Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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

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	$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: 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

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

Facility

$22.57

Service Code	NDC 00409174630
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$9.03
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 Commercial	$15.80
Rate for Payer: Cofinity Commercial	$19.41
Rate for Payer: Cofinity Medicare Advantage	$15.80
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: PHP Commercial	$19.18
Rate for Payer: Priority Health Cigna Priority Health	$14.67
Rate for Payer: Priority Health SBD	$14.22

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

Facility

$43.93

Service Code	NDC 63323046837
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$27.68
Max. Negotiated Rate	$39.54
Rate for Payer: Aetna Commercial	$37.34
Rate for Payer: Aetna New Business (MI Preferred)	$28.55
Rate for Payer: Cash Price	$35.14
Rate for Payer: Cofinity Commercial	$30.75
Rate for Payer: Cofinity Commercial	$37.78
Rate for Payer: Cofinity Medicare Advantage	$30.75
Rate for Payer: Encore Health Key Benefits Commercial	$35.14
Rate for Payer: Healthscope Commercial	$39.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.34
Rate for Payer: PHP Commercial	$37.34
Rate for Payer: Priority Health Cigna Priority Health	$28.55
Rate for Payer: Priority Health SBD	$27.68

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

Facility

$23.39

Service Code	NDC 00409573801
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$21.05
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare	$11.70
Rate for Payer: Aetna New Business (MI Preferred)	$15.20
Rate for Payer: BCBS Complete	$9.36
Rate for Payer: Cash Price	$18.71
Rate for Payer: Cofinity Commercial	$16.37
Rate for Payer: Cofinity Commercial	$20.12
Rate for Payer: Cofinity Medicare Advantage	$16.37
Rate for Payer: Encore Health Key Benefits Commercial	$18.71
Rate for Payer: Healthscope Commercial	$21.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.88
Rate for Payer: PHP Commercial	$19.88
Rate for Payer: Priority Health Cigna Priority Health	$15.20
Rate for Payer: Priority Health SBD	$14.74

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

Facility

$17.10

Service Code	NDC 00409904217
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: Cofinity Medicare Advantage	$11.97
Rate for Payer: Encore Health Key Benefits Commercial	$13.68
Rate for Payer: Healthscope Commercial	$15.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.54
Rate for Payer: PHP Commercial	$14.54
Rate for Payer: Priority Health Cigna Priority Health	$11.12
Rate for Payer: Priority Health SBD	$10.77

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

Facility

$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 Commercial	$15.80
Rate for Payer: Cofinity Commercial	$19.41
Rate for Payer: Cofinity Medicare Advantage	$15.80
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: PHP Commercial	$19.18
Rate for Payer: Priority Health Cigna Priority Health	$14.67
Rate for Payer: Priority Health SBD	$14.22

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

Facility

$43.93

Service Code	NDC 63323046837
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$17.57
Max. Negotiated Rate	$39.54
Rate for Payer: Aetna Commercial	$37.34
Rate for Payer: Aetna Medicare	$21.96
Rate for Payer: Aetna New Business (MI Preferred)	$28.55
Rate for Payer: BCBS Complete	$17.57
Rate for Payer: Cash Price	$35.14
Rate for Payer: Cofinity Commercial	$30.75
Rate for Payer: Cofinity Commercial	$37.78
Rate for Payer: Cofinity Medicare Advantage	$30.75
Rate for Payer: Encore Health Key Benefits Commercial	$35.14
Rate for Payer: Healthscope Commercial	$39.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.34
Rate for Payer: PHP Commercial	$37.34
Rate for Payer: Priority Health Cigna Priority Health	$28.55
Rate for Payer: Priority Health SBD	$27.68

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	$17.47
Max. Negotiated Rate	$24.96
Rate for Payer: Aetna Commercial	$23.57
Rate for Payer: Aetna New Business (MI Preferred)	$18.02
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

