|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$47.26
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Aetna Commercial |
$40.17
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.77
|
| Rate for Payer: BCBS Complete |
$18.90
|
| Rate for Payer: BCBS MAPPO |
$11.81
|
| Rate for Payer: BCBS Trust/PPO |
$38.85
|
| Rate for Payer: BCN Commercial |
$36.74
|
| Rate for Payer: BCN Medicare Advantage |
$11.81
|
| Rate for Payer: Cash Price |
$37.81
|
| Rate for Payer: Cofinity Commercial |
$40.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.81
|
| Rate for Payer: Healthscope Commercial |
$42.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.17
|
| Rate for Payer: Nomi Health Commercial |
$38.75
|
| Rate for Payer: PACE Senior Care Partners |
$11.22
|
| Rate for Payer: PACE SWMI |
$11.81
|
| Rate for Payer: PHP Commercial |
$40.17
|
| Rate for Payer: PHP Medicare Advantage |
$11.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.72
|
| Rate for Payer: Priority Health HMO/PPO |
$41.12
|
| Rate for Payer: Priority Health Medicare |
$11.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.66
|
| Rate for Payer: Railroad Medicare Medicare |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.59
|
| Rate for Payer: UHC Core |
$39.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.81
|
| Rate for Payer: UHC Exchange |
$11.81
|
| Rate for Payer: UHC Medicare Advantage |
$11.81
|
| Rate for Payer: VA VA |
$11.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.45
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
NDC 00409420801
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.02 |
| 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
|
$18.21
|
|
|
Service Code
|
NDC 00409904517
|
| 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
|
OP
|
$28.44
|
|
|
Service Code
|
NDC 63323046204
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.75 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna Commercial |
$24.17
|
| Rate for Payer: Aetna Medicare |
$7.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.89
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: BCBS MAPPO |
$7.11
|
| Rate for Payer: BCBS Trust/PPO |
$23.38
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: BCN Medicare Advantage |
$7.11
|
| 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: Health Alliance Plan Medicare Advantage |
$7.11
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.17
|
| Rate for Payer: Nomi Health Commercial |
$23.32
|
| Rate for Payer: PACE Senior Care Partners |
$6.75
|
| Rate for Payer: PACE SWMI |
$7.11
|
| Rate for Payer: PHP Commercial |
$24.17
|
| Rate for Payer: PHP Medicare Advantage |
$7.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health HMO/PPO |
$24.74
|
| Rate for Payer: Priority Health Medicare |
$7.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.05
|
| Rate for Payer: Railroad Medicare Medicare |
$7.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.03
|
| Rate for Payer: UHC Core |
$23.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.11
|
| Rate for Payer: UHC Exchange |
$7.11
|
| Rate for Payer: UHC Medicare Advantage |
$7.11
|
| Rate for Payer: VA VA |
$7.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.33
|
|
|
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 |
$14.48 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$18.19
|
| Rate for Payer: BCN Commercial |
$17.22
|
| 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: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO |
$19.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.93
|
| 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
|
$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
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 00409174910
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.96
|
| Rate for Payer: BCBS Complete |
$8.91
|
| Rate for Payer: BCBS MAPPO |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.32
|
| Rate for Payer: BCN Commercial |
$17.32
|
| Rate for Payer: BCN Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.57
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: Nomi Health Commercial |
$18.27
|
| Rate for Payer: PACE Senior Care Partners |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.57
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: PHP Medicare Advantage |
