|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$32.40
|
|
|
Service Code
|
NDC 63323046217
|
| 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
|
$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
|
$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
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 00409812610
|
| 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
|
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
|
$20.03
|
|
|
Service Code
|
NDC 00409174971
|
| 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
|
$20.03
|
|
|
Service Code
|
NDC 00409420801
|
| 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
|
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
|
$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 LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION
|
Facility
|
IP
|
$1,148.23
|
|
|
Service Code
|
HCPCS J0666
|
| Hospital Charge Code |
155788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$799.17 |
| Max. Negotiated Rate |
$1,033.41 |
| Rate for Payer: Aetna Commercial |
$976.00
|
| Rate for Payer: BCBS Trust/PPO |
$948.32
|
| Rate for Payer: BCN Commercial |
$948.32
|
| Rate for Payer: Cash Price |
$918.58
|
| Rate for Payer: Cofinity Commercial |
$987.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.58
|
| Rate for Payer: Healthscope Commercial |
$1,033.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$861.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$976.00
|
| Rate for Payer: Nomi Health Commercial |
$941.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$861.17
|
| Rate for Payer: PHP Commercial |
$976.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$998.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$799.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,010.44
|
| Rate for Payer: UHC Core |
$958.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$861.17
|
|
|
BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION
|
Facility
|
OP
|
$1,148.23
|
|
|
Service Code
|
HCPCS J0666
|
| Hospital Charge Code |
155788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$202.43 |
| Max. Negotiated Rate |
$1,033.41 |
| Rate for Payer: Aetna Commercial |
$976.00
|
| Rate for Payer: Aetna Medicare |
$298.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$358.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$358.82
|
| Rate for Payer: BCBS Complete |
$212.54
|
| Rate for Payer: BCBS MAPPO |
$287.06
|
| Rate for Payer: BCBS Trust/PPO |
$943.96
|
| Rate for Payer: BCN Commercial |
$943.96
|
| Rate for Payer: BCN Medicare Advantage |
$287.06
|
| Rate for Payer: Cash Price |
$918.58
|
| Rate for Payer: Cofinity Commercial |
$987.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$918.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.06
|
| Rate for Payer: Healthscope Commercial |
$1,033.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$861.17
|
| Rate for Payer: Mclaren Medicaid |
$202.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.41
|
| Rate for Payer: Meridian Medicaid |
$212.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$330.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$315.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$976.00
|
| Rate for Payer: Nomi Health Commercial |
$941.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$861.17
|
| Rate for Payer: PACE Senior Care Partners |
$272.70
|
| Rate for Payer: PACE SWMI |
$287.06
|
| Rate for Payer: PHP Commercial |
$976.00
|
| Rate for Payer: PHP Medicare Advantage |
$287.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$998.96
|
| Rate for Payer: Priority Health Medicare |
$289.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$799.17
|
| Rate for Payer: Railroad Medicare Medicare |
$287.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,010.44
|
| Rate for Payer: UHC Core |
$958.77
|
| Rate for Payer: UHC Exchange |
$287.06
|
| Rate for Payer: UHC Medicaid |
$202.43
|
| Rate for Payer: UHC Medicare Advantage |
$287.06
|
| Rate for Payer: UHCCP Medicaid |
$202.43
|
| Rate for Payer: VA VA |
$287.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$861.17
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$33.91
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$30.52 |
| Rate for Payer: Aetna Commercial |
$28.82
|
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: BCBS Trust/PPO |
$28.01
|
