|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$175.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 50268013011
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 69238148901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna American Axle |
$195.13
|
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.13
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$210.14
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health SBD |
$189.13
|
| Rate for Payer: UMR Bronson Commercial |
$132.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 50268013011
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$215.76
|
|
|
Service Code
|
NDC 50268013015
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.83 |
| Max. Negotiated Rate |
$194.18 |
| Rate for Payer: Aetna American Axle |
$140.24
|
| Rate for Payer: Aetna Commercial |
$183.40
|
| Rate for Payer: Aetna Medicare |
$107.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.24
|
| Rate for Payer: BCBS Complete |
$86.30
|
| Rate for Payer: Cash Price |
$172.61
|
| Rate for Payer: Cofinity Commercial |
$151.03
|
| Rate for Payer: Cofinity Commercial |
$185.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.61
|
| Rate for Payer: Healthscope Commercial |
$194.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.40
|
| Rate for Payer: PHP Commercial |
$183.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.24
|
| Rate for Payer: Priority Health SBD |
$135.93
|
| Rate for Payer: UMR Bronson Commercial |
$79.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.82
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$147.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$258.40
|
|
|
Service Code
|
NDC 69238149001
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.61 |
| Max. Negotiated Rate |
$232.56 |
| Rate for Payer: Aetna American Axle |
$167.96
|
| Rate for Payer: Aetna Commercial |
$219.64
|
| Rate for Payer: Aetna Medicare |
$129.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.96
|
| Rate for Payer: BCBS Complete |
$103.36
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cofinity Commercial |
$180.88
|
| Rate for Payer: Cofinity Commercial |
$222.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.72
|
| Rate for Payer: Healthscope Commercial |
$232.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.64
|
| Rate for Payer: PHP Commercial |
$219.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.96
|
| Rate for Payer: Priority Health SBD |
$162.79
|
| Rate for Payer: UMR Bronson Commercial |
$95.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.80
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 42799012001
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.07 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna American Axle |
$195.13
|
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna Medicare |
$150.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.13
|
| Rate for Payer: BCBS Complete |
$120.08
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$210.14
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health SBD |
$189.13
|
| Rate for Payer: UMR Bronson Commercial |
$111.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$394.56
|
|
|
Service Code
|
NDC 00904701661
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.61 |
| Max. Negotiated Rate |
$355.10 |
| Rate for Payer: Aetna American Axle |
$256.46
|
| Rate for Payer: Aetna Commercial |
$335.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.46
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Cofinity Commercial |
$276.19
|
| Rate for Payer: Cofinity Commercial |
$339.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.65
|
| Rate for Payer: Healthscope Commercial |
$355.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.38
|
| Rate for Payer: PHP Commercial |
$335.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.46
|
| Rate for Payer: Priority Health SBD |
$248.57
|
| Rate for Payer: UMR Bronson Commercial |
$173.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.92
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$394.56
|
|
|
Service Code
|
NDC 00904701661
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.99 |
| Max. Negotiated Rate |
$355.10 |
| Rate for Payer: Aetna American Axle |
$256.46
|
| Rate for Payer: Aetna Commercial |
$335.38
|
| Rate for Payer: Aetna Medicare |
$197.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.46
|
| Rate for Payer: BCBS Complete |
$157.82
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Cofinity Commercial |
$276.19
|
| Rate for Payer: Cofinity Commercial |
$339.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$276.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.65
|
| Rate for Payer: Healthscope Commercial |
$355.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.38
|
| Rate for Payer: PHP Commercial |
$335.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.46
|
| Rate for Payer: Priority Health SBD |
$248.57
|
| Rate for Payer: UMR Bronson Commercial |
$145.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.92
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna American Axle |
$260.58
|
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna Medicare |
$200.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health SBD |
$252.57
|
| Rate for Payer: UMR Bronson Commercial |
$148.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 42799012001
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna American Axle |
$195.13
|
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.13
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$210.14
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health SBD |
$189.13
|
| Rate for Payer: UMR Bronson Commercial |
$132.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$258.40
|
|
|
Service Code
