|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 00362901150
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 00362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 00362901150
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.08
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: BCBS MAPPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCN Commercial |
$12.63
|
| Rate for Payer: BCN Medicare Advantage |
$4.06
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.06
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PACE Senior Care Partners |
$3.86
|
| Rate for Payer: PACE SWMI |
$4.06
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.06
|
| Rate for Payer: UHC Exchange |
$4.06
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: VA VA |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$27.73
|
|
|
Service Code
|
NDC 63323046801
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.67
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: BCN Medicare Advantage |
$6.93
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.93
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: Nomi Health Commercial |
$22.74
|
| Rate for Payer: PACE Senior Care Partners |
$6.59
|
| Rate for Payer: PACE SWMI |
$6.93
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: PHP Medicare Advantage |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.93
|
| Rate for Payer: UHC Exchange |
$6.93
|
| Rate for Payer: UHC Medicare Advantage |
$6.93
|
| Rate for Payer: VA VA |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
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 |
$5.84 |
| 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 |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$6.14
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: BCN Commercial |
$19.10
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Nomi Health Commercial |
$20.15
|
| 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 Cigna Priority Health |
$15.97
|
| Rate for Payer: Priority Health HMO/PPO |
$21.38
|
| Rate for Payer: Priority Health Medicare |
$6.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.46
|
| 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 Dual Complete DSNP |
$6.14
|
| Rate for Payer: UHC Exchange |
$6.14
|
| Rate for Payer: UHC Medicare Advantage |
$6.14
|
| 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
|
OP
|
$43.93
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna Commercial |
$37.34
|
| Rate for Payer: Aetna Medicare |
$11.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.73
|
| Rate for Payer: BCBS Complete |
$17.57
|
| Rate for Payer: BCBS MAPPO |
$10.98
|
| Rate for Payer: BCBS Trust/PPO |
$36.11
|
| Rate for Payer: BCN Commercial |
$34.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.98
|
| Rate for Payer: Cash Price |
$35.14
|
| Rate for Payer: Cofinity Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.34
|
| Rate for Payer: Nomi Health Commercial |
$36.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.43
|
| Rate for Payer: PACE SWMI |
$10.98
|
| Rate for Payer: PHP Commercial |
$37.34
|
| Rate for Payer: PHP Medicare Advantage |
$10.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.55
|
| Rate for Payer: Priority Health HMO/PPO |
$38.22
|
| Rate for Payer: Priority Health Medicare |
$11.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.43
|
| Rate for Payer: Railroad Medicare Medicare |
$10.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.66
|
| Rate for Payer: UHC Core |
$36.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.98
|
| Rate for Payer: UHC Exchange |
$10.98
|
| Rate for Payer: UHC Medicare Advantage |
$10.98
|
| Rate for Payer: VA VA |
$10.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.95
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$27.73
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$22.64
|
| Rate for Payer: BCN Commercial |
$21.43
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: Nomi Health Commercial |
$22.74
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
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 |
$5.84 |
| 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 |
$9.83
|
| Rate for Payer: BCBS MAPPO |
$6.14
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: BCN Commercial |
$19.10
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Nomi Health Commercial |
$20.15
|
| 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 Cigna Priority Health |
$15.97
|
| Rate for Payer: Priority Health HMO/PPO |
$21.38
|
| Rate for Payer: Priority Health Medicare |
$6.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.46
|
| 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 Dual Complete DSNP |
$6.14
|
| Rate for Payer: UHC Exchange |
$6.14
|
| Rate for Payer: UHC Medicare Advantage |
$6.14
|
| 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
|
$43.93
|
|
|
Service Code
|
NDC 63323046802
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna Commercial |
$37.34
|
| Rate for Payer: BCBS Trust/PPO |
$35.86
|
| Rate for Payer: BCN Commercial |
$33.95
|
| Rate for Payer: Cash Price |
$35.14
|
| Rate for Payer: Cofinity Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.14
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.34
|
| Rate for Payer: Nomi Health Commercial |
$36.02
|
| Rate for Payer: PHP Commercial |
$37.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.55
|
| Rate for Payer: Priority Health HMO/PPO |
