Payer: Healthscope Whirlpool |
$36.95
|
| Rate for Payer: Healthscope Whirlpool |
$20.24
|
| Rate for Payer: Mclaren Commercial |
$34.28
|
| Rate for Payer: Mclaren Commercial |
$47.70
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$43.46
|
| Rate for Payer: Nomi Health Commercial |
$31.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.64
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$38.09
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
15985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.76 |
| Max. Negotiated Rate |
$38.09 |
| Rate for Payer: Aetna Commercial |
$34.28
|
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: ASR ASR |
$36.95
|
| Rate for Payer: ASR ASR |
$51.41
|
| Rate for Payer: ASR Commercial |
$36.95
|
| Rate for Payer: ASR Commercial |
$20.24
|
| Rate for Payer: ASR Commercial |
$51.41
|
| Rate for Payer: BCBS Trust/PPO |
$43.19
|
| Rate for Payer: BCBS Trust/PPO |
$17.01
|
| Rate for Payer: BCBS Trust/PPO |
$31.04
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Commercial |
$41.09
|
| Rate for Payer: BCN Commercial |
$29.53
|
| Rate for Payer: Cash Price |
$30.47
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.40
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Healthscope Commercial |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$53.00
|
| Rate for Payer: Healthscope Whirlpool |
$36.95
|
| Rate for Payer: Healthscope Whirlpool |
$20.24
|
| Rate for Payer: Healthscope Whirlpool |
$51.41
|
| Rate for Payer: Mclaren Commercial |
$34.28
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Mclaren Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Nomi Health Commercial |
$31.23
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$43.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.37
|
|
|
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 |
$0.01 |
| Max. Negotiated Rate |
$80.99 |
| Rate for Payer: Aetna Commercial |
$72.89
|
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: ASR ASR |
$38.76
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR ASR |
$78.56
|
| Rate for Payer: ASR Commercial |
$20.24
|
| Rate for Payer: ASR Commercial |
$41.18
|
| Rate for Payer: ASR Commercial |
$78.56
|
| Rate for Payer: ASR Commercial |
$38.76
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$66.32
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCBS Trust/PPO |
$17.09
|
| Rate for Payer: BCBS Trust/PPO |
$34.76
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Commercial |
$62.79
|
| Rate for Payer: BCN Commercial |
$30.98
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cofinity Commercial |
$37.56
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$76.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$80.99
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Whirlpool |
$38.76
|
| Rate for Payer: Healthscope Whirlpool |
$20.24
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$78.56
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Commercial |
$72.89
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Mclaren Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.84
|
| Rate for Payer: Nomi Health Commercial |
$32.77
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Nomi Health Commercial |
$66.41
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
|
|
LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$42.45
|
|
|
Service Code
|
HCPCS J2004
|
| Hospital Charge Code |
10431
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Commercial |
$35.96
|
| Rate for Payer: Aetna Commercial |
$72.89
|
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: ASR ASR |
$20.24
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: ASR ASR |
$38.76
|
| Rate for Payer: ASR ASR |
$78.56
|
| Rate for Payer: ASR Commercial |
$41.18
|
| Rate for Payer: ASR Commercial |
$78.56
|
| Rate for Payer: ASR Commercial |
$38.76
|
| Rate for Payer: ASR Commercial |
$20.24
|
| Rate for Payer: BCBS Trust/PPO |
$66.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.01
|
| Rate for Payer: BCBS Trust/PPO |
$32.56
|
| Rate for Payer: BCBS Trust/PPO |
$34.59
|
| Rate for Payer: BCN Commercial |
$62.79
|
| Rate for Payer: BCN Commercial |
$16.18
|
| Rate for Payer: BCN Commercial |
$32.91
|
| Rate for Payer: BCN Commercial |
$30.98
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cash Price |
$16.69
|
| Rate for Payer: Cash Price |
$64.79
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.90
|
| Rate for Payer: Cofinity Commercial |
$37.56
|
| Rate for Payer: Cofinity Commercial |
$76.13
|
| Rate for Payer: Cofinity Commercial |
$19.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$39.96
|
| Rate for Payer: Healthscope Commercial |
$20.87
|
| Rate for Payer: Healthscope Commercial |
$42.45
|
| Rate for Payer: Healthscope Commercial |
$80.99
|
| Rate for Payer: Healthscope Whirlpool |
$78.56
|
| Rate for Payer: Healthscope Whirlpool |
$38.76
|
| Rate for Payer: Healthscope Whirlpool |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$20.24
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Mclaren Commercial |
$72.89
|
| Rate for Payer: Mclaren Commercial |
$35.96
|
| Rate for Payer: Mclaren Commercial |
$18.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Nomi Health Commercial |
$17.11
|
| Rate for Payer: Nomi Health Commercial |
$66.41
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Nomi Health Commercial |
$32.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.37
|
|