|
NDC 69238149001
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.70 |
| Max. Negotiated Rate |
$232.56 |
| Rate for Payer: Aetna American Axle |
$167.96
|
| Rate for Payer: Aetna Commercial |
$219.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.96
|
| Rate for Payer: Cash Price |
$206.72
|
| Rate for Payer: Cofinity Commercial |
$180.88
|
| Rate for Payer: Cofinity Commercial |
$222.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.72
|
| Rate for Payer: Healthscope Commercial |
$232.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.64
|
| Rate for Payer: PHP Commercial |
$219.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.96
|
| Rate for Payer: Priority Health SBD |
$162.79
|
| Rate for Payer: UMR Bronson Commercial |
$113.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.80
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna American Axle |
$260.58
|
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health SBD |
$252.57
|
| Rate for Payer: UMR Bronson Commercial |
$176.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 31382055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health SBD |
$10.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| 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 31382055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health SBD |
$10.23
|
| Rate for Payer: UMR Bronson Commercial |
$6.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 00362901150
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health SBD |
$10.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| 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 |
$6.01 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health SBD |
$10.23
|
| Rate for Payer: UMR Bronson Commercial |
$6.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$36.94
|
|
|
Service Code
|
NDC 00409175250
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna American Axle |
$24.01
|
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: Cash Price |
$29.55
|
| Rate for Payer: Cofinity Commercial |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.40
|
| Rate for Payer: PHP Commercial |
$31.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.01
|
| Rate for Payer: Priority Health SBD |
$23.27
|
| Rate for Payer: UMR Bronson Commercial |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$70.31
|
|
|
Service Code
|
NDC 63323046157
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$63.28 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$35.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: BCBS Complete |
$28.12
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cofinity Commercial |
$49.22
|
| Rate for Payer: Cofinity Commercial |
$60.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.25
|
| Rate for Payer: Healthscope Commercial |
$63.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.30
|
| Rate for Payer: UMR Bronson Commercial |
$26.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$36.94
|
|
|
Service Code
|
NDC 00409175250
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna American Axle |
$24.01
|
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna Medicare |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: BCBS Complete |
$14.78
|
| Rate for Payer: Cash Price |
$29.55
|
| Rate for Payer: Cofinity Commercial |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.40
|
| Rate for Payer: PHP Commercial |
$31.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.01
|
| Rate for Payer: Priority Health SBD |
$23.27
|
| Rate for Payer: UMR Bronson Commercial |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$70.31
|
|
|
Service Code
|
NDC 63323046157
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.94 |
| Max. Negotiated Rate |
$63.28 |
| Rate for Payer: Aetna American Axle |
$45.70
|
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.70
|
| Rate for Payer: Cash Price |
$56.25
|
| Rate for Payer: Cofinity Commercial |
$49.22
|
| Rate for Payer: Cofinity Commercial |
$60.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.25
|
| Rate for Payer: Healthscope Commercial |
$63.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.76
|
| Rate for Payer: PHP Commercial |
$59.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.70
|
| Rate for Payer: Priority Health SBD |
$44.30
|
| Rate for Payer: UMR Bronson Commercial |
$30.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.73
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
NDC 00409904301
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: UMR Bronson Commercial |
$7.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$36.94
|
|
|
Service Code
|
NDC 00409381201
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna American Axle |
$24.01
|
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna Medicare |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: BCBS Complete |
$14.78
|
| Rate for Payer: Cash Price |
$29.55
|
| Rate for Payer: Cofinity Commercial |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.40
|
| Rate for Payer: PHP Commercial |
$31.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.01
|
| Rate for Payer: Priority Health SBD |
$23.27
|
| Rate for Payer: UMR Bronson Commercial |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$36.94
|
|
|
Service Code
|
NDC 00409381201
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna American Axle |
$24.01
|
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: Cash Price |
$29.55
|
| Rate for Payer: Cofinity Commercial |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.40
|
| Rate for Payer: PHP Commercial |
$31.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.01
|
| Rate for Payer: Priority Health SBD |
$23.27
|
| Rate for Payer: UMR Bronson Commercial |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