$5.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health HMO/PPO |
$19.38
|
| Rate for Payer: Priority Health Medicare |
$5.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.93
|
| Rate for Payer: Railroad Medicare Medicare |
$5.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.61
|
| Rate for Payer: UHC Core |
$18.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.57
|
| Rate for Payer: UHC Exchange |
$5.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.57
|
| Rate for Payer: VA VA |
$5.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$31.11
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$26.44
|
| 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 |
$23.17
|
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: BCBS Trust/PPO |
$25.40
|
| Rate for Payer: BCBS Trust/PPO |
$22.25
|
| Rate for Payer: BCBS Trust/PPO |
$22.37
|
| Rate for Payer: BCBS Trust/PPO |
$17.75
|
| Rate for Payer: BCBS Trust/PPO |
$15.27
|
| Rate for Payer: BCBS Trust/PPO |
$19.17
|
| Rate for Payer: BCN Commercial |
$21.18
|
| Rate for Payer: BCN Commercial |
$21.07
|
| Rate for Payer: BCN Commercial |
$14.46
|
| Rate for Payer: BCN Commercial |
$18.15
|
| Rate for Payer: BCN Commercial |
$24.04
|
| Rate for Payer: BCN Commercial |
$16.81
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| 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 |
$21.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$16.84
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| 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 |
$20.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.17
|
| 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 |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Nomi Health Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$17.84
|
| Rate for Payer: Nomi Health Commercial |
$22.35
|
| Rate for Payer: Nomi Health Commercial |
$19.26
|
| Rate for Payer: Nomi Health Commercial |
$25.51
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$18.49
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health HMO/PPO |
$16.28
|
| Rate for Payer: Priority Health HMO/PPO |
$18.92
|
| Rate for Payer: Priority Health HMO/PPO |
$23.72
|
| Rate for Payer: Priority Health HMO/PPO |
$23.85
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health HMO/PPO |
$27.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.99
|
| 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) |
$27.38
|
| Rate for Payer: UHC Core |
$25.98
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Core |
$22.89
|
| Rate for Payer: UHC Core |
$22.76
|
| 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 |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$23.49
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Medicare |
$7.13
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Aetna Medicare |
$4.86
|
| Rate for Payer: Aetna Medicare |
$7.09
|
| Rate for Payer: Aetna Medicare |
$8.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.85
|
| 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 |
$8.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.85
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS MAPPO |
$6.82
|
| Rate for Payer: BCBS MAPPO |
$4.68
|
| Rate for Payer: BCBS MAPPO |
$5.44
|
| Rate for Payer: BCBS MAPPO |
$7.78
|
| Rate for Payer: BCBS MAPPO |
$6.85
|
| Rate for Payer: BCBS MAPPO |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$22.41
|
| Rate for Payer: BCBS Trust/PPO |
$17.88
|
| Rate for Payer: BCBS Trust/PPO |
$15.38
|
| Rate for Payer: BCBS Trust/PPO |
$22.53
|
| Rate for Payer: BCBS Trust/PPO |
$25.58
|
| Rate for Payer: BCBS Trust/PPO |
$19.31
|
| Rate for Payer: BCN Commercial |
$21.19
|
| Rate for Payer: BCN Commercial |
$16.91
|
| Rate for Payer: BCN Commercial |
$14.55
|
| Rate for Payer: BCN Commercial |
$24.19
|
| Rate for Payer: BCN Commercial |
$21.31
|
| Rate for Payer: BCN Commercial |
$18.26
|
| Rate for Payer: BCN Medicare Advantage |
$5.87
|
| Rate for Payer: BCN Medicare Advantage |
$6.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.44
|
| Rate for Payer: BCN Medicare Advantage |
$4.68
|
| Rate for Payer: BCN Medicare Advantage |
$7.78
|
| Rate for Payer: BCN Medicare Advantage |
$6.85
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| 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 |
