|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$6.73
|
|
|
Service Code
|
NDC 50268013211
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.37
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Advantage |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$6.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.05
|
| Rate for Payer: PHP Commercial |
$5.72
|
| Rate for Payer: Priority Health SBD |
$4.24
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
OP
|
$7.41
|
|
|
Service Code
|
NDC 60687053511
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.82
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: Cash Price |
$5.93
|
| Rate for Payer: Cofinity Advantage |
$5.19
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.93
|
| Rate for Payer: Healthscope Commercial |
$6.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.56
|
| Rate for Payer: PHP Commercial |
$6.30
|
| Rate for Payer: Priority Health SBD |
$4.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.82
|
| Rate for Payer: UHC Core |
$3.86
|
| Rate for Payer: UHC Exchange |
$2.91
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$370.08
|
|
|
Service Code
|
NDC 60687053565
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.15 |
| Max. Negotiated Rate |
$333.07 |
| Rate for Payer: Aetna Commercial |
$314.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.55
|
| Rate for Payer: Cash Price |
$296.06
|
| Rate for Payer: Cofinity Advantage |
$259.06
|
| Rate for Payer: Cofinity Commercial |
$318.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.06
|
| Rate for Payer: Healthscope Commercial |
$333.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.56
|
| Rate for Payer: PHP Commercial |
$314.57
|
| Rate for Payer: Priority Health SBD |
$233.15
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$7.41
|
|
|
Service Code
|
NDC 60687053511
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.67 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.82
|
| Rate for Payer: Cash Price |
$5.93
|
| Rate for Payer: Cofinity Advantage |
$5.19
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.93
|
| Rate for Payer: Healthscope Commercial |
$6.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.56
|
| Rate for Payer: PHP Commercial |
$6.30
|
| Rate for Payer: Priority Health SBD |
$4.67
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$662.40
|
|
|
Service Code
|
NDC 60687053501
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$417.31 |
| Max. Negotiated Rate |
$596.16 |
| Rate for Payer: Aetna Commercial |
$563.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.56
|
| Rate for Payer: Cash Price |
$529.92
|
| Rate for Payer: Cofinity Advantage |
$463.68
|
| Rate for Payer: Cofinity Commercial |
$569.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.92
|
| Rate for Payer: Healthscope Commercial |
$596.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.80
|
| Rate for Payer: PHP Commercial |
$563.04
|
| Rate for Payer: Priority Health SBD |
$417.31
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
OP
|
$6.73
|
|
|
Service Code
|
NDC 50268013211
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$3.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.37
|
| Rate for Payer: BCBS Complete |
$2.69
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Advantage |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$6.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.05
|
| Rate for Payer: PHP Commercial |
$5.72
|
| Rate for Payer: Priority Health SBD |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.37
|
| Rate for Payer: UHC Core |
$3.51
|
| Rate for Payer: UHC Exchange |
$2.64
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
OP
|
$662.40
|
|
|
Service Code
|
NDC 60687053501
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.32 |
| Max. Negotiated Rate |
$596.16 |
| Rate for Payer: Aetna Commercial |
$563.04
|
| Rate for Payer: Aetna Medicare |
$331.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.56
|
| Rate for Payer: BCBS Complete |
$264.96
|
| Rate for Payer: Cash Price |
$529.92
|
| Rate for Payer: Cofinity Advantage |
$463.68
|
| Rate for Payer: Cofinity Commercial |
$569.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.92
|
| Rate for Payer: Healthscope Commercial |
$596.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$529.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.80
|
| Rate for Payer: PHP Commercial |
$563.04
|
| Rate for Payer: Priority Health SBD |
$417.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.56
|
| Rate for Payer: UHC Core |
$345.11
|
| Rate for Payer: UHC Exchange |
$260.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$50.07
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.54 |
| Max. Negotiated Rate |
$45.06 |
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Advantage |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$43.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.55
|
| Rate for Payer: PHP Commercial |
$42.56
|
| Rate for Payer: Priority Health SBD |
$31.54
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$52.60
|
|
|
Service Code
|
NDC 00409904217
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$47.34 |
| Rate for Payer: Aetna Commercial |
$44.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.19
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cofinity Advantage |
$36.82
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.08
|
| Rate for Payer: Healthscope Commercial |
$47.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.45
|
| Rate for Payer: PHP Commercial |
$44.71
|
| Rate for Payer: Priority Health SBD |
$33.14
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$50.07
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.68 |
| Max. Negotiated Rate |
$45.06 |
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: BCBS Complete |
$20.03
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Advantage |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$43.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.55
|
| Rate for Payer: PHP Commercial |
$42.56
|
| Rate for Payer: Priority Health SBD |
$31.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.55
|
| Rate for Payer: UHC Core |
$26.09
|
| Rate for Payer: UHC Exchange |
$19.68
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$52.60
|
|
|
Service Code
|