| Rate for Payer: BCBS Trust/PPO |
$22.99
|
| Rate for Payer: BCBS Trust/PPO |
$23.12
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCBS Trust/PPO |
$15.45
|
| Rate for Payer: BCBS Trust/PPO |
$19.40
|
| Rate for Payer: BCN Commercial |
$23.12
|
| Rate for Payer: BCN Commercial |
$22.99
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: BCN Commercial |
$19.40
|
| Rate for Payer: BCN Commercial |
$28.01
|
| Rate for Payer: BCN Commercial |
$17.96
|
| Rate for Payer: Cash Price |
$27.13
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$29.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.13
|
| Rate for Payer: Healthscope Commercial |
$16.84
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Healthscope Commercial |
$30.52
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Nomi Health Commercial |
$22.95
|
| Rate for Payer: Nomi Health Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$17.84
|
| Rate for Payer: Nomi Health Commercial |
$22.83
|
| Rate for Payer: Nomi Health Commercial |
$19.26
|
| Rate for Payer: Nomi Health Commercial |
$27.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.88
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: PHP Commercial |
$28.82
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: PHP Commercial |
$18.49
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.84
|
| Rate for Payer: UHC Core |
$28.31
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Core |
$23.37
|
| Rate for Payer: UHC Core |
$23.25
|
| Rate for Payer: UHC Core |
$15.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$33.91
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$30.52 |
| Rate for Payer: Aetna Commercial |
$28.82
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Medicare |
$7.24
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Aetna Medicare |
$4.86
|
| Rate for Payer: Aetna Medicare |
$8.82
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.70
|
| Rate for Payer: BCBS Complete |
$4.35
|
| Rate for Payer: BCBS Complete |
$5.18
|
| Rate for Payer: BCBS Complete |
$4.03
|
| Rate for Payer: BCBS Complete |
$3.46
|
| Rate for Payer: BCBS Complete |
$6.28
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: BCBS MAPPO |
$6.96
|
| Rate for Payer: BCBS MAPPO |
$8.48
|
| Rate for Payer: BCBS MAPPO |
$7.00
|
| Rate for Payer: BCBS MAPPO |
$5.44
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS MAPPO |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$15.38
|
| Rate for Payer: BCBS Trust/PPO |
$23.01
|
| Rate for Payer: BCBS Trust/PPO |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.31
|
| Rate for Payer: BCBS Trust/PPO |
$22.89
|
| Rate for Payer: BCBS Trust/PPO |
$27.88
|
| Rate for Payer: BCN Commercial |
$19.31
|
| Rate for Payer: BCN Commercial |
$22.89
|
| Rate for Payer: BCN Commercial |
$15.38
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: BCN Commercial |
$23.01
|
| Rate for Payer: BCN Commercial |
$27.88
|
| Rate for Payer: BCN Medicare Advantage |
$7.00
|
| Rate for Payer: BCN Medicare Advantage |
$8.48
|
| Rate for Payer: BCN Medicare Advantage |
$5.87
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: BCN Medicare Advantage |
$6.96
|
| Rate for Payer: BCN Medicare Advantage |
$5.44
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$27.13
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$29.16
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.44
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$30.52
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Healthscope Commercial |
$16.84
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Mclaren Medicaid |
$3.83
|
| Rate for Payer: Mclaren Medicaid |
$3.30
|
| Rate for Payer: Mclaren Medicaid |
$4.14
|
| Rate for Payer: Mclaren Medicaid |
$4.91
|
| Rate for Payer: Mclaren Medicaid |
$4.93
|
| Rate for Payer: Mclaren Medicaid |
$5.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: Meridian Medicaid |
$5.18
|
| Rate for Payer: Meridian Medicaid |
$6.28
|
| Rate for Payer: Meridian Medicaid |
$4.03
|
| Rate for Payer: Meridian Medicaid |
$3.46
|
| Rate for Payer: Meridian Medicaid |
$4.35
|
| Rate for Payer: Meridian Medicaid |
$5.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.82
|
| Rate for Payer: Nomi Health Commercial |
$19.26
|
| Rate for Payer: Nomi Health Commercial |
$22.83
|
| Rate for Payer: Nomi Health Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$22.95
|
