|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.04 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: BCBS Trust/PPO |
$328.75
|
| Rate for Payer: BCN Commercial |
$328.75
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.28
|
| Rate for Payer: UHC Core |
$332.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
NDC 50268013011
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: BCBS Trust/PPO |
$4.86
|
| Rate for Payer: BCN Commercial |
$4.86
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.41
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
NDC 50268013011
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna Medicare |
$1.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.84
|
| Rate for Payer: BCBS Complete |
$1.09
|
| Rate for Payer: BCBS MAPPO |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$4.83
|
| Rate for Payer: BCN Commercial |
$4.83
|
| Rate for Payer: BCN Medicare Advantage |
$1.47
|
| Rate for Payer: Cash Price |
$4.70
|
| Rate for Payer: Cofinity Commercial |
$5.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.47
|
| Rate for Payer: Healthscope Commercial |
$5.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.41
|
| Rate for Payer: Mclaren Medicaid |
$1.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.54
|
| Rate for Payer: Meridian Medicaid |
$1.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.00
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.41
|
| Rate for Payer: PACE Senior Care Partners |
$1.40
|
| Rate for Payer: PACE SWMI |
$1.47
|
| Rate for Payer: PHP Commercial |
$5.00
|
| Rate for Payer: PHP Medicare Advantage |
$1.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.12
|
| Rate for Payer: Priority Health Medicare |
$1.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$4.91
|
| Rate for Payer: UHC Exchange |
$1.47
|
| Rate for Payer: UHC Medicaid |
$1.04
|
| Rate for Payer: UHC Medicare Advantage |
$1.47
|
| Rate for Payer: UHCCP Medicaid |
$1.04
|
| Rate for Payer: VA VA |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.41
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$241.30
|
|
|
Service Code
|
NDC 69238148901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna Medicare |
$62.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.41
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS MAPPO |
$60.33
|
| Rate for Payer: BCBS Trust/PPO |
$198.37
|
| Rate for Payer: BCN Commercial |
$198.37
|
| Rate for Payer: BCN Medicare Advantage |
$60.33
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.33
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Mclaren Medicaid |
$42.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.34
|
| Rate for Payer: Meridian Medicaid |
$44.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PACE Senior Care Partners |
$57.31
|
| Rate for Payer: PACE SWMI |
$60.33
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: PHP Medicare Advantage |
$60.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Medicare |
$60.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.94
|
| Rate for Payer: Railroad Medicare Medicare |
$60.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: UHC Exchange |
$60.33
|
| Rate for Payer: UHC Medicaid |
$42.54
|
| Rate for Payer: UHC Medicare Advantage |
$60.33
|
| Rate for Payer: UHCCP Medicaid |
$42.54
|
| Rate for Payer: VA VA |
$60.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 42799011901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.93 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna Medicare |
$78.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.81
|
| Rate for Payer: BCBS Complete |
$55.57
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCBS Trust/PPO |
$246.79
|
| Rate for Payer: BCN Commercial |
$246.79
|
| Rate for Payer: BCN Medicare Advantage |
$75.05
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.05
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Mclaren Medicaid |
$52.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: Meridian Medicaid |
$55.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.15
|
| Rate for Payer: PACE Senior Care Partners |
$71.30
|
| Rate for Payer: PACE SWMI |
$75.05
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: PHP Medicare Advantage |
$75.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Medicare |
$75.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.94
|
| Rate for Payer: Railroad Medicare Medicare |
$75.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.18
|
| Rate for Payer: UHC Core |
$250.67
|
| Rate for Payer: UHC Exchange |
$75.05
|
| Rate for Payer: UHC Medicaid |
$52.93
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
| Rate for Payer: UHCCP Medicaid |
$52.93
|
| Rate for Payer: VA VA |
$75.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$441.12
|
|
|
Service Code
|
NDC 00904701661
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.77 |
| Max. Negotiated Rate |
$397.01 |
| Rate for Payer: Aetna Commercial |
$374.95
|
| Rate for Payer: Aetna Medicare |
$114.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.85
|
| Rate for Payer: BCBS Complete |
$81.65
|
| Rate for Payer: BCBS MAPPO |
$110.28
|
| Rate for Payer: BCBS Trust/PPO |
$362.64
|
| Rate for Payer: BCN Commercial |
$362.64
|
| Rate for Payer: BCN Medicare Advantage |
$110.28
|
| Rate for Payer: Cash Price |
$352.90
|
| Rate for Payer: Cofinity Commercial |
$379.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.28
|
| Rate for Payer: Healthscope Commercial |
$397.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.84
|
| Rate for Payer: Mclaren Medicaid |
