|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$19.14
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Aetna Medicare |
$13.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS Complete |
$7.66
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Advantage |
$16.44
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Advantage |
$19.49
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.88
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: Priority Health SBD |
$12.06
|
| Rate for Payer: Priority Health SBD |
$17.54
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$19.14
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$17.23 |
| Rate for Payer: Aetna Commercial |
$16.27
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$15.31
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Advantage |
$13.40
|
| Rate for Payer: Cofinity Advantage |
$19.49
|
| Rate for Payer: Cofinity Advantage |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$16.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$16.27
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: Priority Health SBD |
$17.54
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$12.06
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$32.71
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: Aetna Medicare |
$7.88
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna Medicare |
$16.36
|
| Rate for Payer: Aetna Medicare |
$10.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.96
|
| Rate for Payer: BCBS Complete |
$13.08
|
| Rate for Payer: BCBS Complete |
$6.31
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Complete |
$6.13
|
| Rate for Payer: BCBS Complete |
$8.33
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cofinity Advantage |
$22.90
|
| Rate for Payer: Cofinity Advantage |
$14.58
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Advantage |
$10.72
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.62
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$13.12
|
| Rate for Payer: Priority Health SBD |
$20.61
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$9.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$15.32
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.96
|
| Rate for Payer: Cash Price |
$26.17
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cofinity Advantage |
$14.58
|
| Rate for Payer: Cofinity Advantage |
$10.72
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$22.90
|
| Rate for Payer: Cofinity Advantage |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$28.13
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.17
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$29.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.53
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$27.80
|
| Rate for Payer: Priority Health SBD |
$20.61
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$9.65
|
| Rate for Payer: Priority Health SBD |
$9.94
|
| Rate for Payer: Priority Health SBD |
$13.12
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$14.94
|
|
|
Service Code
|
NDC 00409361311
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna Commercial |
$12.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.71
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cofinity Advantage |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.21
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health SBD |
$9.41
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$14.94
|
|
|
Service Code
|
NDC 00409361311
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.87 |
| Max. Negotiated Rate |
$13.45 |
| Rate for Payer: Aetna Commercial |
$12.70
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.71
|
| Rate for Payer: BCBS Complete |
$5.98
|
| Rate for Payer: Cash Price |
$11.95
|
| Rate for Payer: Cofinity Advantage |
$10.46
|
| Rate for Payer: Cofinity Commercial |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.95
|
| Rate for Payer: Healthscope Commercial |
$13.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.21
|
| Rate for Payer: PHP Commercial |
$12.70
|
| Rate for Payer: Priority Health SBD |
$9.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$7.78
|
| Rate for Payer: UHC Exchange |
$5.87
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$22.31
|
|
|
Service Code
|
NDC 00409361301
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.77 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Medicare |
$11.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.50
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Advantage |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health SBD |
$14.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.50
|
| Rate for Payer: UHC Core |
$11.62
|
| Rate for Payer: UHC Exchange |
$8.77
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$22.31
|
|
|
Service Code
|
NDC 00409361301
|
| 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 Advantage |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health SBD |
$14.06
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$27.53
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$27.53
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.34 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: Priority Health SBD |
$17.34
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$954.38
|
|
|
Service Code
|
NDC 59011075104
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$601.26 |
| Max. Negotiated Rate |
$858.94 |
| Rate for Payer: Aetna Commercial |
$811.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.35
|
| Rate for Payer: Cash Price |
$763.50
|
