|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$24.57
|
|
|
Service Code
|
NDC 00409174610
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$6.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.68
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS MAPPO |
$6.14
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: BCN Commercial |
$20.20
|
| Rate for Payer: BCN Medicare Advantage |
$6.14
|
| 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: Health Alliance Plan Medicare Advantage |
$6.14
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: Mclaren Medicaid |
$4.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.45
|
| Rate for Payer: Meridian Medicaid |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.76
|
| 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: PACE Senior Care Partners |
$5.84
|
| Rate for Payer: PACE SWMI |
$6.14
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: PHP Medicare Advantage |
$6.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.38
|
| Rate for Payer: Priority Health Medicare |
$6.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.10
|
| Rate for Payer: Railroad Medicare Medicare |
$6.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.62
|
| Rate for Payer: UHC Core |
$20.52
|
| Rate for Payer: UHC Exchange |
$6.14
|
| Rate for Payer: UHC Medicaid |
$4.33
|
| Rate for Payer: UHC Medicare Advantage |
$6.14
|
| Rate for Payer: UHCCP Medicaid |
$4.33
|
| Rate for Payer: VA VA |
$6.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$24.57
|
|
|
Service Code
|
NDC 00409174610
|
| 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
|
$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
|
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
|
$24.57
|
|
|
Service Code
|
NDC 00409174670
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$6.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.68
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS MAPPO |
$6.14
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: BCN Commercial |
$20.20
|
| Rate for Payer: BCN Medicare Advantage |
$6.14
|
| 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: Health Alliance Plan Medicare Advantage |
$6.14
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: Mclaren Medicaid |
$4.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.45
|
| Rate for Payer: Meridian Medicaid |
$4.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.76
|
| 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: PACE Senior Care Partners |
$5.84
|
| Rate for Payer: PACE SWMI |
$6.14
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: PHP Medicare Advantage |
$6.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$21.38
|
| Rate for Payer: Priority Health Medicare |
$6.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.10
|
| Rate for Payer: Railroad Medicare Medicare |
$6.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.62
|
| Rate for Payer: UHC Core |
$20.52
|
| Rate for Payer: UHC Exchange |
$6.14
|
| Rate for Payer: UHC Medicaid |
$4.33
|
| Rate for Payer: UHC Medicare Advantage |
$6.14
|
| Rate for Payer: UHCCP Medicaid |
$4.33
|
| Rate for Payer: VA VA |
$6.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
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
|
OP
|
$50.07
|
|
|
Service Code
|
NDC 63323046802
|
| 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
|
OP
|
$31.64
|
|
|
Service Code
|
NDC 63323046801
|
| 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) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$56.61
|
|
|
Service Code
|
NDC 00409904516
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Aetna Commercial |
$48.12
|
| Rate for Payer: Aetna Medicare |
$14.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.69
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: BCBS MAPPO |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$46.54
|
| Rate for Payer: BCN Commercial |
$46.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.15
|
| Rate for Payer: Cash Price |
$45.29
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.15
|
| Rate for Payer: Healthscope Commercial |
$50.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.46
|
| Rate for Payer: Mclaren Medicaid |
$9.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.86
|
| Rate for Payer: Meridian Medicaid |
$10.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.12
|
| Rate for Payer: Nomi Health Commercial |
$46.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.46
|
| Rate for Payer: PACE Senior Care Partners |
$13.44
|
| Rate for Payer: PACE SWMI |
$14.15
|
| Rate for Payer: PHP Commercial |
$48.12
|
| Rate for Payer: PHP Medicare Advantage |
$14.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$14.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.82
|
| Rate for Payer: UHC Core |
$47.27
|
| Rate for Payer: UHC Exchange |
$14.15
|
| Rate for Payer: UHC Medicaid |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$14.15
|
| Rate for Payer: UHCCP Medicaid |
$9.98
|
| Rate for Payer: VA VA |
$14.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.46
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$32.40
|
|
|
Service Code
|
NDC 63323046204
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.55 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: BCBS Trust/PPO |
$26.76
|
| Rate for Payer: BCN Commercial |
$26.76
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.92
|
| Rate for Payer: Healthscope Commercial |
$29.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.54
|
| Rate for Payer: Nomi Health Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.30
|
| Rate for Payer: PHP Commercial |
$27.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.51
|
| Rate for Payer: UHC Core |
$27.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.30
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$16.54
|
| Rate for Payer: BCN Commercial |
$16.54
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Nomi Health Commercial |
$16.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.63
|
| Rate for Payer: UHC Core |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$32.40
|
|
|
Service Code
|
NDC 63323046204
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.12