$77.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.79
|
| Rate for Payer: Meridian Medicaid |
$81.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.95
|
| Rate for Payer: Nomi Health Commercial |
$361.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.84
|
| Rate for Payer: PACE Senior Care Partners |
$104.77
|
| Rate for Payer: PACE SWMI |
$110.28
|
| Rate for Payer: PHP Commercial |
$374.95
|
| Rate for Payer: PHP Medicare Advantage |
$110.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$383.77
|
| Rate for Payer: Priority Health Medicare |
$111.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.02
|
| Rate for Payer: Railroad Medicare Medicare |
$110.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.19
|
| Rate for Payer: UHC Core |
$368.34
|
| Rate for Payer: UHC Exchange |
$110.28
|
| Rate for Payer: UHC Medicaid |
$77.77
|
| Rate for Payer: UHC Medicare Advantage |
$110.28
|
| Rate for Payer: UHCCP Medicaid |
$77.77
|
| Rate for Payer: VA VA |
$110.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.84
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$441.12
|
|
|
Service Code
|
NDC 00904701661
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.02 |
| Max. Negotiated Rate |
$397.01 |
| Rate for Payer: Aetna Commercial |
$374.95
|
| Rate for Payer: BCBS Trust/PPO |
$364.32
|
| Rate for Payer: BCN Commercial |
$364.32
|
| Rate for Payer: Cash Price |
$352.90
|
| Rate for Payer: Cofinity Commercial |
$379.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.90
|
| Rate for Payer: Healthscope Commercial |
$397.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.95
|
| Rate for Payer: Nomi Health Commercial |
$361.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.84
|
| Rate for Payer: PHP Commercial |
$374.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$383.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$307.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.19
|
| Rate for Payer: UHC Core |
$368.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.84
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna Medicare |
$104.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.28
|
| Rate for Payer: BCBS Complete |
$74.21
|
| Rate for Payer: BCBS MAPPO |
$100.22
|
| Rate for Payer: BCBS Trust/PPO |
$329.58
|
| Rate for Payer: BCN Commercial |
$329.58
|
| Rate for Payer: BCN Medicare Advantage |
$100.22
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.22
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Mclaren Medicaid |
$70.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.24
|
| Rate for Payer: Meridian Medicaid |
$74.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.68
|
| Rate for Payer: PACE Senior Care Partners |
$95.21
|
| Rate for Payer: PACE SWMI |
$100.22
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: PHP Medicare Advantage |
$100.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.78
|
| Rate for Payer: Priority Health Medicare |
$101.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.03
|
| Rate for Payer: Railroad Medicare Medicare |
$100.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.79
|
| Rate for Payer: UHC Core |
$334.75
|
| Rate for Payer: UHC Exchange |
$100.22
|
| Rate for Payer: UHC Medicaid |
$70.68
|
| Rate for Payer: UHC Medicare Advantage |
$100.22
|
| Rate for Payer: UHCCP Medicaid |
$70.68
|
| Rate for Payer: VA VA |
$100.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.03 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: BCBS Trust/PPO |
$331.10
|
| Rate for Payer: BCN Commercial |
$331.10
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.68
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$348.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.79
|
| Rate for Payer: UHC Core |
$334.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 00362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.41
|
| Rate for Payer: BCN Commercial |
$13.41
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 00362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.08
|
| Rate for Payer: BCBS Complete |
$3.01
|
| Rate for Payer: BCBS MAPPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCN Commercial |
$13.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.06
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.06
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.26
|
| Rate for Payer: Meridian Medicaid |
$3.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: PACE Senior Care Partners |
$3.86
|
| Rate for Payer: PACE SWMI |
$4.06
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: UHC Exchange |
$4.06
|
| Rate for Payer: UHC Medicaid |
$2.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: UHCCP Medicaid |
$2.86
|
| Rate for Payer: VA VA |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 00362901150
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.30 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.41
|
| Rate for Payer: BCN Commercial |
$13.41
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 00362901150
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.08
|
| Rate for Payer: BCBS Complete |
$3.01
|
| Rate for Payer: BCBS MAPPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCN Commercial |
$13.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.06
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.06
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Mclaren Medicaid |
$2.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.26
|
| Rate for Payer: Meridian Medicaid |
$3.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: PACE Senior Care Partners |
