Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BUMETANIDE 1 MG TABLET

Facility

$400.90

Service Code	NDC 00185012901
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: Cofinity Medicare Advantage	$280.63
Rate for Payer: Encore Health Key Benefits Commercial	$320.72
Rate for Payer: Healthscope Commercial	$360.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$340.76
Rate for Payer: PHP Commercial	$340.76
Rate for Payer: Priority Health Cigna Priority Health	$260.58
Rate for Payer: Priority Health SBD	$252.57

BUMETANIDE 1 MG TABLET

Facility

$258.40

Service Code	NDC 69238149001
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$103.36
Max. Negotiated Rate	$232.56
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna Medicare	$129.20
Rate for Payer: Aetna New Business (MI Preferred)	$167.96
Rate for Payer: BCBS Complete	$103.36
Rate for Payer: Cash Price	$206.72
Rate for Payer: Cofinity Commercial	$180.88
Rate for Payer: Cofinity Commercial	$222.22
Rate for Payer: Cofinity Medicare Advantage	$180.88
Rate for Payer: Encore Health Key Benefits Commercial	$206.72
Rate for Payer: Healthscope Commercial	$232.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.64
Rate for Payer: PHP Commercial	$219.64
Rate for Payer: Priority Health Cigna Priority Health	$167.96
Rate for Payer: Priority Health SBD	$162.79

BUMETANIDE 1 MG TABLET

Facility

$3.90

Service Code	NDC 50268013111
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$3.51
Rate for Payer: Aetna Commercial	$3.31
Rate for Payer: Aetna Medicare	$1.95
Rate for Payer: Aetna New Business (MI Preferred)	$2.54
Rate for Payer: BCBS Complete	$1.56
Rate for Payer: Cash Price	$3.12
Rate for Payer: Cofinity Commercial	$2.73
Rate for Payer: Cofinity Commercial	$3.35
Rate for Payer: Cofinity Medicare Advantage	$2.73
Rate for Payer: Encore Health Key Benefits Commercial	$3.12
Rate for Payer: Healthscope Commercial	$3.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.31
Rate for Payer: PHP Commercial	$3.31
Rate for Payer: Priority Health Cigna Priority Health	$2.54
Rate for Payer: Priority Health SBD	$2.46

BUMETANIDE 1 MG TABLET

Facility

$194.88

Service Code	NDC 50268013115
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$122.77
Max. Negotiated Rate	$175.39
Rate for Payer: Aetna Commercial	$165.65
Rate for Payer: Aetna New Business (MI Preferred)	$126.67
Rate for Payer: Cash Price	$155.90
Rate for Payer: Cofinity Commercial	$136.42
Rate for Payer: Cofinity Commercial	$167.60
Rate for Payer: Cofinity Medicare Advantage	$136.42
Rate for Payer: Encore Health Key Benefits Commercial	$155.90
Rate for Payer: Healthscope Commercial	$175.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.65
Rate for Payer: PHP Commercial	$165.65
Rate for Payer: Priority Health Cigna Priority Health	$126.67
Rate for Payer: Priority Health SBD	$122.77

BUMETANIDE 1 MG TABLET

Facility

$400.90

Service Code	NDC 00185012901
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$160.36
Max. Negotiated Rate	$360.81
Rate for Payer: Aetna Commercial	$340.76
Rate for Payer: Aetna Medicare	$200.45
Rate for Payer: Aetna New Business (MI Preferred)	$260.58
Rate for Payer: BCBS Complete	$160.36
Rate for Payer: Cash Price	$320.72
Rate for Payer: Cofinity Commercial	$280.63
Rate for Payer: Cofinity Commercial	$344.77
Rate for Payer: Cofinity Medicare Advantage	$280.63
Rate for Payer: Encore Health Key Benefits Commercial	$320.72
Rate for Payer: Healthscope Commercial	$360.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$340.76
Rate for Payer: PHP Commercial	$340.76
Rate for Payer: Priority Health Cigna Priority Health	$260.58
Rate for Payer: Priority Health SBD	$252.57

