|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.57
|
|
|
Service Code
|
NDC 00409174671
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna American Axle |
$14.67
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| 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 |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$43.93
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.33 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna American Axle |
$28.55
|
| Rate for Payer: Aetna Commercial |
$37.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.55
|
| 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 |
$19.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.95
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$24.57
|
|
|
Service Code
|
NDC 00409174670
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna American Axle |
$15.97
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.97
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$21.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.97
|
| Rate for Payer: Priority Health SBD |
$15.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$43.93
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$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
|
IP
|
$24.57
|
|
|
Service Code
|
NDC 00409174610
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna American Axle |
$15.97
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.97
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$21.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.97
|
| Rate for Payer: Priority Health SBD |
$15.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.57
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna American Axle |
$14.67
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| 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 |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$27.73
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna American Axle |
$18.02
|
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Medicare |
$13.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.02
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health SBD |
$17.47
|
| Rate for Payer: UMR Bronson Commercial |
$10.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$27.73
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.20 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna American Axle |
$18.02
|
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.02
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health SBD |
$17.47
|
| Rate for Payer: UMR Bronson Commercial |
$12.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$17.10
|
|
|
Service Code
|
NDC 00409904217
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$15.39 |
| Rate for Payer: Aetna American Axle |
$11.12
|
| Rate for Payer: Aetna Commercial |
$14.54
|
| Rate for Payer: Aetna Medicare |
$8.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.12
|
| Rate for Payer: BCBS Complete |
$6.84
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$15.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.12
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: UMR Bronson Commercial |
$6.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$17.10
|
|
|
Service Code
|
NDC 00409904217
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$15.39 |
| Rate for Payer: Aetna American Axle |
$11.12
|
| Rate for Payer: Aetna Commercial |
$14.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.12
|
| Rate for Payer: Cash Price |
$13.68
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Cofinity Commercial |
$14.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.68
|
| Rate for Payer: Healthscope Commercial |
$15.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.54
|
| Rate for Payer: PHP Commercial |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.12
|
| Rate for Payer: Priority Health SBD |
$10.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.82
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$25.76
|
|
|
Service Code
|
NDC 00409904201
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna American Axle |
$16.74
|
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Medicare |
$12.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.74
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health SBD |
$16.23
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$25.76
|
|
|
Service Code
|
NDC 00409904201
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna American Axle |
$16.74
|
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.74
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health SBD |
$16.23
|
| Rate for Payer: UMR Bronson Commercial |
$11.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$22.57
|
|
|
Service Code
|
NDC 00409174630
|
| 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
|
|
|
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
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.03
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna American Axle |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UMR Bronson Commercial |
$7.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 00409174970
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna American Axle |
$14.48
|
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: BCBS Complete |
$8.91
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: UMR Bronson Commercial |
$8.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$47.26
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Aetna American Axle |
$30.72
|
| Rate for Payer: Aetna Commercial |
$40.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.72
|
| Rate for Payer: Cash Price |
$37.81
|
| Rate for Payer: Cofinity Commercial |
$33.08
|
| Rate for Payer: Cofinity Commercial |
$40.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.81
|
| Rate for Payer: Healthscope Commercial |
$42.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.17
|
| Rate for Payer: PHP Commercial |
$40.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.72
|
| Rate for Payer: Priority Health SBD |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$20.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.45
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 00409812610
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.76
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
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 |
$17.49 |
| Max. Negotiated Rate |
$42.53 |
| Rate for Payer: Aetna American Axle |
$30.72
|
| Rate for Payer: Aetna Commercial |
$40.17
|
| Rate for Payer: Aetna Medicare |
$23.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.72
|
| Rate for Payer: BCBS Complete |
$18.90
|
| Rate for Payer: Cash Price |
$37.81
|
| Rate for Payer: Cofinity Commercial |
$33.08
|
| Rate for Payer: Cofinity Commercial |
$40.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.81
|
| Rate for Payer: Healthscope Commercial |
$42.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.17
|
| Rate for Payer: PHP Commercial |
$40.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.72
|
| Rate for Payer: Priority Health SBD |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$17.49
|
| 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 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna American Axle |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Commercial |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.02
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 00409812601
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.76
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
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 |
$9.80 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna American Axle |
$14.48
|
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| 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 |
$12.51 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna American Axle |
$18.49
|
| Rate for Payer: Aetna Commercial |
$24.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.49
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$24.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.75
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.17
|
| Rate for Payer: PHP Commercial |
$24.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health SBD |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$12.51
|
| 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 00409174970
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna American Axle |
$14.48
|
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
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 |
$10.52 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna American Axle |
$18.49
|
| Rate for Payer: Aetna Commercial |
$24.17
|
| Rate for Payer: Aetna Medicare |
$14.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.49
|
| Rate for Payer: BCBS Complete |
$11.38
|
| Rate for Payer: Cash Price |
$22.75
|
| Rate for Payer: Cofinity Commercial |
$19.91
|
| Rate for Payer: Cofinity Commercial |
$24.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.75
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.17
|
| Rate for Payer: PHP Commercial |
$24.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health SBD |
$17.92
|
| Rate for Payer: UMR Bronson Commercial |
$10.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.33
|
|