$21.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.85
|
| Rate for Payer: Healthscope Commercial |
$16.84
|
| Rate for Payer: Healthscope Commercial |
$19.57
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| 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 |
$7.20
|
| 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 |
$8.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| 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 |
$23.17
|
| Rate for Payer: Nomi Health Commercial |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$22.48
|
| Rate for Payer: Nomi Health Commercial |
$17.84
|
| Rate for Payer: Nomi Health Commercial |
$19.26
|
| Rate for Payer: Nomi Health Commercial |
$25.51
|
| Rate for Payer: Nomi Health Commercial |
$22.35
|
| Rate for Payer: PACE Senior Care Partners |
$7.39
|
| Rate for Payer: PACE Senior Care Partners |
$6.47
|
| Rate for Payer: PACE Senior Care Partners |
$5.17
|
| Rate for Payer: PACE Senior Care Partners |
$4.44
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE Senior Care Partners |
$6.51
|
| Rate for Payer: PACE SWMI |
$6.82
|
| Rate for Payer: PACE SWMI |
$5.87
|
| Rate for Payer: PACE SWMI |
$7.78
|
| Rate for Payer: PACE SWMI |
$5.44
|
| Rate for Payer: PACE SWMI |
$6.85
|
| Rate for Payer: PACE SWMI |
$4.68
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: PHP Commercial |
$18.49
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: PHP Medicare Advantage |
$4.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.82
|
| Rate for Payer: PHP Medicare Advantage |
$6.85
|
| Rate for Payer: PHP Medicare Advantage |
$7.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.87
|
| Rate for Payer: PHP Medicare Advantage |
$5.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health HMO/PPO |
$18.92
|
| Rate for Payer: Priority Health HMO/PPO |
$27.07
|
| Rate for Payer: Priority Health HMO/PPO |
$23.72
|
| Rate for Payer: Priority Health HMO/PPO |
$16.28
|
| Rate for Payer: Priority Health HMO/PPO |
$23.85
|
| Rate for Payer: Priority Health Medicare |
$7.86
|
| Rate for Payer: Priority Health Medicare |
$6.92
|
| Rate for Payer: Priority Health Medicare |
$4.72
|
| Rate for Payer: Priority Health Medicare |
$5.49
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Medicare |
$6.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.57
|
| Rate for Payer: Railroad Medicare Medicare |
$6.85
|
| Rate for Payer: Railroad Medicare Medicare |
$5.87
|
| Rate for Payer: Railroad Medicare Medicare |
$7.78
|
| Rate for Payer: Railroad Medicare Medicare |
$6.82
|
| Rate for Payer: Railroad Medicare Medicare |
$5.44
|
| Rate for Payer: Railroad Medicare Medicare |
$4.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.14
|
| Rate for Payer: UHC Core |
$22.89
|
| Rate for Payer: UHC Core |
$22.76
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Core |
$15.62
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Core |
$25.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.68
|
| Rate for Payer: UHC Exchange |
$6.85
|
| Rate for Payer: UHC Exchange |
$5.44
|
| Rate for Payer: UHC Exchange |
$5.87
|
| Rate for Payer: UHC Exchange |
$4.68
|
| Rate for Payer: UHC Exchange |
$7.78
|
| Rate for Payer: UHC Exchange |
$6.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.87
|
| Rate for Payer: UHC Medicare Advantage |
$7.78
|
| Rate for Payer: UHC Medicare Advantage |
$5.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.85
|
| Rate for Payer: UHC Medicare Advantage |
$4.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.82
|
| Rate for Payer: VA VA |
$6.82
|
| Rate for Payer: VA VA |
$4.68
|
| Rate for Payer: VA VA |
$5.87
|
| Rate for Payer: VA VA |
$5.44
|
| Rate for Payer: VA VA |
$7.78
|
| Rate for Payer: VA VA |
$6.85
|
| 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 |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.56
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$19.58
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$17.62 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Aetna Medicare |
$3.91
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Aetna Medicare |
$5.42
|
| Rate for Payer: Aetna Medicare |
$4.75
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna Medicare |
