Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BUMETANIDE 1 MG TABLET

Facility

$2,004.50

Service Code	NDC 0185-0129-05
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$1,262.84
Max. Negotiated Rate	$1,804.05
Rate for Payer: Aetna Commercial	$1,703.82
Rate for Payer: Aetna New Business (MI Preferred)	$1,302.92
Rate for Payer: Cash Price	$1,603.60
Rate for Payer: Cofinity Commercial	$1,403.15
Rate for Payer: Cofinity Commercial	$1,723.87
Rate for Payer: Healthscope Commercial	$1,804.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,703.82
Rate for Payer: PHP Commercial	$1,703.82
Rate for Payer: Priority Health Cigna Priority Health	$1,403.15
Rate for Payer: Priority Health SBD	$1,262.84

BUMETANIDE 1 MG TABLET

Facility

$4.14

Service Code	NDC 50268-131-11
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$3.73
Rate for Payer: Aetna Commercial	$3.52
Rate for Payer: Aetna New Business (MI Preferred)	$2.69
Rate for Payer: Cash Price	$3.31
Rate for Payer: Cofinity Commercial	$2.90
Rate for Payer: Cofinity Commercial	$3.56
Rate for Payer: Healthscope Commercial	$3.73
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.52
Rate for Payer: PHP Commercial	$3.52
Rate for Payer: Priority Health Cigna Priority Health	$2.90
Rate for Payer: Priority Health SBD	$2.61

BUMETANIDE 1 MG TABLET

Facility

$176.16

Service Code	NDC 0904-7016-06
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$110.98
Max. Negotiated Rate	$158.54
Rate for Payer: Aetna Commercial	$149.74
Rate for Payer: Aetna New Business (MI Preferred)	$114.50
Rate for Payer: Cash Price	$140.93
Rate for Payer: Cofinity Commercial	$123.31
Rate for Payer: Cofinity Commercial	$151.50
Rate for Payer: Healthscope Commercial	$158.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$149.74
Rate for Payer: PHP Commercial	$149.74
Rate for Payer: Priority Health Cigna Priority Health	$123.31
Rate for Payer: Priority Health SBD	$110.98

BUMETANIDE 1 MG TABLET

Facility

$448.85

Service Code	NDC 69238-1490-1
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$282.78
Max. Negotiated Rate	$403.96
Rate for Payer: Aetna Commercial	$381.52
Rate for Payer: Aetna New Business (MI Preferred)	$291.75
Rate for Payer: Cash Price	$359.08
Rate for Payer: Cofinity Commercial	$314.20
Rate for Payer: Cofinity Commercial	$386.01
Rate for Payer: Healthscope Commercial	$403.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$381.52
Rate for Payer: PHP Commercial	$381.52
Rate for Payer: Priority Health Cigna Priority Health	$314.20
Rate for Payer: Priority Health SBD	$282.78

BUMETANIDE 1 MG TABLET

Facility

$400.90

Service Code	NDC 0185-0129-01
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$252.57
Max. Negotiated Rate	$360.81
Rate for Payer: Aetna Commercial	$340.76
Rate for Payer: Aetna New Business (MI Preferred)	$260.58
Rate for Payer: Cash Price	$320.72
Rate for Payer: Cofinity Commercial	$280.63
Rate for Payer: Cofinity Commercial	$344.77
Rate for Payer: Healthscope Commercial	$360.81
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$340.76
Rate for Payer: PHP Commercial	$340.76
Rate for Payer: Priority Health Cigna Priority Health	$280.63
Rate for Payer: Priority Health SBD	$252.57

BUMETANIDE 2 MG TABLET

Facility

$658.56

Service Code	NDC 60687-535-01
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$414.89
Max. Negotiated Rate	$592.70
Rate for Payer: Aetna Commercial	$559.78
Rate for Payer: Aetna New Business (MI Preferred)	$428.06
Rate for Payer: Cash Price	$526.85
Rate for Payer: Cofinity Commercial	$460.99
Rate for Payer: Cofinity Commercial	$566.36
Rate for Payer: Healthscope Commercial	$592.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$559.78
Rate for Payer: PHP Commercial	$559.78
Rate for Payer: Priority Health Cigna Priority Health	$460.99
Rate for Payer: Priority Health SBD	$414.89