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$8.10
|
| Rate for Payer: BCBS Trust/PPO |
$26.64
|
| Rate for Payer: BCN Commercial |
$26.64
|
| Rate for Payer: BCN Medicare Advantage |
$8.10
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$29.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.30
|
| Rate for Payer: Mclaren Medicaid |
$5.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.51
|
| Rate for Payer: Meridian Medicaid |
$6.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.54
|
| Rate for Payer: Nomi Health Commercial |
$26.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.30
|
| Rate for Payer: PACE Senior Care Partners |
$7.70
|
| Rate for Payer: PACE SWMI |
$8.10
|
| Rate for Payer: PHP Commercial |
$27.54
|
| Rate for Payer: PHP Medicare Advantage |
$8.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.19
|
| Rate for Payer: Priority Health Medicare |
$8.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.55
|
| Rate for Payer: Railroad Medicare Medicare |
$8.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.51
|
| Rate for Payer: UHC Core |
$27.05
|
| Rate for Payer: UHC Exchange |
$8.10
|
| Rate for Payer: UHC Medicaid |
$5.71
|
| Rate for Payer: UHC Medicare Advantage |
$8.10
|
| Rate for Payer: UHCCP Medicaid |
$5.71
|
| Rate for Payer: VA VA |
$8.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.30
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$21.17
|
|
|
Service Code
|
NDC 00409812610
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.62
|
| Rate for Payer: BCBS Complete |
$3.92
|
| Rate for Payer: BCBS MAPPO |
$5.29
|
| Rate for Payer: BCBS Trust/PPO |
$17.40
|
| Rate for Payer: BCN Commercial |
$17.40
|
| Rate for Payer: BCN Medicare Advantage |
$5.29
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.29
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Mclaren Medicaid |
$3.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.56
|
| Rate for Payer: Meridian Medicaid |
$3.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Nomi Health Commercial |
$17.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.88
|
| Rate for Payer: PACE Senior Care Partners |
$5.03
|
| Rate for Payer: PACE SWMI |
$5.29
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: PHP Medicare Advantage |
$5.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.42
|
| Rate for Payer: Priority Health Medicare |
$5.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.73
|
| Rate for Payer: Railroad Medicare Medicare |
$5.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.63
|
| Rate for Payer: UHC Core |
$17.68
|
| Rate for Payer: UHC Exchange |
$5.29
|
| Rate for Payer: UHC Medicaid |
$3.73
|
| Rate for Payer: UHC Medicare Advantage |
$5.29
|
| Rate for Payer: UHCCP Medicaid |
$3.73
|
| Rate for Payer: VA VA |
$5.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$56.61
|
|
|
Service Code
|
NDC 00409904516
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Aetna Commercial |
$48.12
|
| Rate for Payer: BCBS Trust/PPO |
$46.75
|
| Rate for Payer: BCN Commercial |
$46.75
|
| Rate for Payer: Cash Price |
$45.29
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.29
|
| Rate for Payer: Healthscope Commercial |
$50.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.12
|
| Rate for Payer: Nomi Health Commercial |
$46.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.46
|
| Rate for Payer: PHP Commercial |
$48.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.82
|
| Rate for Payer: UHC Core |
$47.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.46
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$53.94
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$48.55 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.86
|
| Rate for Payer: BCBS Complete |
$9.98
|
| Rate for Payer: BCBS MAPPO |
$13.48
|
| Rate for Payer: BCBS Trust/PPO |
$44.34
|
| Rate for Payer: BCN Commercial |
$44.34
|
| Rate for Payer: BCN Medicare Advantage |
$13.48
|
| Rate for Payer: Cash Price |
$43.15
|
| Rate for Payer: Cofinity Commercial |
$46.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.45
|
| Rate for Payer: Mclaren Medicaid |
$9.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.16
|
| Rate for Payer: Meridian Medicaid |
$9.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.85
|
| Rate for Payer: Nomi Health Commercial |
$44.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.45
|
| Rate for Payer: PACE Senior Care Partners |
$12.81
|
| Rate for Payer: PACE SWMI |
$13.48
|
| Rate for Payer: PHP Commercial |
$45.85
|
| Rate for Payer: PHP Medicare Advantage |
$13.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.93
|
| Rate for Payer: Priority Health Medicare |
$13.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.54
|
| Rate for Payer: Railroad Medicare Medicare |
$13.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.47
|
| Rate for Payer: UHC Core |
$45.04
|
| Rate for Payer: UHC Exchange |
$13.48
|
| Rate for Payer: UHC Medicaid |
$9.51
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: UHCCP Medicaid |
$9.51
|
| Rate for Payer: VA VA |
$13.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.45
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$56.61
|
|
|
Service Code
|
NDC 00409904517
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Aetna Commercial |
$48.12
|
| Rate for Payer: Aetna Medicare |
$14.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.69
|
| Rate for Payer: BCBS Complete |
$10.48
|
| Rate for Payer: BCBS MAPPO |
$14.15
|
| Rate for Payer: BCBS Trust/PPO |
$46.54
|
| Rate for Payer: BCN Commercial |
$46.54
|
| Rate for Payer: BCN Medicare Advantage |
$14.15
|
| Rate for Payer: Cash Price |
$45.29
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.15
|
| Rate for Payer: Healthscope Commercial |
$50.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.46
|
| Rate for Payer: Mclaren Medicaid |
$9.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.86
|
| Rate for Payer: Meridian Medicaid |
$10.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.12
|
| Rate for Payer: Nomi Health Commercial |
$46.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.46
|
| Rate for Payer: PACE Senior Care Partners |
$13.44
|
| Rate for Payer: PACE SWMI |