$4.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.12
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Complete |
$6.01
|
| Rate for Payer: BCBS Complete |
$6.13
|
| Rate for Payer: BCBS Complete |
$7.31
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Complete |
$6.22
|
| Rate for Payer: BCBS Complete |
$8.33
|
| Rate for Payer: BCBS MAPPO |
$4.89
|
| Rate for Payer: BCBS MAPPO |
$5.21
|
| Rate for Payer: BCBS MAPPO |
$5.11
|
| Rate for Payer: BCBS MAPPO |
$4.57
|
| Rate for Payer: BCBS MAPPO |
$3.83
|
| Rate for Payer: BCBS MAPPO |
$3.76
|
| Rate for Payer: BCBS MAPPO |
$3.88
|
| Rate for Payer: BCBS Trust/PPO |
$12.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.59
|
| Rate for Payer: BCBS Trust/PPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$16.81
|
| Rate for Payer: BCBS Trust/PPO |
$12.78
|
| Rate for Payer: BCBS Trust/PPO |
$16.10
|
| Rate for Payer: BCBS Trust/PPO |
$15.02
|
| Rate for Payer: BCN Commercial |
$14.20
|
| Rate for Payer: BCN Commercial |
$11.69
|
| Rate for Payer: BCN Commercial |
$12.08
|
| Rate for Payer: BCN Commercial |
$11.91
|
| Rate for Payer: BCN Commercial |
$15.90
|
| Rate for Payer: BCN Commercial |
$15.22
|
| Rate for Payer: BCN Commercial |
$16.20
|
| Rate for Payer: BCN Medicare Advantage |
$5.21
|
| Rate for Payer: BCN Medicare Advantage |
$4.89
|
| Rate for Payer: BCN Medicare Advantage |
$5.11
|
| Rate for Payer: BCN Medicare Advantage |
$3.88
|
| Rate for Payer: BCN Medicare Advantage |
$3.76
|
| Rate for Payer: BCN Medicare Advantage |
$3.83
|
| Rate for Payer: BCN Medicare Advantage |
$4.57
|
| Rate for Payer: Cash Price |
$12.02
|
| 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 |
$16.36
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$12.93
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.57
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.95
|
| 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 |
$4.08
|
| 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 |
$5.14
|
| 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 |
$5.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.25
|
| 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 |
$4.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.02
|
| Rate for Payer: Nomi Health Commercial |
$16.77
|
| Rate for Payer: Nomi Health Commercial |
$12.32
|
| Rate for Payer: Nomi Health Commercial |
$12.56
|
| Rate for Payer: Nomi Health Commercial |
$17.08
|
| Rate for Payer: Nomi Health Commercial |
$14.98
|
| Rate for Payer: Nomi Health Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| 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 |
$3.64
|
| Rate for Payer: PACE Senior Care Partners |
$3.57
|
| Rate for Payer: PACE Senior Care Partners |
$3.69
|
| Rate for Payer: PACE Senior Care Partners |
$4.86
|
| Rate for Payer: PACE SWMI |
$5.11
|
| Rate for Payer: PACE SWMI |
$3.88
|
| Rate for Payer: PACE SWMI |
$4.89
|
| Rate for Payer: PACE SWMI |
$3.76
|
| Rate for Payer: PACE SWMI |
$4.57
|
| Rate for Payer: PACE SWMI |
$3.83
|
| Rate for Payer: PACE SWMI |
$5.21
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Medicare Advantage |
$3.76
|
| Rate for Payer: PHP Medicare Advantage |
$4.57
|
| Rate for Payer: PHP Medicare Advantage |
$3.88
|
| Rate for Payer: PHP Medicare Advantage |
$4.89
|
| Rate for Payer: PHP Medicare Advantage |
$5.11
|
| Rate for Payer: PHP Medicare Advantage |
$3.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.77
|
| Rate for Payer: Priority Health HMO/PPO |
$13.33
|
| Rate for Payer: Priority Health HMO/PPO |
$15.89
|
| Rate for Payer: Priority Health HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health HMO/PPO |
$17.79
|
| Rate for Payer: Priority Health HMO/PPO |
$13.52
|
| Rate for Payer: Priority Health HMO/PPO |
$18.12
|
| Rate for Payer: Priority Health HMO/PPO |
$13.08
|
| Rate for Payer: Priority Health Medicare |
$3.87
|
| Rate for Payer: Priority Health Medicare |
$4.61
|
| Rate for Payer: Priority Health Medicare |
$3.92
|
| Rate for Payer: Priority Health Medicare |
$3.80
|
| Rate for Payer: Priority Health Medicare |
$4.94
|
| Rate for Payer: Priority Health Medicare |
$5.16
|
| Rate for Payer: Priority Health Medicare |
$5.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.24
|
| Rate for Payer: Railroad Medicare Medicare |