$3.86
|
| Rate for Payer: PACE SWMI |
$4.06
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.30
|
| Rate for Payer: Railroad Medicare Medicare |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: UHC Exchange |
$4.06
|
| Rate for Payer: UHC Medicaid |
$2.86
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: UHCCP Medicaid |
$2.86
|
| Rate for Payer: VA VA |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$31.64
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.89
|
| Rate for Payer: BCBS Complete |
$5.86
|
| Rate for Payer: BCBS MAPPO |
$7.91
|
| Rate for Payer: BCBS Trust/PPO |
$26.01
|
| Rate for Payer: BCN Commercial |
$26.01
|
| Rate for Payer: BCN Medicare Advantage |
$7.91
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.91
|
| Rate for Payer: Healthscope Commercial |
$28.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.73
|
| Rate for Payer: Mclaren Medicaid |
$5.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.31
|
| Rate for Payer: Meridian Medicaid |
$5.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Nomi Health Commercial |
$25.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.73
|
| Rate for Payer: PACE Senior Care Partners |
$7.51
|
| Rate for Payer: PACE SWMI |
$7.91
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: PHP Medicare Advantage |
$7.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.53
|
| Rate for Payer: Priority Health Medicare |
$7.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.02
|
| Rate for Payer: Railroad Medicare Medicare |
$7.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.84
|
| Rate for Payer: UHC Core |
$26.42
|
| Rate for Payer: UHC Exchange |
$7.91
|
| Rate for Payer: UHC Medicaid |
$5.58
|
| Rate for Payer: UHC Medicare Advantage |
$7.91
|
| Rate for Payer: UHCCP Medicaid |
$5.58
|
| Rate for Payer: VA VA |
$7.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.73
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$31.64
|
|
|
Service Code
|
NDC 63323046801
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: BCBS Trust/PPO |
$26.13
|
| Rate for Payer: BCN Commercial |
$26.13
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.31
|
| Rate for Payer: Healthscope Commercial |
$28.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Nomi Health Commercial |
$25.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.73
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.84
|
| Rate for Payer: UHC Core |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.73
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
NDC 00409154101
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna Medicare |
$5.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.72
|
| Rate for Payer: BCBS Complete |
$3.98
|
| Rate for Payer: BCBS MAPPO |
$5.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.68
|
| Rate for Payer: BCN Commercial |
$17.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.38
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Mclaren Medicaid |
$3.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.64
|
| Rate for Payer: Meridian Medicaid |
$3.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PACE Senior Care Partners |
$5.11
|
| Rate for Payer: PACE SWMI |
$5.38
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.70
|
| Rate for Payer: Priority Health Medicare |
$5.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.96
|
| Rate for Payer: Railroad Medicare Medicare |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.92
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: UHC Exchange |
$5.38
|
| Rate for Payer: UHC Medicaid |
$3.79
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: VA VA |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$31.64
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: BCBS Trust/PPO |
$26.13
|
| Rate for Payer: BCN Commercial |
$26.13
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.31
|
| Rate for Payer: Healthscope Commercial |
$28.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Nomi Health Commercial |
$25.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.73
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.84
|
| Rate for Payer: UHC Core |
$26.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.73
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
NDC 00409154110
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna Medicare |
$5.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.72
|
| Rate for Payer: BCBS Complete |
$3.98
|
| Rate for Payer: BCBS MAPPO |
$5.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.68
|
| Rate for Payer: BCN Commercial |
$17.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.38
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Mclaren Medicaid |
$3.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.64
|
| Rate for Payer: Meridian Medicaid |
$3.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PACE Senior Care Partners |
$5.11
|
| Rate for Payer: PACE SWMI |
$5.38
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: PHP Medicare Advantage |
$5.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.70
|
| Rate for Payer: Priority Health Medicare |
$5.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.96
|
| Rate for Payer: Railroad Medicare Medicare |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.92
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: UHC Exchange |
$5.38
|
| Rate for Payer: UHC Medicaid |
$3.79
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$3.79
|
| Rate for Payer: VA VA |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