$23.39

Service Code	NDC 00409573810
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$21.05
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna Medicare	$11.70
Rate for Payer: Aetna New Business (MI Preferred)	$15.20
Rate for Payer: BCBS Complete	$9.36
Rate for Payer: Cash Price	$18.71
Rate for Payer: Cofinity Commercial	$16.37
Rate for Payer: Cofinity Commercial	$20.12
Rate for Payer: Cofinity Medicare Advantage	$16.37
Rate for Payer: Encore Health Key Benefits Commercial	$18.71
Rate for Payer: Healthscope Commercial	$21.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.88
Rate for Payer: PHP Commercial	$19.88
Rate for Payer: Priority Health Cigna Priority Health	$15.20
Rate for Payer: Priority Health SBD	$14.74

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

Facility

$23.39

Service Code	NDC 00409573810
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$14.74
Max. Negotiated Rate	$21.05
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna New Business (MI Preferred)	$15.20
Rate for Payer: Cash Price	$18.71
Rate for Payer: Cofinity Commercial	$16.37
Rate for Payer: Cofinity Commercial	$20.12
Rate for Payer: Cofinity Medicare Advantage	$16.37
Rate for Payer: Encore Health Key Benefits Commercial	$18.71
Rate for Payer: Healthscope Commercial	$21.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.88
Rate for Payer: PHP Commercial	$19.88
Rate for Payer: Priority Health Cigna Priority Health	$15.20
Rate for Payer: Priority Health SBD	$14.74

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

Facility

$25.76

Service Code	NDC 00409904211
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: Cofinity Medicare Advantage	$18.03
Rate for Payer: Encore Health Key Benefits Commercial	$20.61
Rate for Payer: Healthscope Commercial	$23.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.90
Rate for Payer: PHP Commercial	$21.90
Rate for Payer: Priority Health Cigna Priority Health	$16.74
Rate for Payer: Priority Health SBD	$16.23

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

$23.39

Service Code	NDC 00409573801
Hospital Charge Code	105633
Hospital Revenue Code	250
Min. Negotiated Rate	$14.74
Max. Negotiated Rate	$21.05
Rate for Payer: Aetna Commercial	$19.88
Rate for Payer: Aetna New Business (MI Preferred)	$15.20
Rate for Payer: Cash Price	$18.71
Rate for Payer: Cofinity Commercial	$16.37
Rate for Payer: Cofinity Commercial	$20.12
Rate for Payer: Cofinity Medicare Advantage	$16.37
Rate for Payer: Encore Health Key Benefits Commercial	$18.71
Rate for Payer: Healthscope Commercial	$21.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.88
Rate for Payer: PHP Commercial	$19.88
Rate for Payer: Priority Health Cigna Priority Health	$15.20
Rate for Payer: Priority Health SBD	$14.74

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

Facility

$20.03

Service Code	NDC 00409174929
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$8.01
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 Commercial	$14.02
Rate for Payer: Cofinity Commercial	$17.23
Rate for Payer: Cofinity Medicare Advantage	$14.02
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: PHP Commercial	$17.03
Rate for Payer: Priority Health Cigna Priority Health	$13.02
Rate for Payer: Priority Health SBD	$12.62

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

Facility

$47.26

Service Code	NDC 63323046237
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$18.90
Max. Negotiated Rate	$42.53
Rate for Payer: Aetna Commercial	$40.17
Rate for Payer: Aetna Medicare	$23.63
Rate for Payer: Aetna New Business (MI Preferred)	$30.72
Rate for Payer: BCBS Complete	$18.90
Rate for Payer: Cash Price	$37.81
Rate for Payer: Cofinity Commercial	$33.08
Rate for Payer: Cofinity Commercial	$40.64
Rate for Payer: Cofinity Medicare Advantage	$33.08
Rate for Payer: Encore Health Key Benefits Commercial	$37.81
Rate for Payer: Healthscope Commercial	$42.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.17
Rate for Payer: PHP Commercial	$40.17
Rate for Payer: Priority Health Cigna Priority Health	$30.72
Rate for Payer: Priority Health SBD	$29.77

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

Facility

$15.23

Service Code	NDC 09900001068
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$6.09
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 Commercial	$10.66
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Medicare Advantage	$10.66
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: PHP Commercial	$12.95
Rate for Payer: Priority Health Cigna Priority Health	$9.90
Rate for Payer: Priority Health SBD	$9.59