$5.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5.11
|
| Rate for Payer: Railroad Medicare Medicare |
$4.57
|
| Rate for Payer: Railroad Medicare Medicare |
$3.88
|
| Rate for Payer: Railroad Medicare Medicare |
$3.83
|
| Rate for Payer: Railroad Medicare Medicare |
$4.89
|
| 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) |
$16.08
|
| 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) |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.23
|
| Rate for Payer: UHC Core |
$12.79
|
| Rate for Payer: UHC Core |
$17.08
|
| Rate for Payer: UHC Core |
$12.55
|
| Rate for Payer: UHC Core |
$15.26
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Core |
$17.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.21
|
| Rate for Payer: UHC Exchange |
$4.57
|
| Rate for Payer: UHC Exchange |
$5.11
|
| Rate for Payer: UHC Exchange |
$5.21
|
| Rate for Payer: UHC Exchange |
$3.83
|
| Rate for Payer: UHC Exchange |
$3.88
|
| Rate for Payer: UHC Exchange |
$3.76
|
| Rate for Payer: UHC Exchange |
$4.89
|
| Rate for Payer: UHC Medicare Advantage |
$5.21
|
| Rate for Payer: UHC Medicare Advantage |
$3.76
|
| Rate for Payer: UHC Medicare Advantage |
$3.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$4.89
|
| Rate for Payer: UHC Medicare Advantage |
$5.11
|
| Rate for Payer: UHC Medicare Advantage |
$3.83
|
| Rate for Payer: VA VA |
$3.88
|
| Rate for Payer: VA VA |
$4.57
|
| Rate for Payer: VA VA |
$3.83
|
| Rate for Payer: VA VA |
$5.21
|
| Rate for Payer: VA VA |
$3.76
|
| Rate for Payer: VA VA |
$4.89
|
| Rate for Payer: VA VA |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.62
|
| 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
|
$20.83
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$12.51
|
| Rate for Payer: BCBS Trust/PPO |
$16.69
|
| Rate for Payer: BCBS Trust/PPO |
$12.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$12.69
|
| Rate for Payer: BCBS Trust/PPO |
$14.91
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: BCN Commercial |
$15.80
|
| Rate for Payer: BCN Commercial |
$16.10
|
| Rate for Payer: BCN Commercial |
$15.13
|
| Rate for Payer: BCN Commercial |
$11.84
|
| Rate for Payer: BCN Commercial |
$14.12
|
| Rate for Payer: BCN Commercial |
$11.62
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$12.93
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| 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 |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.66
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$18.41
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.02
|
| 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 |
$13.21
|
| Rate for Payer: Nomi Health Commercial |
$14.98
|
| Rate for Payer: Nomi Health Commercial |
$12.32
|
| Rate for Payer: Nomi Health Commercial |
$17.08
|
| Rate for Payer: Nomi Health Commercial |
$16.77
|
| Rate for Payer: Nomi Health Commercial |
$16.06
|
| Rate for Payer: Nomi Health Commercial |
$12.74
|
| Rate for Payer: Nomi Health Commercial |
$12.56
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health HMO/PPO |
$13.33
|
| Rate for Payer: Priority Health HMO/PPO |
$17.03
|
| Rate for Payer: Priority Health HMO/PPO |
$18.12
|
| Rate for Payer: Priority Health HMO/PPO |
$13.52
|
| Rate for Payer: Priority Health HMO/PPO |
$15.89
|
| Rate for Payer: Priority Health HMO/PPO |
$13.08
|
| Rate for Payer: Priority Health HMO/PPO |
$17.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.23
|
| 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) |
$16.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.68
|
| Rate for Payer: UHC Core |
$12.55
|
| Rate for Payer: UHC Core |
$17.08
|
| Rate for Payer: UHC Core |
$12.79
|
| Rate for Payer: UHC Core |
$12.98
|
| Rate for Payer: UHC Core |
$16.35
|
| Rate for Payer: UHC Core |
$17.39
|
| Rate for Payer: UHC Core |
$15.26
|
| 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 |
$13.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.34
|
|
|
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 |
$18.14 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: BCBS Trust/PPO |
$22.77
|
| Rate for Payer: BCN Commercial |
$21.56
|
| 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: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health HMO/PPO |
$24.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.69