BUMETANIDE 1 MG TABLET

Facility

$258.40

Service Code	NDC 69238149001
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$162.79
Max. Negotiated Rate	$232.56
Rate for Payer: Aetna Commercial	$219.64
Rate for Payer: Aetna New Business (MI Preferred)	$167.96
Rate for Payer: Cash Price	$206.72
Rate for Payer: Cofinity Commercial	$180.88
Rate for Payer: Cofinity Commercial	$222.22
Rate for Payer: Cofinity Medicare Advantage	$180.88
Rate for Payer: Encore Health Key Benefits Commercial	$206.72
Rate for Payer: Healthscope Commercial	$232.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$219.64
Rate for Payer: PHP Commercial	$219.64
Rate for Payer: Priority Health Cigna Priority Health	$167.96
Rate for Payer: Priority Health SBD	$162.79

BUMETANIDE 1 MG TABLET

Facility

$2,004.50

Service Code	NDC 00185012905
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$801.80
Max. Negotiated Rate	$1,804.05
Rate for Payer: Aetna Commercial	$1,703.83
Rate for Payer: Aetna Medicare	$1,002.25
Rate for Payer: Aetna New Business (MI Preferred)	$1,302.92
Rate for Payer: BCBS Complete	$801.80
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: Cofinity Medicare Advantage	$1,403.15
Rate for Payer: Encore Health Key Benefits Commercial	$1,603.60
Rate for Payer: Healthscope Commercial	$1,804.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,703.83
Rate for Payer: PHP Commercial	$1,703.83
Rate for Payer: Priority Health Cigna Priority Health	$1,302.92
Rate for Payer: Priority Health SBD	$1,262.84

BUMETANIDE 1 MG TABLET

Facility

$178.80

Service Code	NDC 00904701606
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$112.64
Max. Negotiated Rate	$160.92
Rate for Payer: Aetna Commercial	$151.98
Rate for Payer: Aetna New Business (MI Preferred)	$116.22
Rate for Payer: Cash Price	$143.04
Rate for Payer: Cofinity Commercial	$125.16
Rate for Payer: Cofinity Commercial	$153.77
Rate for Payer: Cofinity Medicare Advantage	$125.16
Rate for Payer: Encore Health Key Benefits Commercial	$143.04
Rate for Payer: Healthscope Commercial	$160.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.98
Rate for Payer: PHP Commercial	$151.98
Rate for Payer: Priority Health Cigna Priority Health	$116.22
Rate for Payer: Priority Health SBD	$112.64

BUMETANIDE 1 MG TABLET

Facility

$194.88

Service Code	NDC 50268013115
Hospital Charge Code	9310
Hospital Revenue Code	637
Min. Negotiated Rate	$77.95
Max. Negotiated Rate	$175.39
Rate for Payer: Aetna Commercial	$165.65
Rate for Payer: Aetna Medicare	$97.44
Rate for Payer: Aetna New Business (MI Preferred)	$126.67
Rate for Payer: BCBS Complete	$77.95
Rate for Payer: Cash Price	$155.90
Rate for Payer: Cofinity Commercial	$136.42
Rate for Payer: Cofinity Commercial	$167.60
Rate for Payer: Cofinity Medicare Advantage	$136.42
Rate for Payer: Encore Health Key Benefits Commercial	$155.90
Rate for Payer: Healthscope Commercial	$175.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.65
Rate for Payer: PHP Commercial	$165.65
Rate for Payer: Priority Health Cigna Priority Health	$126.67
Rate for Payer: Priority Health SBD	$122.77

BUMETANIDE 2 MG TABLET

Facility

$421.80

Service Code	NDC 69238149101
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$265.73
Max. Negotiated Rate	$379.62
Rate for Payer: Aetna Commercial	$358.53
Rate for Payer: Aetna New Business (MI Preferred)	$274.17
Rate for Payer: Cash Price	$337.44
Rate for Payer: Cofinity Commercial	$295.26
Rate for Payer: Cofinity Commercial	$362.75
Rate for Payer: Cofinity Medicare Advantage	$295.26
Rate for Payer: Encore Health Key Benefits Commercial	$337.44
Rate for Payer: Healthscope Commercial	$379.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.53
Rate for Payer: PHP Commercial	$358.53
Rate for Payer: Priority Health Cigna Priority Health	$274.17
Rate for Payer: Priority Health SBD	$265.73