$14.15
|
| Rate for Payer: PHP Commercial |
$48.12
|
| Rate for Payer: PHP Medicare Advantage |
$14.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.25
|
| Rate for Payer: Priority Health Medicare |
$14.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.40
|
| Rate for Payer: Railroad Medicare Medicare |
$14.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.82
|
| Rate for Payer: UHC Core |
$47.27
|
| Rate for Payer: UHC Exchange |
$14.15
|
| Rate for Payer: UHC Medicaid |
$9.98
|
| Rate for Payer: UHC Medicare Advantage |
$14.15
|
| Rate for Payer: UHCCP Medicaid |
$9.98
|
| Rate for Payer: VA VA |
$14.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.46
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 00409812601
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: BCBS Trust/PPO |
$17.48
|
| Rate for Payer: BCN Commercial |
$17.48
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Nomi Health Commercial |
$17.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.88
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.63
|
| Rate for Payer: UHC Core |
$17.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$53.94
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.54 |
| Max. Negotiated Rate |
$48.55 |
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: BCBS Trust/PPO |
$44.55
|
| Rate for Payer: BCN Commercial |
$44.55
|
| Rate for Payer: Cash Price |
$43.15
|
| Rate for Payer: Cofinity Commercial |
$46.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.15
|
| Rate for Payer: Healthscope Commercial |
$48.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.85
|
| Rate for Payer: Nomi Health Commercial |
$44.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.45
|
| Rate for Payer: PHP Commercial |
$45.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.47
|
| Rate for Payer: UHC Core |
$45.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.45
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 00409174910
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.32
|
| Rate for Payer: BCN Commercial |
$18.32
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Mclaren Medicaid |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: Meridian Medicaid |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: Nomi Health Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.71
|
| Rate for Payer: PACE Senior Care Partners |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.38
|
| Rate for Payer: Priority Health Medicare |
$5.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.51
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$18.60
|
| Rate for Payer: UHC Exchange |
$5.57
|
| Rate for Payer: UHC Medicaid |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: UHCCP Medicaid |
$3.93
|
| Rate for Payer: VA VA |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
NDC 00409420801
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$16.54
|
| Rate for Payer: BCN Commercial |
$16.54
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Nomi Health Commercial |
$16.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.63
|
| Rate for Payer: UHC Core |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 00409174970
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: Nomi Health Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.71
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$18.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 00409174910
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.51 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: Nomi Health Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.71
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$18.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.03
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$5.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.26
|
| Rate for Payer: BCBS Complete |
$3.71
|
| Rate for Payer: BCBS MAPPO |
$5.01
|
| Rate for Payer: BCBS Trust/PPO |
$16.47
|
| Rate for Payer: BCN Commercial |
$16.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.01
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.01
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Mclaren Medicaid |
$3.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.26
|
| Rate for Payer: Meridian Medicaid |
$3.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Nomi Health Commercial |
$16.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PACE Senior Care Partners |
$4.76
|
| Rate for Payer: PACE SWMI |
$5.01
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: PHP Medicare Advantage |
$5.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.43
|
| Rate for Payer: Priority Health Medicare |
$5.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.63
|
| Rate for Payer: UHC Core |
$16.73
|
| Rate for Payer: UHC Exchange |
$5.01
|
| Rate for Payer: UHC Medicaid |
$3.53
|
| Rate for Payer: UHC Medicare Advantage |
$5.01
|
| Rate for Payer: UHCCP Medicaid |
$3.53
|
| Rate for Payer: VA VA |
$5.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$56.61
|
|
|
Service Code
|
NDC 00409904517
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$50.95 |
| Rate for Payer: Aetna Commercial |
$48.12
|
| Rate for Payer: BCBS Trust/PPO |
$46.75
|
| Rate for Payer: BCN Commercial |
$46.75
|
| Rate for Payer: Cash Price |
$45.29
|
| Rate for Payer: Cofinity Commercial |
$48.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.29
|
| Rate for Payer: Healthscope Commercial |
$50.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.12
|
| Rate for Payer: Nomi Health Commercial |
$46.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.46
|
| Rate for Payer: PHP Commercial |
$48.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.82
|
| Rate for Payer: UHC Core |
$47.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.46
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
NDC 00409420810
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$16.54
|
| Rate for Payer: BCN Commercial |
$16.54
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Nomi Health Commercial |
$16.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.63
|
| Rate for Payer: UHC Core |
$16.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