$38.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.66
|
| Rate for Payer: UHC Core |
$36.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.95
|
|
|
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 |
$15.97 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.06
|
| Rate for Payer: BCN Commercial |
$18.99
|
| 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: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.97
|
| Rate for Payer: Priority Health HMO/PPO |
$21.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.46
|
| 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
|
$27.73
|
|
|
Service Code
|
NDC 63323046801
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$22.64
|
| Rate for Payer: BCN Commercial |
$21.43
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: Nomi Health Commercial |
$22.74
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$25.76
|
|
|
Service Code
|
NDC 00409904211
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: BCBS Trust/PPO |
$21.03
|
| Rate for Payer: BCN Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: Nomi Health Commercial |
$21.12
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO |
$22.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$25.76
|
|
|
Service Code
|
NDC 00409904201
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: BCBS Trust/PPO |
$21.03
|
| Rate for Payer: BCN Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: Nomi Health Commercial |
$21.12
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO |
$22.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$25.76
|
|
|
Service Code
|
NDC 00409904201
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Medicare |
$6.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.05
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$6.44
|
| Rate for Payer: BCBS Trust/PPO |
$21.18
|
| Rate for Payer: BCN Commercial |
$20.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.44
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.44
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: Nomi Health Commercial |
$21.12
|
| Rate for Payer: PACE Senior Care Partners |
$6.12
|
| Rate for Payer: PACE SWMI |
$6.44
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: PHP Medicare Advantage |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO |
$22.41
|
| Rate for Payer: Priority Health Medicare |
$6.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.44
|
| Rate for Payer: UHC Exchange |
$6.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.44
|
| Rate for Payer: VA VA |
$6.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
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 |
$15.97 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.06
|
| Rate for Payer: BCN Commercial |
$18.99
|
| 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: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.97
|
| Rate for Payer: Priority Health HMO/PPO |
$21.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.46
|
| 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
|
$25.76
|
|
|
Service Code
|
NDC 00409904211
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Medicare |
$6.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.05
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$6.44
|
| Rate for Payer: BCBS Trust/PPO |
$21.18
|
| Rate for Payer: BCN Commercial |
$20.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.44
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.44
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: Nomi Health Commercial |
$21.12
|
| Rate for Payer: PACE Senior Care Partners |
$6.12
|
| Rate for Payer: PACE SWMI |
$6.44
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: PHP Medicare Advantage |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO |
$22.41
|
| Rate for Payer: Priority Health Medicare |
$6.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.44
|
| Rate for Payer: UHC Exchange |
$6.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.44
|
| Rate for Payer: VA VA |
$6.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$43.93
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna Commercial |
$37.34
|
| Rate for Payer: BCBS Trust/PPO |
$35.86
|
| Rate for Payer: BCN Commercial |
$33.95
|
| Rate for Payer: Cash Price |
$35.14
|
| Rate for Payer: Cofinity Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.14
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.34
|
| Rate for Payer: Nomi Health Commercial |
$36.02
|
| Rate for Payer: PHP Commercial |
$37.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.55
|
| Rate for Payer: Priority Health HMO/PPO |
$38.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.66
|
| Rate for Payer: UHC Core |
$36.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.95
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$43.93
|
|
|
Service Code
|
NDC 63323046802
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna Commercial |
$37.34
|
| Rate for Payer: Aetna Medicare |
$11.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.73
|
| Rate for Payer: BCBS Complete |
$17.57
|
| Rate for Payer: BCBS MAPPO |
$10.98
|
| Rate for Payer: BCBS Trust/PPO |
$36.11
|
| Rate for Payer: BCN Commercial |
$34.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.98
|
| Rate for Payer: Cash Price |
$35.14
|
| Rate for Payer: Cofinity Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.34
|
| Rate for Payer: Nomi Health Commercial |
$36.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.43