BUMETANIDE 2 MG TABLET

Facility

$299.76

Service Code	NDC 50268013215
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$188.85
Max. Negotiated Rate	$269.78
Rate for Payer: Aetna Commercial	$254.80
Rate for Payer: Aetna New Business (MI Preferred)	$194.84
Rate for Payer: Cash Price	$239.81
Rate for Payer: Cofinity Commercial	$209.83
Rate for Payer: Cofinity Commercial	$257.79
Rate for Payer: Cofinity Medicare Advantage	$209.83
Rate for Payer: Encore Health Key Benefits Commercial	$239.81
Rate for Payer: Healthscope Commercial	$269.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.80
Rate for Payer: PHP Commercial	$254.80
Rate for Payer: Priority Health Cigna Priority Health	$194.84
Rate for Payer: Priority Health SBD	$188.85

BUMETANIDE 2 MG TABLET

Facility

$375.84

Service Code	NDC 00185013001
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: Cofinity Medicare Advantage	$263.09
Rate for Payer: Encore Health Key Benefits Commercial	$300.67
Rate for Payer: Healthscope Commercial	$338.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.46
Rate for Payer: PHP Commercial	$319.46
Rate for Payer: Priority Health Cigna Priority Health	$244.30
Rate for Payer: Priority Health SBD	$236.78

BUMETANIDE 2 MG TABLET

Facility

$329.52

Service Code	NDC 60687053565
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$207.60
Max. Negotiated Rate	$296.57
Rate for Payer: Aetna Commercial	$280.09
Rate for Payer: Aetna New Business (MI Preferred)	$214.19
Rate for Payer: Cash Price	$263.62
Rate for Payer: Cofinity Commercial	$230.66
Rate for Payer: Cofinity Commercial	$283.39
Rate for Payer: Cofinity Medicare Advantage	$230.66
Rate for Payer: Encore Health Key Benefits Commercial	$263.62
Rate for Payer: Healthscope Commercial	$296.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$280.09
Rate for Payer: PHP Commercial	$280.09
Rate for Payer: Priority Health Cigna Priority Health	$214.19
Rate for Payer: Priority Health SBD	$207.60

BUMETANIDE 2 MG TABLET

Facility

$6.60

Service Code	NDC 60687053511
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$5.94
Rate for Payer: Aetna Commercial	$5.61
Rate for Payer: Aetna New Business (MI Preferred)	$4.29
Rate for Payer: Cash Price	$5.28
Rate for Payer: Cofinity Commercial	$4.62
Rate for Payer: Cofinity Commercial	$5.68
Rate for Payer: Cofinity Medicare Advantage	$4.62
Rate for Payer: Encore Health Key Benefits Commercial	$5.28
Rate for Payer: Healthscope Commercial	$5.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.61
Rate for Payer: PHP Commercial	$5.61
Rate for Payer: Priority Health Cigna Priority Health	$4.29
Rate for Payer: Priority Health SBD	$4.16

BUMETANIDE 2 MG TABLET

Facility

$421.80

Service Code	NDC 69238149101
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$379.62
Rate for Payer: Aetna Commercial	$358.53
Rate for Payer: Aetna Medicare	$210.90
Rate for Payer: Aetna New Business (MI Preferred)	$274.17
Rate for Payer: BCBS Complete	$168.72
Rate for Payer: Cash Price	$337.44
Rate for Payer: Cofinity Commercial	$295.26
Rate for Payer: Cofinity Commercial	$362.75
Rate for Payer: Cofinity Medicare Advantage	$295.26
Rate for Payer: Encore Health Key Benefits Commercial	$337.44
Rate for Payer: Healthscope Commercial	$379.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.53
Rate for Payer: PHP Commercial	$358.53
Rate for Payer: Priority Health Cigna Priority Health	$274.17
Rate for Payer: Priority Health SBD	$265.73