| Rate for Payer: Nomi Health Commercial |
$27.81
|
| Rate for Payer: Nomi Health Commercial |
$17.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.31
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE Senior Care Partners |
$5.17
|
| Rate for Payer: PACE Senior Care Partners |
$6.61
|
| Rate for Payer: PACE Senior Care Partners |
$6.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.44
|
| Rate for Payer: PACE Senior Care Partners |
$8.05
|
| Rate for Payer: PACE SWMI |
$5.44
|
| Rate for Payer: PACE SWMI |
$6.96
|
| Rate for Payer: PACE SWMI |
$8.48
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PACE SWMI |
$7.00
|
| Rate for Payer: PACE SWMI |
$5.87
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$18.49
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: PHP Commercial |
$28.82
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: PHP Medicare Advantage |
$8.48
|
| Rate for Payer: PHP Medicare Advantage |
$5.44
|
| Rate for Payer: PHP Medicare Advantage |
$7.00
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.96
|
| Rate for Payer: PHP Medicare Advantage |
$5.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$29.50
|
| Rate for Payer: Priority Health Medicare |
$4.72
|
| Rate for Payer: Priority Health Medicare |
$8.56
|
| Rate for Payer: Priority Health Medicare |
$5.49
|
| Rate for Payer: Priority Health Medicare |
$7.03
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Medicare |
$7.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.38
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: Railroad Medicare Medicare |
$7.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6.96
|
| Rate for Payer: Railroad Medicare Medicare |
$5.44
|
| Rate for Payer: Railroad Medicare Medicare |
$5.87
|
| Rate for Payer: Railroad Medicare Medicare |
$8.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Core |
$23.37
|
| Rate for Payer: UHC Core |
$23.25
|
| Rate for Payer: UHC Core |
$28.31
|
| Rate for Payer: UHC Core |
$15.62
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Exchange |
$5.44
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Exchange |
$6.96
|
| Rate for Payer: UHC Exchange |
$5.87
|
| Rate for Payer: UHC Exchange |
$7.00
|
| Rate for Payer: UHC Exchange |
$8.48
|
| Rate for Payer: UHC Medicaid |
$4.93
|
| Rate for Payer: UHC Medicaid |
$4.91
|
| Rate for Payer: UHC Medicaid |
$3.83
|
| Rate for Payer: UHC Medicaid |
$4.14
|
| Rate for Payer: UHC Medicaid |
$3.30
|
| Rate for Payer: UHC Medicaid |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.44
|
| Rate for Payer: UHC Medicare Advantage |
$7.00
|
| Rate for Payer: UHC Medicare Advantage |
$6.96
|
| Rate for Payer: UHC Medicare Advantage |
$5.87
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$8.48
|
| Rate for Payer: UHCCP Medicaid |
$4.93
|
| Rate for Payer: UHCCP Medicaid |
$4.91
|
| Rate for Payer: UHCCP Medicaid |
$4.14
|
| Rate for Payer: UHCCP Medicaid |
$3.83
|
| Rate for Payer: UHCCP Medicaid |
$3.30
|
| Rate for Payer: UHCCP Medicaid |
$5.98
|
| Rate for Payer: VA VA |
$5.87
|
| Rate for Payer: VA VA |
$5.44
|
| Rate for Payer: VA VA |
$7.00
|
| Rate for Payer: VA VA |
$6.96
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: VA VA |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$15.32
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Medicare |
$4.31
|
| Rate for Payer: Aetna Medicare |
$4.97
|
| Rate for Payer: Aetna Medicare |
$4.10
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: Aetna Medicare |
$5.42
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.51
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: BCBS Complete |
$3.86
|
| Rate for Payer: BCBS Complete |
$2.88
|
| Rate for Payer: BCBS Complete |
$3.07
|
| Rate for Payer: BCBS Complete |
$2.92
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS Complete |
$3.79
|
| Rate for Payer: BCBS Complete |
$2.84
|
| Rate for Payer: BCBS Complete |
$3.62
|
| Rate for Payer: BCBS MAPPO |
$4.14
|
| Rate for Payer: BCBS MAPPO |
$4.57
|
| Rate for Payer: BCBS MAPPO |
$3.94
|
| Rate for Payer: BCBS MAPPO |
$4.89
|
| Rate for Payer: BCBS MAPPO |
$3.88
|
| Rate for Payer: BCBS MAPPO |
$4.78
|
| Rate for Payer: BCBS MAPPO |
$3.83
|
| Rate for Payer: BCBS MAPPO |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$5.21
|
| Rate for Payer: BCBS Trust/PPO |
$12.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$15.70