|
| 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) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$22.31
|
|
|
Service Code
|
NDC 00409361301
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.30 |
| 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 |
$8.92
|
| Rate for Payer: BCBS MAPPO |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$18.34
|
| Rate for Payer: BCN Commercial |
$17.35
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.96
|
| Rate for Payer: Nomi Health Commercial |
$18.29
|
| 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 Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health HMO/PPO |
$19.41
|
| Rate for Payer: Priority Health Medicare |
$5.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.95
|
| 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 Dual Complete DSNP |
$5.58
|
| Rate for Payer: UHC Exchange |
$5.58
|
| Rate for Payer: UHC Medicare Advantage |
$5.58
|
| 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 |
$14.50 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$18.21
|
| Rate for Payer: BCN Commercial |
$17.24
|
| 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: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health HMO/PPO |
$19.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.95
|
| 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
|
OP
|
$27.90
|
|
|
Service Code
|
NDC 63323047302
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.63 |
| 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 |
$11.16
|
| Rate for Payer: BCBS MAPPO |
$6.97
|
| Rate for Payer: BCBS Trust/PPO |
$22.94
|
| Rate for Payer: BCN Commercial |
$21.69
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Nomi Health Commercial |
$22.88
|
| 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 Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health HMO/PPO |
$24.27
|
| Rate for Payer: Priority Health Medicare |
$7.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.69
|
| 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 Dual Complete DSNP |
$6.97
|
| Rate for Payer: UHC Exchange |
$6.97
|
| Rate for Payer: UHC Medicare Advantage |
$6.97
|
| 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) INJECTION SOLUTION
|
Facility
|
IP
|
$16.06
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: BCBS Trust/PPO |
$18.82
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCBS Trust/PPO |
$19.84
|
| Rate for Payer: BCN Commercial |
$17.82
|
| Rate for Payer: BCN Commercial |
$12.41
|
| Rate for Payer: BCN Commercial |
$18.78
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.44
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| 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 |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.66
|
| Rate for Payer: Nomi Health Commercial |
$13.17
|
| Rate for Payer: Nomi Health Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$19.93
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health HMO/PPO |
$21.14
|
| Rate for Payer: Priority Health HMO/PPO |
$20.06
|
| Rate for Payer: Priority Health HMO/PPO |
$13.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.13
|
| Rate for Payer: UHC Core |
$13.41
|
| Rate for Payer: UHC Core |
$20.29
|
| Rate for Payer: UHC Core |
$19.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$16.06
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Medicare |
$6.32
|
| Rate for Payer: Aetna Medicare |
$4.18
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.59
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Complete |
$9.72
|
| Rate for Payer: BCBS MAPPO |
$6.08
|
| Rate for Payer: BCBS MAPPO |
$4.01
|
| Rate for Payer: BCBS MAPPO |
$5.76
|
| Rate for Payer: BCBS Trust/PPO |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$19.98
|
| Rate for Payer: BCN Commercial |
$17.93
|
| Rate for Payer: BCN Commercial |
$18.89
|
| Rate for Payer: BCN Commercial |
$12.49
|
| Rate for Payer: BCN Medicare Advantage |
$4.01
|
| Rate for Payer: BCN Medicare Advantage |
$5.76
|
| Rate for Payer: BCN Medicare Advantage |
$6.08
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.01
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.22
|
| 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 |
$6.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.65
|