BUMETANIDE 2 MG TABLET

Facility

$416.10

Service Code	NDC 69238-1491-1
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$262.14
Max. Negotiated Rate	$374.49
Rate for Payer: Aetna Commercial	$353.68
Rate for Payer: Aetna New Business (MI Preferred)	$270.46
Rate for Payer: Cash Price	$332.88
Rate for Payer: Cofinity Commercial	$291.27
Rate for Payer: Cofinity Commercial	$357.85
Rate for Payer: Healthscope Commercial	$374.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$353.68
Rate for Payer: PHP Commercial	$353.68
Rate for Payer: Priority Health Cigna Priority Health	$291.27
Rate for Payer: Priority Health SBD	$262.14

BUMETANIDE 2 MG TABLET

Facility

$6.59

Service Code	NDC 60687-535-11
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$4.15
Max. Negotiated Rate	$5.93
Rate for Payer: Aetna Commercial	$5.60
Rate for Payer: Aetna New Business (MI Preferred)	$4.28
Rate for Payer: Cash Price	$5.27
Rate for Payer: Cofinity Commercial	$4.61
Rate for Payer: Cofinity Commercial	$5.67
Rate for Payer: Healthscope Commercial	$5.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$5.60
Rate for Payer: PHP Commercial	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.61
Rate for Payer: Priority Health SBD	$4.15

BUMETANIDE 2 MG TABLET

Facility

$375.84

Service Code	NDC 0185-0130-01
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$236.78
Max. Negotiated Rate	$338.26
Rate for Payer: Aetna Commercial	$319.46
Rate for Payer: Aetna New Business (MI Preferred)	$244.30
Rate for Payer: Cash Price	$300.67
Rate for Payer: Cofinity Commercial	$263.09
Rate for Payer: Cofinity Commercial	$323.22
Rate for Payer: Healthscope Commercial	$338.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$319.46
Rate for Payer: PHP Commercial	$319.46
Rate for Payer: Priority Health Cigna Priority Health	$263.09
Rate for Payer: Priority Health SBD	$236.78

BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION

Facility

$17.10

Service Code	NDC 0409-9042-17
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$10.77
Max. Negotiated Rate	$15.39
Rate for Payer: Aetna Commercial	$14.54
Rate for Payer: Aetna New Business (MI Preferred)	$11.12
Rate for Payer: Cash Price	$13.68
Rate for Payer: Cofinity Commercial	$11.97
Rate for Payer: Cofinity Commercial	$14.71
Rate for Payer: Healthscope Commercial	$15.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.54
Rate for Payer: PHP Commercial	$14.54
Rate for Payer: Priority Health Cigna Priority Health	$11.97
Rate for Payer: Priority Health SBD	$10.77

BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION

Facility

$25.76

Service Code	NDC 0409-9042-11
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$16.23
Max. Negotiated Rate	$23.18
Rate for Payer: Aetna Commercial	$21.90
Rate for Payer: Aetna New Business (MI Preferred)	$16.74
Rate for Payer: Cash Price	$20.61
Rate for Payer: Cofinity Commercial	$18.03
Rate for Payer: Cofinity Commercial	$22.15
Rate for Payer: Healthscope Commercial	$23.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.90
Rate for Payer: PHP Commercial	$21.90
Rate for Payer: Priority Health Cigna Priority Health	$18.03
Rate for Payer: Priority Health SBD	$16.23

BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION

Facility

$40.32

Service Code	NDC 63323-468-37
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$25.40
Max. Negotiated Rate	$36.29
Rate for Payer: Aetna Commercial	$34.27
Rate for Payer: Aetna New Business (MI Preferred)	$26.21
Rate for Payer: Cash Price	$32.26
Rate for Payer: Cofinity Commercial	$28.22
Rate for Payer: Cofinity Commercial	$34.68
Rate for Payer: Healthscope Commercial	$36.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.27
Rate for Payer: PHP Commercial	$34.27
Rate for Payer: Priority Health Cigna Priority Health	$28.22
Rate for Payer: Priority Health SBD	$25.40

BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION

Facility

$21.94

Service Code	NDC 9900-0018-97
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$13.82
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna Commercial	$18.65
Rate for Payer: Aetna New Business (MI Preferred)	$14.26
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cofinity Commercial	$15.36
Rate for Payer: Cofinity Commercial	$18.87
Rate for Payer: Healthscope Commercial	$19.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.65
Rate for Payer: PHP Commercial	$18.65
Rate for Payer: Priority Health Cigna Priority Health	$15.36
Rate for Payer: Priority Health SBD	$13.82

BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION

Facility

$25.50

Service Code	NDC 63323-468-17
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$16.06
Max. Negotiated Rate	$22.95
Rate for Payer: Aetna Commercial	$21.68
Rate for Payer: Aetna New Business (MI Preferred)	$16.58
Rate for Payer: Cash Price	$20.40
Rate for Payer: Cofinity Commercial	$21.93
Rate for Payer: Cofinity Commercial	$17.85
Rate for Payer: Healthscope Commercial	$22.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.68
Rate for Payer: PHP Commercial	$21.68
Rate for Payer: Priority Health Cigna Priority Health	$17.85
Rate for Payer: Priority Health SBD	$16.06

BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION

Facility

$21.50

Service Code	NDC 0409-1746-30
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$13.54
Max. Negotiated Rate	$19.35
Rate for Payer: Aetna Commercial	$18.28
Rate for Payer: Aetna New Business (MI Preferred)	$13.98
Rate for Payer: Cash Price	$17.20
Rate for Payer: Cofinity Commercial	$15.05
Rate for Payer: Cofinity Commercial	$18.49
Rate for Payer: Healthscope Commercial	$19.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.28
Rate for Payer: PHP Commercial	$18.28
Rate for Payer: Priority Health Cigna Priority Health	$15.05
Rate for Payer: Priority Health SBD	$13.54

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION

Facility

$19.10

Service Code	NDC 0409-1749-71
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna Commercial	$16.24
Rate for Payer: Aetna New Business (MI Preferred)	$12.42
Rate for Payer: Cash Price	$15.28
Rate for Payer: Cofinity Commercial	$13.37
Rate for Payer: Cofinity Commercial	$16.43
Rate for Payer: Healthscope Commercial	$17.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.24
Rate for Payer: PHP Commercial	$16.24
Rate for Payer: Priority Health Cigna Priority Health	$13.37
Rate for Payer: Priority Health SBD	$12.03

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION

Facility

$43.39

Service Code	NDC 63323-462-37
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$27.34
Max. Negotiated Rate	$39.05
Rate for Payer: Aetna Commercial	$36.88
Rate for Payer: Aetna New Business (MI Preferred)	$28.20
Rate for Payer: Cash Price	$34.71
Rate for Payer: Cofinity Commercial	$30.37
Rate for Payer: Cofinity Commercial	$37.32
Rate for Payer: Healthscope Commercial	$39.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$36.88
Rate for Payer: PHP Commercial	$36.88
Rate for Payer: Priority Health Cigna Priority Health	$30.37
Rate for Payer: Priority Health SBD	$27.34

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION

Facility

$19.10

Service Code	NDC 0409-1749-29
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna Commercial	$16.24
Rate for Payer: Aetna New Business (MI Preferred)	$12.42
Rate for Payer: Cash Price	$15.28
Rate for Payer: Cofinity Commercial	$13.37
Rate for Payer: Cofinity Commercial	$16.43
Rate for Payer: Healthscope Commercial	$17.19
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.24
Rate for Payer: PHP Commercial	$16.24
Rate for Payer: Priority Health Cigna Priority Health	$13.37
Rate for Payer: Priority Health SBD	$12.03

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION

Facility

$16.65

Service Code	NDC 0409-9045-17
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$10.49
Max. Negotiated Rate	$14.98
Rate for Payer: Aetna Commercial	$14.15
Rate for Payer: Aetna New Business (MI Preferred)	$10.82
Rate for Payer: Cash Price	$13.32
Rate for Payer: Cofinity Commercial	$14.32
Rate for Payer: Cofinity Commercial	$11.66
Rate for Payer: Healthscope Commercial	$14.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.15
Rate for Payer: PHP Commercial	$14.15
Rate for Payer: Priority Health Cigna Priority Health	$11.66
Rate for Payer: Priority Health SBD	$10.49

BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION

Facility

$15.23

Service Code	NDC 9900-0010-68
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$13.71
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna New Business (MI Preferred)	$9.90
Rate for Payer: Cash Price	$12.18
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$10.66
Rate for Payer: Healthscope Commercial	$13.71
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.95
Rate for Payer: PHP Commercial	$12.95
Rate for Payer: Priority Health Cigna Priority Health	$10.66
Rate for Payer: Priority Health SBD	$9.59

BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION

Facility

$18.87

Service Code	HCPCS J0665
Hospital Charge Code	1223
Hospital Revenue Code	636
Min. Negotiated Rate	$11.89
Max. Negotiated Rate	$16.98
Rate for Payer: Aetna Commercial	$16.04
Rate for Payer: Aetna New Business (MI Preferred)	$12.27
Rate for Payer: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$13.21
Rate for Payer: Cofinity Commercial	$16.23
Rate for Payer: Healthscope Commercial	$16.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.04
Rate for Payer: PHP Commercial	$16.04
Rate for Payer: Priority Health Cigna Priority Health	$13.21
Rate for Payer: Priority Health SBD	$11.89

BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION

Facility

$25.23

Service Code	HCPCS J0665
Hospital Charge Code	1222
Hospital Revenue Code	636
Min. Negotiated Rate	$15.89
Max. Negotiated Rate	$22.71
Rate for Payer: Aetna Commercial	$21.45
Rate for Payer: Aetna Commercial	$19.97
Rate for Payer: Aetna Commercial	$9.56
Rate for Payer: Aetna Commercial	$24.04
Rate for Payer: Aetna Commercial	$23.08
Rate for Payer: Aetna Commercial	$21.20
Rate for Payer: Aetna New Business (MI Preferred)	$16.40
Rate for Payer: Aetna New Business (MI Preferred)	$7.31
Rate for Payer: Aetna New Business (MI Preferred)	$15.27
Rate for Payer: Aetna New Business (MI Preferred)	$16.21
Rate for Payer: Aetna New Business (MI Preferred)	$17.65
Rate for Payer: Aetna New Business (MI Preferred)	$18.38
Rate for Payer: Cash Price	$18.79
Rate for Payer: Cash Price	$21.72
Rate for Payer: Cash Price	$22.62
Rate for Payer: Cash Price	$9.00
Rate for Payer: Cash Price	$19.95
Rate for Payer: Cash Price	$20.18
Rate for Payer: Cofinity Commercial	$19.80
Rate for Payer: Cofinity Commercial	$17.46
Rate for Payer: Cofinity Commercial	$21.45
Rate for Payer: Cofinity Commercial	$20.20
Rate for Payer: Cofinity Commercial	$7.88
Rate for Payer: Cofinity Commercial	$16.44
Rate for Payer: Cofinity Commercial	$23.35
Rate for Payer: Cofinity Commercial	$9.68
Rate for Payer: Cofinity Commercial	$17.66
Rate for Payer: Cofinity Commercial	$21.70
Rate for Payer: Cofinity Commercial	$19.00
Rate for Payer: Cofinity Commercial	$24.32
Rate for Payer: Healthscope Commercial	$22.71
Rate for Payer: Healthscope Commercial	$25.45
Rate for Payer: Healthscope Commercial	$22.45
Rate for Payer: Healthscope Commercial	$24.44
Rate for Payer: Healthscope Commercial	$10.12
Rate for Payer: Healthscope Commercial	$21.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$9.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$19.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$21.45
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.04
Rate for Payer: PHP Commercial	$19.97
Rate for Payer: PHP Commercial	$21.45
Rate for Payer: PHP Commercial	$21.20
Rate for Payer: PHP Commercial	$24.04
Rate for Payer: PHP Commercial	$9.56
Rate for Payer: PHP Commercial	$23.08
Rate for Payer: Priority Health Cigna Priority Health	$17.46
Rate for Payer: Priority Health Cigna Priority Health	$19.80
Rate for Payer: Priority Health Cigna Priority Health	$19.00
Rate for Payer: Priority Health Cigna Priority Health	$7.88
Rate for Payer: Priority Health Cigna Priority Health	$17.66
Rate for Payer: Priority Health Cigna Priority Health	$16.44
Rate for Payer: Priority Health SBD	$17.82
Rate for Payer: Priority Health SBD	$15.71
Rate for Payer: Priority Health SBD	$17.10
Rate for Payer: Priority Health SBD	$14.80
Rate for Payer: Priority Health SBD	$7.09
Rate for Payer: Priority Health SBD	$15.89

BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION

Facility

$19.10

Service Code	HCPCS J0665
Hospital Charge Code	105640
Hospital Revenue Code	636
Min. Negotiated Rate	$12.03
Max. Negotiated Rate	$17.19
Rate for Payer: Aetna Commercial	$16.24
Rate for Payer: Aetna Commercial	$13.02
Rate for Payer: Aetna Commercial	$17.38
Rate for Payer: Aetna Commercial	$23.66
Rate for Payer: Aetna Commercial	$25.53
Rate for Payer: Aetna New Business (MI Preferred)	$18.10
Rate for Payer: Aetna New Business (MI Preferred)	$12.42
Rate for Payer: Aetna New Business (MI Preferred)	$13.29
Rate for Payer: Aetna New Business (MI Preferred)	$19.53
Rate for Payer: Aetna New Business (MI Preferred)	$9.96
Rate for Payer: Cash Price	$24.03
Rate for Payer: Cash Price	$16.36
Rate for Payer: Cash Price	$12.26
Rate for Payer: Cash Price	$15.28
Rate for Payer: Cash Price	$22.27
Rate for Payer: Cofinity Commercial	$25.83
Rate for Payer: Cofinity Commercial	$21.03
Rate for Payer: Cofinity Commercial	$13.18
Rate for Payer: Cofinity Commercial	$13.37
Rate for Payer: Cofinity Commercial	$16.43
Rate for Payer: Cofinity Commercial	$10.72
Rate for Payer: Cofinity Commercial	$14.32
Rate for Payer: Cofinity Commercial	$17.59
Rate for Payer: Cofinity Commercial	$19.49
Rate for Payer: Cofinity Commercial	$23.94
Rate for Payer: Healthscope Commercial	$18.40
Rate for Payer: Healthscope Commercial	$17.19
Rate for Payer: Healthscope Commercial	$13.79
Rate for Payer: Healthscope Commercial	$27.04
Rate for Payer: Healthscope Commercial	$25.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$16.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.38
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.53
Rate for Payer: PHP Commercial	$25.53
Rate for Payer: PHP Commercial	$13.02
Rate for Payer: PHP Commercial	$16.24
Rate for Payer: PHP Commercial	$23.66
Rate for Payer: PHP Commercial	$17.38
Rate for Payer: Priority Health Cigna Priority Health	$19.49
Rate for Payer: Priority Health Cigna Priority Health	$10.72
Rate for Payer: Priority Health Cigna Priority Health	$13.37
Rate for Payer: Priority Health Cigna Priority Health	$14.32
Rate for Payer: Priority Health Cigna Priority Health	$21.03
Rate for Payer: Priority Health SBD	$17.54
Rate for Payer: Priority Health SBD	$12.03
Rate for Payer: Priority Health SBD	$12.88
Rate for Payer: Priority Health SBD	$9.65
Rate for Payer: Priority Health SBD	$18.93

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$22.31

Service Code	NDC 0409-3613-01
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$20.08
Rate for Payer: Aetna Commercial	$18.96
Rate for Payer: Aetna New Business (MI Preferred)	$14.50
Rate for Payer: Cash Price	$17.85
Rate for Payer: Cofinity Commercial	$15.62
Rate for Payer: Cofinity Commercial	$19.19
Rate for Payer: Healthscope Commercial	$20.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.96
Rate for Payer: PHP Commercial	$18.96
Rate for Payer: Priority Health Cigna Priority Health	$15.62
Rate for Payer: Priority Health SBD	$14.06

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$28.17

Service Code	NDC 0409-1761-19
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna New Business (MI Preferred)	$18.31
Rate for Payer: Cash Price	$22.54
Rate for Payer: Cofinity Commercial	$19.72
Rate for Payer: Cofinity Commercial	$24.23
Rate for Payer: Healthscope Commercial	$25.35
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$23.94
Rate for Payer: PHP Commercial	$23.94
Rate for Payer: Priority Health Cigna Priority Health	$19.72
Rate for Payer: Priority Health SBD	$17.75

Know your out-of-pocket cost for care.

All Charges