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

Facility

$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 Commercial	$14.02
Rate for Payer: Cofinity Commercial	$17.23
Rate for Payer: Cofinity Medicare Advantage	$14.02
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: PHP Commercial	$17.03
Rate for Payer: Priority Health Cigna Priority Health	$13.02
Rate for Payer: Priority Health SBD	$12.62

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

Facility

$47.26

Service Code	NDC 63323046237
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$29.77
Max. Negotiated Rate	$42.53
Rate for Payer: Aetna Commercial	$40.17
Rate for Payer: Aetna New Business (MI Preferred)	$30.72
Rate for Payer: Cash Price	$37.81
Rate for Payer: Cofinity Commercial	$33.08
Rate for Payer: Cofinity Commercial	$40.64
Rate for Payer: Cofinity Medicare Advantage	$33.08
Rate for Payer: Encore Health Key Benefits Commercial	$37.81
Rate for Payer: Healthscope Commercial	$42.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$40.17
Rate for Payer: PHP Commercial	$40.17
Rate for Payer: Priority Health Cigna Priority Health	$30.72
Rate for Payer: Priority Health SBD	$29.77

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

Facility

$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 Commercial	$10.66
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Medicare Advantage	$10.66
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: PHP Commercial	$12.95
Rate for Payer: Priority Health Cigna Priority Health	$9.90
Rate for Payer: Priority Health SBD	$9.59

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

Facility

$18.21

Service Code	NDC 00409904517
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$16.39
Rate for Payer: Aetna Commercial	$15.48
Rate for Payer: Aetna Medicare	$9.11
Rate for Payer: Aetna New Business (MI Preferred)	$11.84
Rate for Payer: BCBS Complete	$7.28
Rate for Payer: Cash Price	$14.57
Rate for Payer: Cofinity Commercial	$12.75
Rate for Payer: Cofinity Commercial	$15.66
Rate for Payer: Cofinity Medicare Advantage	$12.75
Rate for Payer: Encore Health Key Benefits Commercial	$14.57
Rate for Payer: Healthscope Commercial	$16.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.48
Rate for Payer: PHP Commercial	$15.48
Rate for Payer: Priority Health Cigna Priority Health	$11.84
Rate for Payer: Priority Health SBD	$11.47

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

Facility

$18.21

Service Code	NDC 00409904517
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$11.47
Max. Negotiated Rate	$16.39
Rate for Payer: Aetna Commercial	$15.48
Rate for Payer: Aetna New Business (MI Preferred)	$11.84
Rate for Payer: Cash Price	$14.57
Rate for Payer: Cofinity Commercial	$12.75
Rate for Payer: Cofinity Commercial	$15.66
Rate for Payer: Cofinity Medicare Advantage	$12.75
Rate for Payer: Encore Health Key Benefits Commercial	$14.57
Rate for Payer: Healthscope Commercial	$16.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$15.48
Rate for Payer: PHP Commercial	$15.48
Rate for Payer: Priority Health Cigna Priority Health	$11.84
Rate for Payer: Priority Health SBD	$11.47

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

Facility

$20.03

Service Code	NDC 00409174971
Hospital Charge Code	105634
Hospital Revenue Code	250
Min. Negotiated Rate	$8.01
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 Commercial	$14.02
Rate for Payer: Cofinity Commercial	$17.23
Rate for Payer: Cofinity Medicare Advantage	$14.02
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: PHP Commercial	$17.03
Rate for Payer: Priority Health Cigna Priority Health	$13.02
Rate for Payer: Priority Health SBD	$12.62

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

Facility

$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 Commercial	$14.02
Rate for Payer: Cofinity Commercial	$17.23
Rate for Payer: Cofinity Medicare Advantage	$14.02
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: PHP Commercial	$17.03
Rate for Payer: Priority Health Cigna Priority Health	$13.02
Rate for Payer: Priority Health SBD	$12.62

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	$7.55
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: Cash Price	$15.10
Rate for Payer: Cofinity Commercial	$13.21
Rate for Payer: Cofinity Commercial	$16.23
Rate for Payer: Cofinity Medicare Advantage	$13.21
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: PHP Commercial	$16.04
Rate for Payer: Priority Health Cigna Priority Health	$12.27
Rate for Payer: Priority Health SBD	$11.89

Know your out-of-pocket cost for care.

All Charges