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCBS Trust/PPO |
$12.96
|
| Rate for Payer: BCBS Trust/PPO |
$15.02
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCBS Trust/PPO |
$16.81
|
| Rate for Payer: BCN Commercial |
$16.81
|
| Rate for Payer: BCN Commercial |
$12.78
|
| Rate for Payer: BCN Commercial |
$12.59
|
| Rate for Payer: BCN Commercial |
$15.02
|
| Rate for Payer: BCN Commercial |
$15.70
|
| Rate for Payer: BCN Commercial |
$17.12
|
| Rate for Payer: BCN Commercial |
$13.63
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Medicare Advantage |
$3.88
|
| Rate for Payer: BCN Medicare Advantage |
$4.78
|
| Rate for Payer: BCN Medicare Advantage |
$4.57
|
| Rate for Payer: BCN Medicare Advantage |
$5.21
|
| Rate for Payer: BCN Medicare Advantage |
$4.14
|
| Rate for Payer: BCN Medicare Advantage |
$5.11
|
| Rate for Payer: BCN Medicare Advantage |
$4.89
|
| Rate for Payer: BCN Medicare Advantage |
$3.94
|
| Rate for Payer: BCN Medicare Advantage |
$3.83
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| 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 |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.14
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$14.92
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.44
|
| Rate for Payer: Mclaren Medicaid |
$2.78
|
| Rate for Payer: Mclaren Medicaid |
$3.61
|
| Rate for Payer: Mclaren Medicaid |
$2.92
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Mclaren Medicaid |
$3.37
|
| Rate for Payer: Mclaren Medicaid |
$2.70
|
| Rate for Payer: Mclaren Medicaid |
$2.74
|
| Rate for Payer: Mclaren Medicaid |
$3.22
|
| Rate for Payer: Mclaren Medicaid |
$3.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.14
|
| Rate for Payer: Meridian Medicaid |
$3.86
|
| Rate for Payer: Meridian Medicaid |
$3.54
|
| Rate for Payer: Meridian Medicaid |
$3.38
|
| Rate for Payer: Meridian Medicaid |
$2.88
|
| Rate for Payer: Meridian Medicaid |
$2.84
|
| Rate for Payer: Meridian Medicaid |
$3.62
|
| Rate for Payer: Meridian Medicaid |
$3.79
|
| Rate for Payer: Meridian Medicaid |
$2.92
|
| Rate for Payer: Meridian Medicaid |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Nomi Health Commercial |
$14.98
|
| Rate for Payer: Nomi Health Commercial |
$17.08
|
| Rate for Payer: Nomi Health Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$12.56
|
| Rate for Payer: Nomi Health Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$16.77
|
| Rate for Payer: Nomi Health Commercial |
$13.60
|
| Rate for Payer: Nomi Health Commercial |
$15.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: PACE Senior Care Partners |
$4.65
|
| Rate for Payer: PACE Senior Care Partners |
$4.95
|
| Rate for Payer: PACE Senior Care Partners |
$4.34
|
| Rate for Payer: PACE Senior Care Partners |
$4.54
|
| Rate for Payer: PACE Senior Care Partners |
$3.69
|
| Rate for Payer: PACE Senior Care Partners |
$3.64
|
| Rate for Payer: PACE Senior Care Partners |
$3.94
|
| Rate for Payer: PACE Senior Care Partners |
$4.86
|
| Rate for Payer: PACE Senior Care Partners |
$3.75
|
| Rate for Payer: PACE SWMI |
$4.14
|
| Rate for Payer: PACE SWMI |
$4.89
|
| Rate for Payer: PACE SWMI |
$5.21
|
| Rate for Payer: PACE SWMI |
$4.57
|
| Rate for Payer: PACE SWMI |
$3.94
|
| Rate for Payer: PACE SWMI |
$5.11
|
| Rate for Payer: PACE SWMI |
$3.83
|
| Rate for Payer: PACE SWMI |
$3.88
|
| Rate for Payer: PACE SWMI |
$4.78
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$14.09
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Medicare Advantage |
$4.78
|
| Rate for Payer: PHP Medicare Advantage |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$3.88
|
| Rate for Payer: PHP Medicare Advantage |
$4.14
|
| Rate for Payer: PHP Medicare Advantage |
$5.21
|
| Rate for Payer: PHP Medicare Advantage |
$3.83
|
| Rate for Payer: PHP Medicare Advantage |
$3.94
|
| Rate for Payer: PHP Medicare Advantage |
$5.11
|
| Rate for Payer: PHP Medicare Advantage |
$4.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.33
|
| Rate for Payer: Priority Health Medicare |
$3.98
|
| Rate for Payer: Priority Health Medicare |
$4.19
|
| Rate for Payer: Priority Health Medicare |
$4.82
|
| Rate for Payer: Priority Health Medicare |
$4.61
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Medicare |
$3.92
|
| Rate for Payer: Priority Health Medicare |
$5.16
|
| Rate for Payer: Priority Health Medicare |
$3.87
|