| Rate for Payer: Cofinity Advantage |
$668.07
|
| Rate for Payer: Cofinity Commercial |
$820.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.50
|
| Rate for Payer: Healthscope Commercial |
$858.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$811.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.78
|
| Rate for Payer: PHP Commercial |
$811.22
|
| Rate for Payer: Priority Health SBD |
$601.26
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$954.38
|
|
|
Service Code
|
NDC 59011075104
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$375.07 |
| Max. Negotiated Rate |
$858.94 |
| Rate for Payer: Aetna Commercial |
$811.22
|
| Rate for Payer: Aetna Medicare |
$477.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.35
|
| Rate for Payer: BCBS Complete |
$381.75
|
| Rate for Payer: Cash Price |
$763.50
|
| Rate for Payer: Cofinity Advantage |
$668.07
|
| Rate for Payer: Cofinity Commercial |
$820.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.50
|
| Rate for Payer: Healthscope Commercial |
$858.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$763.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$811.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.78
|
| Rate for Payer: PHP Commercial |
$811.22
|
| Rate for Payer: Priority Health SBD |
$601.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.35
|
| Rate for Payer: UHC Core |
$497.23
|
| Rate for Payer: UHC Exchange |
$375.07
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$420.62
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.30 |
| Max. Negotiated Rate |
$378.56 |
| Rate for Payer: Aetna Commercial |
$357.53
|
| Rate for Payer: Aetna Medicare |
$210.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.40
|
| Rate for Payer: BCBS Complete |
$168.25
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cofinity Advantage |
$294.43
|
| Rate for Payer: Cofinity Commercial |
$361.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.50
|
| Rate for Payer: Healthscope Commercial |
$378.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.46
|
| Rate for Payer: PHP Commercial |
$357.53
|
| Rate for Payer: Priority Health SBD |
$264.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.40
|
| Rate for Payer: UHC Core |
$219.14
|
| Rate for Payer: UHC Exchange |
$165.30
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$420.62
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.99 |
| Max. Negotiated Rate |
$378.56 |
| Rate for Payer: Aetna Commercial |
$357.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.40
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cofinity Advantage |
$294.43
|
| Rate for Payer: Cofinity Commercial |
$361.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.50
|
| Rate for Payer: Healthscope Commercial |
$378.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.46
|
| Rate for Payer: PHP Commercial |
$357.53
|
| Rate for Payer: Priority Health SBD |
$264.99
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
NDC 59011075004
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$355.95 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna Commercial |
$480.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.25
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Advantage |
$395.50
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.00
|
| Rate for Payer: Healthscope Commercial |
$508.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.75
|
| Rate for Payer: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health SBD |
$355.95
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$465.37
|
|
|
Service Code
|
NDC 00093365640
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.18 |
| Max. Negotiated Rate |
$418.83 |
| Rate for Payer: Aetna Commercial |
$395.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.49
|
| Rate for Payer: Cash Price |
$372.30
|
| Rate for Payer: Cofinity Advantage |
$325.76
|
| Rate for Payer: Cofinity Commercial |
$400.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.30
|
| Rate for Payer: Healthscope Commercial |
$418.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.03
|
| Rate for Payer: PHP Commercial |
$395.56
|
| Rate for Payer: Priority Health SBD |
$293.18
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$650.08
|
|
|
Service Code
|
NDC 69238120202
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$409.55 |
| Max. Negotiated Rate |
$585.07 |
| Rate for Payer: Aetna Commercial |
$552.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.55
|
| Rate for Payer: Cash Price |
$520.06
|
| Rate for Payer: Cofinity Advantage |
$455.06
|
| Rate for Payer: Cofinity Commercial |
$559.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.06
|
| Rate for Payer: Healthscope Commercial |
$585.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$487.56
|
| Rate for Payer: PHP Commercial |
$552.57
|
| Rate for Payer: Priority Health SBD |
$409.55
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$465.37
|
|
|
Service Code
|
NDC 00093365640
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.89 |
| Max. Negotiated Rate |
$418.83 |
| Rate for Payer: Aetna Commercial |
$395.56
|
| Rate for Payer: Aetna Medicare |
$232.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.49
|
| Rate for Payer: BCBS Complete |
$186.15
|
| Rate for Payer: Cash Price |
$372.30
|
| Rate for Payer: Cofinity Advantage |
$325.76
|
| Rate for Payer: Cofinity Commercial |
$400.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.30
|
| Rate for Payer: Healthscope Commercial |
$418.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.03
|
| Rate for Payer: PHP Commercial |