|
| Rate for Payer: PACE SWMI |
$10.98
|
| Rate for Payer: PHP Commercial |
$37.34
|
| Rate for Payer: PHP Medicare Advantage |
$10.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.55
|
| Rate for Payer: Priority Health HMO/PPO |
$38.22
|
| Rate for Payer: Priority Health Medicare |
$11.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.43
|
| Rate for Payer: Railroad Medicare Medicare |
$10.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.66
|
| Rate for Payer: UHC Core |
$36.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.98
|
| Rate for Payer: UHC Exchange |
$10.98
|
| Rate for Payer: UHC Medicare Advantage |
$10.98
|
| Rate for Payer: VA VA |
$10.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.95
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$27.73
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.67
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: BCN Medicare Advantage |
$6.93
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.93
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: Nomi Health Commercial |
$22.74
|
| Rate for Payer: PACE Senior Care Partners |
$6.59
|
| Rate for Payer: PACE SWMI |
$6.93
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: PHP Medicare Advantage |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.93
|
| Rate for Payer: UHC Exchange |
$6.93
|
| Rate for Payer: UHC Medicare Advantage |
$6.93
|
| Rate for Payer: VA VA |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$18.21
|
|
|
Service Code
|
NDC 00409904516
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.84 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: BCBS Trust/PPO |
$14.86
|
| Rate for Payer: BCN Commercial |
$14.07
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.84
|
| Rate for Payer: Priority Health HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$18.21
|
|
|
Service Code
|
NDC 00409904516
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.69
|
| Rate for Payer: BCBS Complete |
$7.28
|
| Rate for Payer: BCBS MAPPO |
$4.55
|
| Rate for Payer: BCBS Trust/PPO |
$14.97
|
| Rate for Payer: BCN Commercial |
$14.16
|
| Rate for Payer: BCN Medicare Advantage |
$4.55
|
| Rate for Payer: Cash Price |
$14.57
|
| Rate for Payer: Cofinity Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.55
|
| Rate for Payer: Healthscope Commercial |
$16.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.48
|
| Rate for Payer: Nomi Health Commercial |
$14.93
|
| Rate for Payer: PACE Senior Care Partners |
$4.32
|
| Rate for Payer: PACE SWMI |
$4.55
|
| Rate for Payer: PHP Commercial |
$15.48
|
| Rate for Payer: PHP Medicare Advantage |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.84
|
| Rate for Payer: Priority Health HMO/PPO |
$15.84
|
| Rate for Payer: Priority Health Medicare |
$4.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.02
|
| Rate for Payer: UHC Core |
$15.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.55
|
| Rate for Payer: UHC Exchange |
$4.55
|
| Rate for Payer: UHC Medicare Advantage |
$4.55
|
| Rate for Payer: VA VA |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.66
|
|
|
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 |
$13.02 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$16.35
|
| Rate for Payer: BCN Commercial |
$15.48
|
| 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: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health HMO/PPO |
$17.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.42
|
| 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 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.76 |
| 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 |
$8.01
|
| Rate for Payer: BCBS MAPPO |
$5.01
|
| Rate for Payer: BCBS Trust/PPO |
$16.47
|
| Rate for Payer: BCN Commercial |
$15.57
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Nomi Health Commercial |
$16.42
|
| 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 Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health HMO/PPO |
$17.43
|
| Rate for Payer: Priority Health Medicare |
$5.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.42
|
| 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 Dual Complete DSNP |
$5.01
|
| Rate for Payer: UHC Exchange |
$5.01
|
| Rate for Payer: UHC Medicare Advantage |
$5.01
|
| 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
|
$28.44
|
|
|
Service Code
|
NDC 63323046217
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna Commercial |
$24.17
|
| Rate for Payer: BCBS Trust/PPO |
$23.22
|
| Rate for Payer: BCN Commercial |
$21.98
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$24.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.75
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.17
|
| Rate for Payer: Nomi Health Commercial |
$23.32
|
| Rate for Payer: PHP Commercial |
$24.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health HMO/PPO |
$24.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.03
|
| Rate for Payer: UHC Core |
$23.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.33
|
|
|
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 |
$13.02 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: BCBS Trust/PPO |
$16.35
|
| Rate for Payer: BCN Commercial |
$15.48
|
| 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: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health HMO/PPO |
$17.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.42
|
| 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
|
|