| Rate for Payer: Priority Health Medicare |
$5.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4.57
|
| Rate for Payer: Railroad Medicare Medicare |
$4.14
|
| Rate for Payer: Railroad Medicare Medicare |
$4.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4.89
|
| Rate for Payer: Railroad Medicare Medicare |
$5.11
|
| Rate for Payer: Railroad Medicare Medicare |
$3.83
|
| Rate for Payer: Railroad Medicare Medicare |
$5.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.08
|
| Rate for Payer: UHC Core |
$13.17
|
| Rate for Payer: UHC Core |
$12.79
|
| Rate for Payer: UHC Core |
$17.39
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Core |
$15.26
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: UHC Core |
$15.95
|
| Rate for Payer: UHC Core |
$17.08
|
| Rate for Payer: UHC Exchange |
$4.89
|
| Rate for Payer: UHC Exchange |
$4.78
|
| Rate for Payer: UHC Exchange |
$5.11
|
| Rate for Payer: UHC Exchange |
$3.88
|
| Rate for Payer: UHC Exchange |
$5.21
|
| Rate for Payer: UHC Exchange |
$3.94
|
| Rate for Payer: UHC Exchange |
$3.83
|
| Rate for Payer: UHC Exchange |
$4.14
|
| Rate for Payer: UHC Exchange |
$4.57
|
| Rate for Payer: UHC Medicaid |
$3.67
|
| Rate for Payer: UHC Medicaid |
$3.45
|
| Rate for Payer: UHC Medicaid |
$2.74
|
| Rate for Payer: UHC Medicaid |
$2.78
|
| Rate for Payer: UHC Medicaid |
$3.37
|
| Rate for Payer: UHC Medicaid |
$3.61
|
| Rate for Payer: UHC Medicaid |
$2.70
|
| Rate for Payer: UHC Medicaid |
$2.92
|
| Rate for Payer: UHC Medicaid |
$3.22
|
| Rate for Payer: UHC Medicare Advantage |
$3.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.21
|
| Rate for Payer: UHC Medicare Advantage |
$5.11
|
| Rate for Payer: UHC Medicare Advantage |
$3.83
|
| Rate for Payer: UHC Medicare Advantage |
$4.78
|
| Rate for Payer: UHC Medicare Advantage |
$4.14
|
| Rate for Payer: UHC Medicare Advantage |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: UHC Medicare Advantage |
$3.94
|
| Rate for Payer: UHCCP Medicaid |
$3.45
|
| Rate for Payer: UHCCP Medicaid |
$2.74
|
| Rate for Payer: UHCCP Medicaid |
$2.78
|
| Rate for Payer: UHCCP Medicaid |
$3.61
|
| Rate for Payer: UHCCP Medicaid |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$2.92
|
| Rate for Payer: UHCCP Medicaid |
$3.37
|
| Rate for Payer: UHCCP Medicaid |
$3.22
|
| Rate for Payer: UHCCP Medicaid |
$2.70
|
| Rate for Payer: VA VA |
$5.11
|
| Rate for Payer: VA VA |
$3.83
|
| Rate for Payer: VA VA |
$3.94
|
| Rate for Payer: VA VA |
$4.14
|
| Rate for Payer: VA VA |
$4.78
|
| Rate for Payer: VA VA |
$3.88
|
| Rate for Payer: VA VA |
$4.57
|
| Rate for Payer: VA VA |
$4.89
|
| Rate for Payer: VA VA |
$5.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$15.32
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$13.79 |
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$13.40
|
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$15.09
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCBS Trust/PPO |
$15.77
|
| Rate for Payer: BCBS Trust/PPO |
$12.83
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCBS Trust/PPO |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$13.02
|
| Rate for Payer: BCBS Trust/PPO |
$16.89
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCN Commercial |
$13.69
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: BCN Commercial |
$13.02
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: BCN Commercial |
$12.83
|
| Rate for Payer: BCN Commercial |
$15.77
|
| Rate for Payer: BCN Commercial |
$16.17
|
| Rate for Payer: BCN Commercial |
$15.09
|
| Rate for Payer: BCN Commercial |
$16.89
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$12.62
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$13.56
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$14.26
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| 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 |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Healthscope Commercial |
$14.92
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$14.19
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Nomi Health Commercial |
$14.98
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Nomi Health Commercial |
$12.56
|
| Rate for Payer: Nomi Health Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$13.60
|
| Rate for Payer: Nomi Health Commercial |
$15.66
|
| Rate for Payer: Nomi Health Commercial |
$12.93
|