NDC 00409904217
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$47.34 |
| Rate for Payer: Aetna Commercial |
$44.71
|
| Rate for Payer: Aetna Medicare |
$26.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.19
|
| Rate for Payer: BCBS Complete |
$21.04
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cofinity Advantage |
$36.82
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.08
|
| Rate for Payer: Healthscope Commercial |
$47.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.45
|
| Rate for Payer: PHP Commercial |
$44.71
|
| Rate for Payer: Priority Health SBD |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.19
|
| Rate for Payer: UHC Core |
$27.40
|
| Rate for Payer: UHC Exchange |
$20.67
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.57
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Advantage |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health SBD |
$14.22
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$22.57
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Advantage |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health SBD |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.67
|
| Rate for Payer: UHC Core |
$11.76
|
| Rate for Payer: UHC Exchange |
$8.87
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.03
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$10.44
|
| Rate for Payer: UHC Exchange |
$7.87
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
NDC 00409174971
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.62 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$15.23
|
|
|
Service Code
|
NDC 09900001068
|
| 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 Advantage |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.42
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: Priority Health SBD |
$9.59
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$56.61
|
|
|
Service Code
|
NDC 00409904517
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Aetna Commercial |
$48.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.80
|
| Rate for Payer: Cash Price |
$45.29
|
| Rate for Payer: Cofinity Advantage |
$39.63
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.29
|
| Rate for Payer: Healthscope Commercial |
$50.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.46
|
| Rate for Payer: PHP Commercial |
$48.12
|
| Rate for Payer: Priority Health SBD |
$35.66
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.03
|
|
|
Service Code
|
NDC 00409174971
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$10.44
|
| Rate for Payer: UHC Exchange |
$7.87
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$56.61
|
|
|
Service Code
|
NDC 00409904517
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.25 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Aetna Commercial |
$48.12
|
| Rate for Payer: Aetna Medicare |
$28.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.80
|
| Rate for Payer: BCBS Complete |
$22.64
|
| Rate for Payer: Cash Price |
$45.29
|
| Rate for Payer: Cofinity Advantage |
$39.63
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.29
|
| Rate for Payer: Healthscope Commercial |
$50.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.46
|
| Rate for Payer: PHP Commercial |
$48.12
|
| Rate for Payer: Priority Health SBD |
$35.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.80
|
| Rate for Payer: UHC Core |
$29.49
|
| Rate for Payer: UHC Exchange |
$22.25
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$53.94
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$48.55 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Aetna Medicare |
$26.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.06
|
| Rate for Payer: BCBS Complete |
$21.58
|
| Rate for Payer: Cash Price |
$43.15
|
| Rate for Payer: Cofinity Advantage |
$37.76
|
| Rate for Payer: Cofinity Commercial |
$46.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.15
|
| Rate for Payer: Healthscope Commercial |
$48.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.45
|
| Rate for Payer: PHP Commercial |
$45.85
|
| Rate for Payer: Priority Health SBD |
$33.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.06
|
| Rate for Payer: UHC Core |
$28.10
|
| Rate for Payer: UHC Exchange |
$21.20
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$15.23
|
|
|
Service Code
|
NDC 09900001068
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$13.71 |
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cofinity Advantage |
$10.66
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.42
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: Priority Health SBD |
$9.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.90
|
| Rate for Payer: UHC Core |
$7.93
|
| Rate for Payer: UHC Exchange |
$5.99
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$53.94
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.98 |
| Max. Negotiated Rate |
$48.55 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.06
|
| Rate for Payer: Cash Price |
$43.15
|
| Rate for Payer: Cofinity Advantage |
$37.76
|
| Rate for Payer: Cofinity Commercial |
$46.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.15
|
| Rate for Payer: Healthscope Commercial |
$48.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.45
|
| Rate for Payer: PHP Commercial |
$45.85
|
| Rate for Payer: Priority Health SBD |
$33.98
|
|
|
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$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 Advantage |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$16.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: PHP Commercial |
$16.04
|
| Rate for Payer: Priority Health SBD |
$11.89
|
|
|
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$18.87
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$16.98 |
| Rate for Payer: Aetna Commercial |
$16.04
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.27
|
| Rate for Payer: BCBS Complete |
$7.55
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cash Price |
$15.10
|
| Rate for Payer: Cofinity Advantage |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.10
|
| Rate for Payer: Healthscope Commercial |
$16.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.15
|
| Rate for Payer: PHP Commercial |
$16.04
|
| Rate for Payer: Priority Health SBD |
$11.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
