|
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 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
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$27.41
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$24.67 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$17.27
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$27.41
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$24.67 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Aetna Medicare |
$13.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$17.27
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna Medicare |
$15.02
|
| Rate for Payer: Aetna Medicare |
$10.41
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.96
|
| Rate for Payer: BCBS Complete |
$6.22
|
| Rate for Payer: BCBS Complete |
$8.33
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Complete |
$6.13
|
| Rate for Payer: BCBS Complete |
$12.02
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$27.04
|
| Rate for Payer: Healthscope Commercial |
$18.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.53
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: Priority Health SBD |
$18.93
|
| Rate for Payer: Priority Health SBD |
$9.65
|
| Rate for Payer: Priority Health SBD |
$9.79
|
| Rate for Payer: Priority Health SBD |
$13.12
|
| Rate for Payer: Priority Health SBD |
$12.88
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$15.54
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.79 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$10.72
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.31
|
| 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 |
$12.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.03
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$27.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: Priority Health SBD |
$9.79
|
| Rate for Payer: Priority Health SBD |
$13.12
|
| Rate for Payer: Priority Health SBD |
$18.93
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$9.65
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
NDC 00409176119
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.31
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.94
|
| Rate for Payer: PHP Commercial |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: Priority Health SBD |
$17.75
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
NDC 00409176119
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: Aetna Medicare |
$14.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.31
|
| Rate for Payer: BCBS Complete |
$11.27
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.94
|
| Rate for Payer: PHP Commercial |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: Priority Health SBD |
$17.75
|
|
|
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 Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| 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: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$14.06
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
NDC 00409176102
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: Aetna Medicare |
$14.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.31
|
| Rate for Payer: BCBS Complete |
$11.27
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.94
|
| Rate for Payer: PHP Commercial |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: Priority Health SBD |
$17.75
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
NDC 00409176102
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.75 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.31
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.94
|
| Rate for Payer: PHP Commercial |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: Priority Health SBD |
$17.75
|
|
|
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 |
$8.92 |
| 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 Commercial |
$15.62
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.62
|
| 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: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health SBD |
$14.06
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$16.06
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Aetna Medicare |
$8.03
|
| Rate for Payer: Aetna Medicare |
$12.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.79
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Complete |
$10.84
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.85
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: PHP Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$23.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.79
|
| Rate for Payer: Priority Health SBD |
$17.07
|
| Rate for Payer: Priority Health SBD |
$15.31
|
| Rate for Payer: Priority Health SBD |
$10.12
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$24.30
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.31 |
| Max. Negotiated Rate |
$21.87 |
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.79
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$17.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Healthscope Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: PHP Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: PHP Commercial |
$23.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.61
|
| Rate for Payer: Priority Health SBD |
$17.07
|
| Rate for Payer: Priority Health SBD |
$10.12
|
| Rate for Payer: Priority Health SBD |
$15.31
|
|
|
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 |
$381.75 |
| 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 Commercial |
$668.07
|
| Rate for Payer: Cofinity Commercial |
$820.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$668.07
|
| 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: PHP Commercial |
$811.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.35
|
| Rate for Payer: Priority Health SBD |
$601.26
|
|
|
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 Commercial |
$668.07
|
| Rate for Payer: Cofinity Commercial |
$820.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$668.07
|
| 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: PHP Commercial |
$811.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.35
|
| Rate for Payer: Priority Health SBD |
$601.26
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.34 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: Aetna Medicare |
$320.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.55
|
| Rate for Payer: BCBS Complete |
$256.34
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$448.60
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health SBD |
$403.74
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$403.74 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.55
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$448.60
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health SBD |
$403.74
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$458.11
|
|
|
Service Code
|
NDC 00093365640
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.24 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$389.39
|
| Rate for Payer: Aetna Medicare |
$229.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.77
|
| Rate for Payer: BCBS Complete |
$183.24
|
| Rate for Payer: Cash Price |
$366.49
|
| Rate for Payer: Cofinity Commercial |
$320.68
|
| Rate for Payer: Cofinity Commercial |
$393.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.49
|
| Rate for Payer: Healthscope Commercial |
$412.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.39
|
| Rate for Payer: PHP Commercial |
$389.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.77
|
| Rate for Payer: Priority Health SBD |
$288.61
|
|
|
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 Commercial |
$395.50
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.50
|
| 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: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health SBD |
$355.95
|
|
|
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 |
$226.00 |
| 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 Commercial |
$395.50
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.50
|
| 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: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health SBD |
$355.95
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$458.11
|
|
|
Service Code
|
NDC 00093365640
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$389.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.77
|
| Rate for Payer: Cash Price |
$366.49
|
| Rate for Payer: Cofinity Commercial |
$320.68
|
| Rate for Payer: Cofinity Commercial |
$393.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.49
|
| Rate for Payer: Healthscope Commercial |
$412.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.39
|
| Rate for Payer: PHP Commercial |
$389.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.77
|
| Rate for Payer: Priority Health SBD |
$288.61
|
|
|
BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$145.71
|
|
|
Service Code
|
NDC 00093323921
|
| Hospital Charge Code |
172295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$131.14 |
| Rate for Payer: Aetna Commercial |
$123.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.71
|
| Rate for Payer: Cash Price |
$116.57
|
| Rate for Payer: Cofinity Commercial |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$125.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.57
|
| Rate for Payer: Healthscope Commercial |
$131.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.85
|
| Rate for Payer: PHP Commercial |
$123.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.71
|
| Rate for Payer: Priority Health SBD |
$91.80
|
|
|
BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$582.82
|
|
|
Service Code
|
NDC 00093323940
|
| Hospital Charge Code |
172295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.13 |
| Max. Negotiated Rate |
$524.54 |
| Rate for Payer: Aetna Commercial |
$495.40
|
| Rate for Payer: Aetna Medicare |
$291.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.83
|
| Rate for Payer: BCBS Complete |
$233.13
|
| Rate for Payer: Cash Price |
$466.26
|
| Rate for Payer: Cofinity Commercial |
$407.97
|
| Rate for Payer: Cofinity Commercial |
$501.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.26
|
| Rate for Payer: Healthscope Commercial |
$524.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.40
|
| Rate for Payer: PHP Commercial |
$495.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.83
|
| Rate for Payer: Priority Health SBD |
$367.18
|
|
|
BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$582.82
|
|
|
Service Code
|
NDC 00093323940
|
| Hospital Charge Code |
172295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$367.18 |
| Max. Negotiated Rate |
$524.54 |
| Rate for Payer: Aetna Commercial |
$495.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.83
|
| Rate for Payer: Cash Price |
$466.26
|
| Rate for Payer: Cofinity Commercial |
$407.97
|
| Rate for Payer: Cofinity Commercial |
$501.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$466.26
|
| Rate for Payer: Healthscope Commercial |
$524.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$495.40
|
| Rate for Payer: PHP Commercial |
$495.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.83
|
| Rate for Payer: Priority Health SBD |
$367.18
|
|
|
BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$145.71
|
|
|
Service Code
|
NDC 00093323921
|
| Hospital Charge Code |
172295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$131.14 |
| Rate for Payer: Aetna Commercial |
$123.85
|
| Rate for Payer: Aetna Medicare |
$72.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.71
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: Cash Price |
$116.57
|
| Rate for Payer: Cofinity Commercial |
$102.00
|
| Rate for Payer: Cofinity Commercial |
$125.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.57
|
| Rate for Payer: Healthscope Commercial |
$131.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.85
|
| Rate for Payer: PHP Commercial |
$123.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.71
|
| Rate for Payer: Priority Health SBD |
$91.80
|
|