| Rate for Payer: Nomi Health Commercial |
$17.08
|
| Rate for Payer: Nomi Health Commercial |
$16.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.62
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Commercial |
$14.09
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$13.40
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$16.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$16.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC Core |
$15.95
|
| Rate for Payer: UHC Core |
$17.08
|
| Rate for Payer: UHC Core |
$17.39
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Core |
$13.17
|
| Rate for Payer: UHC Core |
$12.79
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Core |
$13.84
|
| Rate for Payer: UHC Core |
$15.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$27.90
|
|
|
Service Code
|
NDC 63323047302
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.72
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS MAPPO |
$6.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.94
|
| Rate for Payer: BCN Commercial |
$22.94
|
| Rate for Payer: BCN Medicare Advantage |
$6.97
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.97
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Mclaren Medicaid |
$4.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.32
|
| Rate for Payer: Meridian Medicaid |
$5.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Nomi Health Commercial |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: PACE Senior Care Partners |
$6.63
|
| Rate for Payer: PACE SWMI |
$6.97
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: PHP Medicare Advantage |
$6.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.27
|
| Rate for Payer: Priority Health Medicare |
$7.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.55
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: UHC Exchange |
$6.97
|
| Rate for Payer: UHC Medicaid |
$4.92
|
| Rate for Payer: UHC Medicare Advantage |
$6.97
|
| Rate for Payer: UHCCP Medicaid |
$4.92
|
| Rate for Payer: VA VA |
$6.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
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 |
$3.93 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.97
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: BCBS MAPPO |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$18.34
|
| Rate for Payer: BCN Commercial |
$18.34
|
| Rate for Payer: BCN Medicare Advantage |
$5.58
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.58
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Mclaren Medicaid |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.86
|
| Rate for Payer: Meridian Medicaid |
$4.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PACE Senior Care Partners |
$5.30
|
| Rate for Payer: PACE SWMI |
$5.58
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: PHP Medicare Advantage |
$5.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.41
|
| Rate for Payer: Priority Health Medicare |
$5.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: Railroad Medicare Medicare |
$5.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.63
|
| Rate for Payer: UHC Core |
$18.63
|
| Rate for Payer: UHC Exchange |
$5.58
|
| Rate for Payer: UHC Medicaid |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$5.58
|
| Rate for Payer: UHCCP Medicaid |
$3.93
|
| Rate for Payer: VA VA |
$5.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
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 |
$15.53 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$18.43
|
| Rate for Payer: BCN Commercial |
$18.43
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.73
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.63
|
| Rate for Payer: UHC Core |
$18.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$27.90
|
|
|
Service Code
|
NDC 63323047302
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: BCBS Trust/PPO |
$23.04
|
| Rate for Payer: BCN Commercial |
$23.04
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Nomi Health Commercial |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.55
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$17.54
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: BCBS Trust/PPO |
$19.05
|
| Rate for Payer: BCBS Trust/PPO |
$14.49
|
| Rate for Payer: BCBS Trust/PPO |
$21.87
|
| Rate for Payer: BCN Commercial |
$19.05
|
| Rate for Payer: BCN Commercial |