NDC 00409154101
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$17.76
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.92
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$50.07
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.83 |
| Max. Negotiated Rate |
$45.06 |
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna Medicare |
$13.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.65
|
| Rate for Payer: BCBS Complete |
$9.27
|
| Rate for Payer: BCBS MAPPO |
$12.52
|
| Rate for Payer: BCBS Trust/PPO |
$41.16
|
| Rate for Payer: BCN Commercial |
$41.16
|
| Rate for Payer: BCN Medicare Advantage |
$12.52
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$43.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.52
|
| Rate for Payer: Healthscope Commercial |
$45.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.55
|
| Rate for Payer: Mclaren Medicaid |
$8.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.14
|
| Rate for Payer: Meridian Medicaid |
$9.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.56
|
| Rate for Payer: Nomi Health Commercial |
$41.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.55
|
| Rate for Payer: PACE Senior Care Partners |
$11.89
|
| Rate for Payer: PACE SWMI |
$12.52
|
| Rate for Payer: PHP Commercial |
$42.56
|
| Rate for Payer: PHP Medicare Advantage |
$12.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.56
|
| Rate for Payer: Priority Health Medicare |
$12.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.85
|
| Rate for Payer: Railroad Medicare Medicare |
$12.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.06
|
| Rate for Payer: UHC Core |
$41.81
|
| Rate for Payer: UHC Exchange |
$12.52
|
| Rate for Payer: UHC Medicaid |
$8.83
|
| Rate for Payer: UHC Medicare Advantage |
$12.52
|
| Rate for Payer: UHCCP Medicaid |
$8.83
|
| Rate for Payer: VA VA |
$12.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.55
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$33.02
|
|
|
Service Code
|
NDC 00409904201
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$29.72 |
| Rate for Payer: Aetna Commercial |
$28.07
|
| Rate for Payer: BCBS Trust/PPO |
$27.27
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$28.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$29.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.07
|
| Rate for Payer: Nomi Health Commercial |
$27.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: PHP Commercial |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.06
|
| Rate for Payer: UHC Core |
$27.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$33.02
|
|
|
Service Code
|
NDC 00409904211
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$29.72 |
| Rate for Payer: Aetna Commercial |
$28.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.32
|
| Rate for Payer: BCBS Complete |
$6.11
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$27.15
|
| Rate for Payer: BCN Commercial |
$27.15
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$28.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$29.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Mclaren Medicaid |
$5.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Meridian Medicaid |
$6.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.07
|
| Rate for Payer: Nomi Health Commercial |
$27.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: PACE Senior Care Partners |
$7.84
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Commercial |
$28.07
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.73
|
| Rate for Payer: Priority Health Medicare |
$8.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.98
|
| Rate for Payer: Railroad Medicare Medicare |
$8.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.06
|
| Rate for Payer: UHC Core |
$27.57
|
| Rate for Payer: UHC Exchange |
$8.26
|
| Rate for Payer: UHC Medicaid |
$5.82
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHCCP Medicaid |
$5.82
|
| Rate for Payer: VA VA |
$8.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
NDC 00409154110
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$17.76
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Nomi Health Commercial |
$17.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.92
|
| Rate for Payer: UHC Core |
$17.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$24.57
|
|
|
Service Code
|
NDC 00409174670
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.10 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.29
|
| Rate for Payer: BCN Commercial |
$20.29
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$21.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Nomi Health Commercial |
$20.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.43
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.62
|
| Rate for Payer: UHC Core |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$33.02
|
|
|
Service Code
|
NDC 00409904211
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$29.72 |
| Rate for Payer: Aetna Commercial |
$28.07
|
| Rate for Payer: BCBS Trust/PPO |
$27.27
|
| Rate for Payer: BCN Commercial |
$27.27
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Commercial |
$28.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$29.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.07
|
| Rate for Payer: Nomi Health Commercial |
$27.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: PHP Commercial |
$28.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.06
|
| Rate for Payer: UHC Core |
$27.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