BUMETANIDE 2 MG TABLET

Facility

$6.00

Service Code	NDC 50268013211
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$3.78
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Aetna New Business (MI Preferred)	$3.90
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cofinity Commercial	$4.20
Rate for Payer: Cofinity Commercial	$5.16
Rate for Payer: Cofinity Medicare Advantage	$4.20
Rate for Payer: Encore Health Key Benefits Commercial	$4.80
Rate for Payer: Healthscope Commercial	$5.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.10
Rate for Payer: PHP Commercial	$5.10
Rate for Payer: Priority Health Cigna Priority Health	$3.90
Rate for Payer: Priority Health SBD	$3.78

BUMETANIDE 2 MG TABLET

Facility

$329.52

Service Code	NDC 60687053565
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$131.81
Max. Negotiated Rate	$296.57
Rate for Payer: Aetna Commercial	$280.09
Rate for Payer: Aetna Medicare	$164.76
Rate for Payer: Aetna New Business (MI Preferred)	$214.19
Rate for Payer: BCBS Complete	$131.81
Rate for Payer: Cash Price	$263.62
Rate for Payer: Cofinity Commercial	$230.66
Rate for Payer: Cofinity Commercial	$283.39
Rate for Payer: Cofinity Medicare Advantage	$230.66
Rate for Payer: Encore Health Key Benefits Commercial	$263.62
Rate for Payer: Healthscope Commercial	$296.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$280.09
Rate for Payer: PHP Commercial	$280.09
Rate for Payer: Priority Health Cigna Priority Health	$214.19
Rate for Payer: Priority Health SBD	$207.60

BUMETANIDE 2 MG TABLET

Facility

$662.40

Service Code	NDC 60687053501
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$264.96
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 Commercial	$463.68
Rate for Payer: Cofinity Commercial	$569.66
Rate for Payer: Cofinity Medicare Advantage	$463.68
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: PHP Commercial	$563.04
Rate for Payer: Priority Health Cigna Priority Health	$430.56
Rate for Payer: Priority Health SBD	$417.31

BUMETANIDE 2 MG TABLET

Facility

$375.84

Service Code	NDC 00185013001
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$150.34
Max. Negotiated Rate	$338.26
Rate for Payer: Aetna Commercial	$319.46
Rate for Payer: Aetna Medicare	$187.92
Rate for Payer: Aetna New Business (MI Preferred)	$244.30
Rate for Payer: BCBS Complete	$150.34
Rate for Payer: Cash Price	$300.67
Rate for Payer: Cofinity Commercial	$263.09
Rate for Payer: Cofinity Commercial	$323.22
Rate for Payer: Cofinity Medicare Advantage	$263.09
Rate for Payer: Encore Health Key Benefits Commercial	$300.67
Rate for Payer: Healthscope Commercial	$338.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.46
Rate for Payer: PHP Commercial	$319.46
Rate for Payer: Priority Health Cigna Priority Health	$244.30
Rate for Payer: Priority Health SBD	$236.78

BUMETANIDE 2 MG TABLET

Facility

$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 Commercial	$463.68
Rate for Payer: Cofinity Commercial	$569.66
Rate for Payer: Cofinity Medicare Advantage	$463.68
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: PHP Commercial	$563.04
Rate for Payer: Priority Health Cigna Priority Health	$430.56
Rate for Payer: Priority Health SBD	$417.31