$14.49
|
| Rate for Payer: BCN Commercial |
$21.87
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Nomi Health Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$21.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.86
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Core |
$22.11
|
| Rate for Payer: UHC Core |
$19.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$17.54
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$15.79 |
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Medicare |
$6.88
|
| Rate for Payer: Aetna Medicare |
$4.56
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.28
|
| Rate for Payer: BCBS Complete |
$4.27
|
| Rate for Payer: BCBS Complete |
$3.25
|
| Rate for Payer: BCBS Complete |
$4.90
|
| Rate for Payer: BCBS MAPPO |
$6.62
|
| Rate for Payer: BCBS MAPPO |
$4.38
|
| Rate for Payer: BCBS MAPPO |
$5.76
|
| Rate for Payer: BCBS Trust/PPO |
$14.42
|
| Rate for Payer: BCBS Trust/PPO |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$21.77
|
| Rate for Payer: BCN Commercial |
$18.96
|
| Rate for Payer: BCN Commercial |
$21.77
|
| Rate for Payer: BCN Commercial |
$14.42
|
| Rate for Payer: BCN Medicare Advantage |
$6.62
|
| Rate for Payer: BCN Medicare Advantage |
$5.76
|
| Rate for Payer: BCN Medicare Advantage |
$4.38
|
| Rate for Payer: Cash Price |
$21.18
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$22.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.38
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$23.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Mclaren Medicaid |
$3.09
|
| Rate for Payer: Mclaren Medicaid |
$4.67
|
| Rate for Payer: Mclaren Medicaid |
$4.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.95
|
| Rate for Payer: Meridian Medicaid |
$4.90
|
| Rate for Payer: Meridian Medicaid |
$3.25
|
| Rate for Payer: Meridian Medicaid |
$4.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Nomi Health Commercial |
$21.71
|
| Rate for Payer: Nomi Health Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: PACE Senior Care Partners |
$5.48
|
| Rate for Payer: PACE Senior Care Partners |
$4.17
|
| Rate for Payer: PACE Senior Care Partners |
$6.29
|
| Rate for Payer: PACE SWMI |
$6.62
|
| Rate for Payer: PACE SWMI |
$5.76
|
| Rate for Payer: PACE SWMI |
$4.38
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Medicare Advantage |
$5.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.38
|
| Rate for Payer: PHP Medicare Advantage |
$6.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$15.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.04
|
| Rate for Payer: Priority Health Medicare |
$6.69
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health Medicare |
$4.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.21
|
| Rate for Payer: Railroad Medicare Medicare |
$5.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6.62
|
| Rate for Payer: Railroad Medicare Medicare |
$4.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.44
|
| Rate for Payer: UHC Core |
$14.65
|
| Rate for Payer: UHC Core |
$22.11
|
| Rate for Payer: UHC Core |
$19.26
|
| Rate for Payer: UHC Exchange |
$6.62
|
| Rate for Payer: UHC Exchange |
$5.76
|
| Rate for Payer: UHC Exchange |
$4.38
|
| Rate for Payer: UHC Medicaid |
$3.09
|
| Rate for Payer: UHC Medicaid |
$4.67
|
| Rate for Payer: UHC Medicaid |
$4.07
|
| Rate for Payer: UHC Medicare Advantage |
$5.76
|
| Rate for Payer: UHC Medicare Advantage |
$4.38
|
| Rate for Payer: UHC Medicare Advantage |
$6.62
|
| Rate for Payer: UHCCP Medicaid |
$4.07
|
| Rate for Payer: UHCCP Medicaid |
$3.09
|
| Rate for Payer: UHCCP Medicaid |
$4.67
|
| Rate for Payer: VA VA |
$4.38
|
| Rate for Payer: VA VA |
$6.62
|
| Rate for Payer: VA VA |
$5.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.86
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$420.62
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.16 |
| Max. Negotiated Rate |
$378.56 |
| Rate for Payer: Aetna Commercial |
$357.53
|
| Rate for Payer: Aetna Medicare |
$109.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.44
|
| Rate for Payer: BCBS Complete |
$77.86
|
| Rate for Payer: BCBS MAPPO |
$105.16
|
| Rate for Payer: BCBS Trust/PPO |
$345.79
|
| Rate for Payer: BCN Commercial |
$345.79
|
| Rate for Payer: BCN Medicare Advantage |
$105.16
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cofinity Commercial |