| Rate for Payer: Nomi Health Commercial |
$19.93
|
| Rate for Payer: Nomi Health Commercial |
$13.17
|
| Rate for Payer: Nomi Health Commercial |
$18.91
|
| Rate for Payer: PACE Senior Care Partners |
$5.77
|
| Rate for Payer: PACE Senior Care Partners |
$3.81
|
| Rate for Payer: PACE Senior Care Partners |
$5.48
|
| Rate for Payer: PACE SWMI |
$5.76
|
| Rate for Payer: PACE SWMI |
$4.01
|
| Rate for Payer: PACE SWMI |
$6.08
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$13.65
|
| Rate for Payer: PHP Medicare Advantage |
$5.76
|
| Rate for Payer: PHP Medicare Advantage |
$6.08
|
| Rate for Payer: PHP Medicare Advantage |
$4.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health HMO/PPO |
$21.14
|
| Rate for Payer: Priority Health HMO/PPO |
$13.97
|
| Rate for Payer: Priority Health HMO/PPO |
$20.06
|
| Rate for Payer: Priority Health Medicare |
$4.06
|
| Rate for Payer: Priority Health Medicare |
$6.14
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.76
|
| Rate for Payer: Railroad Medicare Medicare |
$5.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6.08
|
| Rate for Payer: Railroad Medicare Medicare |
$4.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.13
|
| Rate for Payer: UHC Core |
$20.29
|
| Rate for Payer: UHC Core |
$19.26
|
| Rate for Payer: UHC Core |
$13.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.76
|
| Rate for Payer: UHC Exchange |
$5.76
|
| Rate for Payer: UHC Exchange |
$4.01
|
| Rate for Payer: UHC Exchange |
$6.08
|
| Rate for Payer: UHC Medicare Advantage |
$4.01
|
| Rate for Payer: UHC Medicare Advantage |
$5.76
|
| Rate for Payer: UHC Medicare Advantage |
$6.08
|
| Rate for Payer: VA VA |
$5.76
|
| Rate for Payer: VA VA |
$6.08
|
| Rate for Payer: VA VA |
$4.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$416.55 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: BCBS Trust/PPO |
$523.13
|
| Rate for Payer: BCN Commercial |
$495.25
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: Nomi Health Commercial |
$525.50
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health HMO/PPO |
$557.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.95
|
| Rate for Payer: UHC Core |
$535.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.64
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: Aetna Medicare |
$166.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.27
|
| Rate for Payer: BCBS Complete |
$256.34
|
| Rate for Payer: BCBS MAPPO |
$160.21
|
| Rate for Payer: BCBS Trust/PPO |
$526.84
|
| Rate for Payer: BCN Commercial |
$498.26
|
| Rate for Payer: BCN Medicare Advantage |
$160.21
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.21
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: Nomi Health Commercial |
$525.50
|
| Rate for Payer: PACE Senior Care Partners |
$152.20
|
| Rate for Payer: PACE SWMI |
$160.21
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: PHP Medicare Advantage |
$160.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health HMO/PPO |
$557.54
|
| Rate for Payer: Priority Health Medicare |
$161.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.37
|
| Rate for Payer: Railroad Medicare Medicare |
$160.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.95
|
| Rate for Payer: UHC Core |
$535.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.21
|
| Rate for Payer: UHC Exchange |
$160.21
|
| Rate for Payer: UHC Medicare Advantage |
$160.21
|
| Rate for Payer: VA VA |
$160.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.64
|
|
|
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 |
$317.38 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: BCBS Trust/PPO |
$398.58
|
| Rate for Payer: BCN Commercial |
$377.34
|
| 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: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.38
|
| Rate for Payer: Priority Health HMO/PPO |
$424.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.15
|
| 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
|
|
|
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 |
$115.97 |
| 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 |
$195.31
|
| Rate for Payer: BCBS MAPPO |
$122.07
|
| Rate for Payer: BCBS Trust/PPO |
$401.41
|
| Rate for Payer: BCN Commercial |
$379.64
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Nomi Health Commercial |
$400.39
|