BUMETANIDE 2 MG TABLET

Facility

$299.76

Service Code	NDC 50268013215
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$119.90
Max. Negotiated Rate	$269.78
Rate for Payer: Aetna Commercial	$254.80
Rate for Payer: Aetna Medicare	$149.88
Rate for Payer: Aetna New Business (MI Preferred)	$194.84
Rate for Payer: BCBS Complete	$119.90
Rate for Payer: Cash Price	$239.81
Rate for Payer: Cofinity Commercial	$209.83
Rate for Payer: Cofinity Commercial	$257.79
Rate for Payer: Cofinity Medicare Advantage	$209.83
Rate for Payer: Encore Health Key Benefits Commercial	$239.81
Rate for Payer: Healthscope Commercial	$269.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$254.80
Rate for Payer: PHP Commercial	$254.80
Rate for Payer: Priority Health Cigna Priority Health	$194.84
Rate for Payer: Priority Health SBD	$188.85

BUMETANIDE 2 MG TABLET

Facility

$6.00

Service Code	NDC 50268013211
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$5.40
Rate for Payer: Aetna Commercial	$5.10
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: Aetna New Business (MI Preferred)	$3.90
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cofinity Commercial	$4.20
Rate for Payer: Cofinity Commercial	$5.16
Rate for Payer: Cofinity Medicare Advantage	$4.20
Rate for Payer: Encore Health Key Benefits Commercial	$4.80
Rate for Payer: Healthscope Commercial	$5.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.10
Rate for Payer: PHP Commercial	$5.10
Rate for Payer: Priority Health Cigna Priority Health	$3.90
Rate for Payer: Priority Health SBD	$3.78

BUMETANIDE 2 MG TABLET

Facility

$6.60

Service Code	NDC 60687053511
Hospital Charge Code	9311
Hospital Revenue Code	637
Min. Negotiated Rate	$2.64
Max. Negotiated Rate	$5.94
Rate for Payer: Aetna Commercial	$5.61
Rate for Payer: Aetna Medicare	$3.30
Rate for Payer: Aetna New Business (MI Preferred)	$4.29
Rate for Payer: BCBS Complete	$2.64
Rate for Payer: Cash Price	$5.28
Rate for Payer: Cofinity Commercial	$4.62
Rate for Payer: Cofinity Commercial	$5.68
Rate for Payer: Cofinity Medicare Advantage	$4.62
Rate for Payer: Encore Health Key Benefits Commercial	$5.28
Rate for Payer: Healthscope Commercial	$5.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.61
Rate for Payer: PHP Commercial	$5.61
Rate for Payer: Priority Health Cigna Priority Health	$4.29
Rate for Payer: Priority Health SBD	$4.16

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

Facility

$27.73

Service Code	NDC 63323046817
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$24.96
Rate for Payer: Aetna Commercial	$23.57
Rate for Payer: Aetna Medicare	$13.87
Rate for Payer: Aetna New Business (MI Preferred)	$18.02
Rate for Payer: BCBS Complete	$11.09
Rate for Payer: Cash Price	$22.18
Rate for Payer: Cofinity Commercial	$19.41
Rate for Payer: Cofinity Commercial	$23.85
Rate for Payer: Cofinity Medicare Advantage	$19.41
Rate for Payer: Encore Health Key Benefits Commercial	$22.18
Rate for Payer: Healthscope Commercial	$24.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.57
Rate for Payer: PHP Commercial	$23.57
Rate for Payer: Priority Health Cigna Priority Health	$18.02
Rate for Payer: Priority Health SBD	$17.47

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

Facility

$21.94

Service Code	NDC 09900001897
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$19.75
Rate for Payer: Aetna Commercial	$18.65
Rate for Payer: Aetna Medicare	$10.97
Rate for Payer: Aetna New Business (MI Preferred)	$14.26
Rate for Payer: BCBS Complete	$8.78
Rate for Payer: Cash Price	$17.55
Rate for Payer: Cofinity Commercial	$15.36
Rate for Payer: Cofinity Commercial	$18.87
Rate for Payer: Cofinity Medicare Advantage	$15.36
Rate for Payer: Encore Health Key Benefits Commercial	$17.55
Rate for Payer: Healthscope Commercial	$19.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.65
Rate for Payer: PHP Commercial	$18.65
Rate for Payer: Priority Health Cigna Priority Health	$14.26
Rate for Payer: Priority Health SBD	$13.82

Know your out-of-pocket cost for care.

All Charges