$361.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.16
|
| Rate for Payer: Healthscope Commercial |
$378.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.46
|
| Rate for Payer: Mclaren Medicaid |
$74.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.41
|
| Rate for Payer: Meridian Medicaid |
$77.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.53
|
| Rate for Payer: Nomi Health Commercial |
$344.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.46
|
| Rate for Payer: PACE Senior Care Partners |
$99.90
|
| Rate for Payer: PACE SWMI |
$105.16
|
| Rate for Payer: PHP Commercial |
$357.53
|
| Rate for Payer: PHP Medicare Advantage |
$105.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.94
|
| Rate for Payer: Priority Health Medicare |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.75
|
| Rate for Payer: Railroad Medicare Medicare |
$105.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.15
|
| Rate for Payer: UHC Core |
$351.22
|
| Rate for Payer: UHC Exchange |
$105.16
|
| Rate for Payer: UHC Medicaid |
$74.16
|
| Rate for Payer: UHC Medicare Advantage |
$105.16
|
| Rate for Payer: UHCCP Medicaid |
$74.16
|
| Rate for Payer: VA VA |
$105.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.46
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$420.62
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$378.56 |
| Rate for Payer: Aetna Commercial |
$357.53
|
| Rate for Payer: BCBS Trust/PPO |
$347.39
|
| Rate for Payer: BCN Commercial |
$347.39
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cofinity Commercial |
$361.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.50
|
| Rate for Payer: Healthscope Commercial |
$378.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.53
|
| Rate for Payer: Nomi Health Commercial |
$344.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.46
|
| Rate for Payer: PHP Commercial |
$357.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.15
|
| Rate for Payer: UHC Core |
$351.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.46
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$488.28
|
|
|
Service Code
|
NDC 00904701006
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.08 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: Aetna Medicare |
$126.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.59
|
| Rate for Payer: BCBS Complete |
$90.38
|
| Rate for Payer: BCBS MAPPO |
$122.07
|
| Rate for Payer: BCBS Trust/PPO |
$401.41
|
| Rate for Payer: BCN Commercial |
$401.41
|
| Rate for Payer: BCN Medicare Advantage |
$122.07
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.07
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.21
|
| Rate for Payer: Mclaren Medicaid |
$86.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.17
|
| Rate for Payer: Meridian Medicaid |
$90.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Nomi Health Commercial |
$400.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.21
|
| Rate for Payer: PACE Senior Care Partners |
$115.97
|
| Rate for Payer: PACE SWMI |
$122.07
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: PHP Medicare Advantage |
$122.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$424.80
|
| Rate for Payer: Priority Health Medicare |
$123.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.84
|
| Rate for Payer: Railroad Medicare Medicare |
$122.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.69
|
| Rate for Payer: UHC Core |
$407.71
|
| Rate for Payer: UHC Exchange |
$122.07
|
| Rate for Payer: UHC Medicaid |
$86.08
|
| Rate for Payer: UHC Medicare Advantage |
$122.07
|
| Rate for Payer: UHCCP Medicaid |
$86.08
|
| Rate for Payer: VA VA |
$122.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.21
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$488.28
|
|
|
Service Code
|
NDC 00904701006
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.84 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: BCBS Trust/PPO |
$403.27
|
| Rate for Payer: BCN Commercial |
$403.27
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Nomi Health Commercial |
$400.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.21
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$424.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$339.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.69
|
| Rate for Payer: UHC Core |
$407.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.21
|
|