| 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 Cigna Priority Health |
$317.38
|
| Rate for Payer: Priority Health HMO/PPO |
$424.80
|
| Rate for Payer: Priority Health Medicare |
$123.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.15
|
| 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 Dual Complete DSNP |
$122.07
|
| Rate for Payer: UHC Exchange |
$122.07
|
| Rate for Payer: UHC Medicare Advantage |
$122.07
|
| Rate for Payer: VA VA |
$122.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.21
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$62.79
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Medicare |
$16.33
|
| Rate for Payer: Aetna Medicare |
$13.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.72
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS Complete |
$25.12
|
| Rate for Payer: BCBS MAPPO |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$15.70
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCBS Trust/PPO |
$43.99
|
| Rate for Payer: BCN Commercial |
$48.82
|
| Rate for Payer: BCN Commercial |
$41.60
|
| Rate for Payer: BCN Medicare Advantage |
$15.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.38
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.70
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Nomi Health Commercial |
$51.49
|
| Rate for Payer: Nomi Health Commercial |
$43.88
|
| Rate for Payer: PACE Senior Care Partners |
$14.91
|
| Rate for Payer: PACE Senior Care Partners |
$12.71
|
| Rate for Payer: PACE SWMI |
$15.70
|
| Rate for Payer: PACE SWMI |
$13.38
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.38
|
| Rate for Payer: PHP Medicare Advantage |
$15.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.78
|
| Rate for Payer: Priority Health HMO/PPO |
$46.55
|
| Rate for Payer: Priority Health HMO/PPO |
$54.63
|
| Rate for Payer: Priority Health Medicare |
$15.85
|
| Rate for Payer: Priority Health Medicare |
$13.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.38
|
| Rate for Payer: Railroad Medicare Medicare |
$15.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| Rate for Payer: UHC Core |
$52.43
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.38
|
| Rate for Payer: UHC Exchange |
$13.38
|
| Rate for Payer: UHC Exchange |
$15.70
|
| Rate for Payer: UHC Medicare Advantage |
$13.38
|
| Rate for Payer: UHC Medicare Advantage |
$15.70
|
| Rate for Payer: VA VA |
$13.38
|
| Rate for Payer: VA VA |
$15.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$53.51
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: BCBS Trust/PPO |
$43.68
|
| Rate for Payer: BCBS Trust/PPO |
$51.26
|
| Rate for Payer: BCN Commercial |
$41.35
|
| Rate for Payer: BCN Commercial |
$48.52
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Nomi Health Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$51.49
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.78
|
| Rate for Payer: Priority Health HMO/PPO |
$54.63
|
| Rate for Payer: Priority Health HMO/PPO |
$46.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Core |
$52.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$386.40
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: BCBS Trust/PPO |
$315.42
|
| Rate for Payer: BCN Commercial |
$298.61
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$316.85
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.16
|
| Rate for Payer: Priority Health HMO/PPO |
$336.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.03
|
| Rate for Payer: UHC Core |
$322.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$195.30
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$175.77 |
| Rate for Payer: Aetna Commercial |
$166.00
|
| Rate for Payer: BCBS Trust/PPO |
$159.42
|
| Rate for Payer: BCN Commercial |
$150.93
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$167.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.24
|
| Rate for Payer: Healthscope Commercial |
$175.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.00
|
| Rate for Payer: Nomi Health Commercial |
$160.15
|
| Rate for Payer: PHP Commercial |
$166.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health HMO/PPO |
$169.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.86
|
| Rate for Payer: UHC Core |
$163.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.47
|
|