$395.56
|
| Rate for Payer: Priority Health SBD |
$293.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.49
|
| Rate for Payer: UHC Core |
$242.46
|
| Rate for Payer: UHC Exchange |
$182.89
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$650.08
|
|
|
Service Code
|
NDC 69238120202
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.48 |
| Max. Negotiated Rate |
$585.07 |
| Rate for Payer: Aetna Commercial |
$552.57
|
| Rate for Payer: Aetna Medicare |
$325.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.55
|
| Rate for Payer: BCBS Complete |
$260.03
|
| Rate for Payer: Cash Price |
$520.06
|
| Rate for Payer: Cofinity Advantage |
$455.06
|
| Rate for Payer: Cofinity Commercial |
$559.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.06
|
| Rate for Payer: Healthscope Commercial |
$585.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$520.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$487.56
|
| Rate for Payer: PHP Commercial |
$552.57
|
| Rate for Payer: Priority Health SBD |
$409.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.55
|
| Rate for Payer: UHC Core |
$338.69
|
| Rate for Payer: UHC Exchange |
$255.48
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
NDC 59011075004
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.04 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna Commercial |
$480.25
|
| Rate for Payer: Aetna Medicare |
$282.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.25
|
| Rate for Payer: BCBS Complete |
$226.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Advantage |
$395.50
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.00
|
| Rate for Payer: Healthscope Commercial |
$508.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.75
|
| Rate for Payer: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health SBD |
$355.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.25
|
| Rate for Payer: UHC Core |
$294.37
|
| Rate for Payer: UHC Exchange |
$222.04
|
|
|
BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$149.26
|
|
|
Service Code
|
NDC 00093323921
|
| Hospital Charge Code |
172295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.66 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$126.87
|
| Rate for Payer: Aetna Medicare |
$74.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.02
|
| Rate for Payer: BCBS Complete |
$59.70
|
| Rate for Payer: Cash Price |
$119.41
|
| Rate for Payer: Cofinity Advantage |
$104.48
|
| Rate for Payer: Cofinity Commercial |
$128.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.41
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.94
|
| Rate for Payer: PHP Commercial |
$126.87
|
| Rate for Payer: Priority Health SBD |
$94.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.02
|
| Rate for Payer: UHC Core |
$77.76
|
| Rate for Payer: UHC Exchange |
$58.66
|
|
|
BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$597.04
|
|
|
Service Code
|
NDC 00093323940
|
| Hospital Charge Code |
172295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.64 |
| Max. Negotiated Rate |
$537.34 |
| Rate for Payer: Aetna Commercial |
$507.48
|
| Rate for Payer: Aetna Medicare |
$298.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.08
|
| Rate for Payer: BCBS Complete |
$238.82
|
| Rate for Payer: Cash Price |
$477.63
|
| Rate for Payer: Cofinity Advantage |
$417.93
|
| Rate for Payer: Cofinity Commercial |
$513.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.63
|
| Rate for Payer: Healthscope Commercial |
$537.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.78
|
| Rate for Payer: PHP Commercial |
$507.48
|
| Rate for Payer: Priority Health SBD |
$376.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.08
|
| Rate for Payer: UHC Core |
$311.06
|
| Rate for Payer: UHC Exchange |
$234.64
|
|
|
BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$149.26
|
|
|
Service Code
|
NDC 00093323921
|
| Hospital Charge Code |
172295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.03 |
| Max. Negotiated Rate |
$134.33 |
| Rate for Payer: Aetna Commercial |
$126.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.02
|
| Rate for Payer: Cash Price |
$119.41
|
| Rate for Payer: Cofinity Advantage |
$104.48
|
| Rate for Payer: Cofinity Commercial |
$128.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.41
|
| Rate for Payer: Healthscope Commercial |
$134.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.94
|
| Rate for Payer: PHP Commercial |
$126.87
|
| Rate for Payer: Priority Health SBD |
$94.03
|
|
|
BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$597.04
|
|
|
Service Code
|
NDC 00093323940
|
| Hospital Charge Code |
172295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.14 |
| Max. Negotiated Rate |
$537.34 |
| Rate for Payer: Aetna Commercial |
$507.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.08
|
| Rate for Payer: Cash Price |
$477.63
|
| Rate for Payer: Cofinity Advantage |
$417.93
|
| Rate for Payer: Cofinity Commercial |
$513.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.63
|
| Rate for Payer: Healthscope Commercial |
$537.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.78
|
| Rate for Payer: PHP Commercial |
$507.48
|
| Rate for Payer: Priority Health SBD |
$376.14
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$488.28
|
|
|
Service Code
|
NDC 00904701006
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.62 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Advantage |
$341.80
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.21
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health SBD |
$307.62
|
|
