|
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
|
|
|
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
|
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
|
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
|
$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
|
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 |
$17.59
|
| 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 |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$17.59
|
| 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 |
$15.53
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
NDC 00409904301
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| 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 |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.46
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
|
|
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
|
|
|
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
|
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 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$43.39
|
|
|
Service Code
|
NDC 00409175550
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$39.05 |
| Rate for Payer: Aetna American Axle |
$28.20
|
| Rate for Payer: Aetna Commercial |
$36.88
|
| Rate for Payer: Aetna Medicare |
$21.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.20
|
| Rate for Payer: BCBS Complete |
$17.36
|
| Rate for Payer: Cash Price |
$34.71
|
| Rate for Payer: Cofinity Commercial |
$30.37
|
| Rate for Payer: Cofinity Commercial |
$37.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$39.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.88
|
| Rate for Payer: PHP Commercial |
$36.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health SBD |
$27.34
|
| Rate for Payer: UMR Bronson Commercial |
$16.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.54
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
NDC 00409904611
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$18.03
|
|
|
Service Code
|
NDC 00409904601
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$75.43
|
|
|
Service Code
|
NDC 63323046301
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.19 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Aetna American Axle |
$49.03
|
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.03
|
| Rate for Payer: Cash Price |
$60.34
|
| Rate for Payer: Cofinity Commercial |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$64.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.34
|
| Rate for Payer: Healthscope Commercial |
$67.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.03
|
| Rate for Payer: Priority Health SBD |
$47.52
|
| Rate for Payer: UMR Bronson Commercial |
$33.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.57
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$43.39
|
|
|
Service Code
|
NDC 00409175550
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$39.05 |
| Rate for Payer: Aetna American Axle |
$28.20
|
| Rate for Payer: Aetna Commercial |
$36.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.20
|
| Rate for Payer: Cash Price |
$34.71
|
| Rate for Payer: Cofinity Commercial |
$30.37
|
| Rate for Payer: Cofinity Commercial |
$37.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$39.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.88
|
| Rate for Payer: PHP Commercial |
$36.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.20
|
| Rate for Payer: Priority Health SBD |
$27.34
|
| Rate for Payer: UMR Bronson Commercial |
$19.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.54
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
NDC 00409904601
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$75.43
|
|
|
Service Code
|
NDC 63323046301
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.91 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Aetna American Axle |
$49.03
|
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.03
|
| Rate for Payer: BCBS Complete |
$30.17
|
| Rate for Payer: Cash Price |
$60.34
|
| Rate for Payer: Cofinity Commercial |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$64.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.34
|
| Rate for Payer: Healthscope Commercial |
$67.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.03
|
| Rate for Payer: Priority Health SBD |
$47.52
|
| Rate for Payer: UMR Bronson Commercial |
$27.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.57
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$18.03
|
|
|
Service Code
|
NDC 00409904611
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Medicare |
$9.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.72
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$75.43
|
|
|
Service Code
|
NDC 63323046357
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.19 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Aetna American Axle |
$49.03
|
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.03
|
| Rate for Payer: Cash Price |
$60.34
|
| Rate for Payer: Cofinity Commercial |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$64.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.34
|
| Rate for Payer: Healthscope Commercial |
$67.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.03
|
| Rate for Payer: Priority Health SBD |
$47.52
|
| Rate for Payer: UMR Bronson Commercial |
$33.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.57
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$75.43
|
|
|
Service Code
|
NDC 63323046357
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.91 |
| Max. Negotiated Rate |
$67.89 |
| Rate for Payer: Aetna American Axle |
$49.03
|
| Rate for Payer: Aetna Commercial |
$64.12
|
| Rate for Payer: Aetna Medicare |
$37.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.03
|
| Rate for Payer: BCBS Complete |
$30.17
|
| Rate for Payer: Cash Price |
$60.34
|
| Rate for Payer: Cofinity Commercial |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$64.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.34
|
| Rate for Payer: Healthscope Commercial |
$67.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.12
|
| Rate for Payer: PHP Commercial |
$64.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.03
|
| Rate for Payer: Priority Health SBD |
$47.52
|
| Rate for Payer: UMR Bronson Commercial |
$27.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.57
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$43.93
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna American Axle |
$28.55
|
| Rate for Payer: Aetna Commercial |
$37.34
|
| Rate for Payer: Aetna Medicare |
$21.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.55
|
| Rate for Payer: BCBS Complete |
$17.57
|
| Rate for Payer: Cash Price |
$35.14
|
| Rate for Payer: Cofinity Commercial |
$30.75
|
| Rate for Payer: Cofinity Commercial |
$37.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.14
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.34
|
| Rate for Payer: PHP Commercial |
$37.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.55
|
| Rate for Payer: Priority Health SBD |
$27.68
|
| Rate for Payer: UMR Bronson Commercial |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.95
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$22.57
|
|
|
Service Code
|
NDC 00409174671
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna American Axle |
$14.67
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Commercial |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.67
|
| Rate for Payer: Priority Health SBD |
$14.22
|
| Rate for Payer: UMR Bronson Commercial |
$8.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
