|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$19.75
|
|
|
Service Code
|
NDC 36000009210
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna Commercial |
$16.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$16.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$17.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.79
|
| Rate for Payer: PHP Commercial |
$16.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health SBD |
$12.44
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.81
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$27.90
|
|
|
Service Code
|
NDC 63323047302
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$28.17
|
|
|
Service Code
|
NDC 00409176102
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna American Axle |
$18.31
|
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: Aetna Medicare |
$14.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.31
|
| Rate for Payer: BCBS Complete |
$11.27
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Healthscope Commercial |
$25.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.94
|
| Rate for Payer: PHP Commercial |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.31
|
| Rate for Payer: Priority Health SBD |
$17.75
|
| Rate for Payer: UMR Bronson Commercial |
$10.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.13
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$19.75
|
|
|
Service Code
|
NDC 36000009210
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$17.77 |
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna Commercial |
$16.79
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$13.82
|
| Rate for Payer: Cofinity Commercial |
$16.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$17.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.79
|
| Rate for Payer: PHP Commercial |
$16.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health SBD |
$12.44
|
| Rate for Payer: UMR Bronson Commercial |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.81
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$85.01
|
|
|
Service Code
|
NDC 09900001084
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$76.51 |
| Rate for Payer: Aetna American Axle |
$55.26
|
| Rate for Payer: Aetna Commercial |
$72.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.26
|
| Rate for Payer: Cash Price |
$68.01
|
| Rate for Payer: Cofinity Commercial |
$59.51
|
| Rate for Payer: Cofinity Commercial |
$73.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.01
|
| Rate for Payer: Healthscope Commercial |
$76.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.26
|
| Rate for Payer: PHP Commercial |
$72.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.26
|
| Rate for Payer: Priority Health SBD |
$53.56
|
| Rate for Payer: UMR Bronson Commercial |
$37.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.76
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$27.90
|
|
|
Service Code
|
NDC 63323047302
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$30.71
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$27.64 |
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna American Axle |
$17.61
|
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna American Axle |
$12.18
|
| Rate for Payer: Aetna American Axle |
$10.44
|
| Rate for Payer: Aetna American Axle |
$10.68
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$24.38
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$23.03
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.18
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$10.35
|
| Rate for Payer: Priority Health SBD |
$10.12
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$17.07
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: UMR Bronson Commercial |
$8.25
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$11.92
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: UMR Bronson Commercial |
$7.23
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: UMR Bronson Commercial |
$10.15
|
| Rate for Payer: UMR Bronson Commercial |
$7.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$27.09
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$24.38 |
| Rate for Payer: Aetna American Axle |
$17.61
|
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna American Axle |
$12.18
|
| Rate for Payer: Aetna American Axle |
$10.68
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$10.44
|
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Medicare |
$9.37
|
| Rate for Payer: Aetna Medicare |
$8.03
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$8.21
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Aetna Medicare |
$15.55
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.61
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Complete |
$10.84
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$24.38
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$23.03
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health SBD |
$10.12
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$10.35
|
| Rate for Payer: Priority Health SBD |
$17.07
|
| Rate for Payer: UMR Bronson Commercial |
$10.02
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$6.08
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: UMR Bronson Commercial |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$6.93
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
BUPIVACAINE WITH EPINEPHRINE IN NS
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 99000000204
|
| Hospital Charge Code |
158462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna American Axle |
$2.92
|
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.92
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$4.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
BUPIVACAINE WITH EPINEPHRINE IN NS
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 99000000204
|
| Hospital Charge Code |
158462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna American Axle |
$2.92
|
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.92
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.60
|
| Rate for Payer: Healthscope Commercial |
$4.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
BUPIVICAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION (OSC)
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
180415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.97
|
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.97
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
BUPIVICAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION (OSC)
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
180415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.97
|
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.97
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.97
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: UMR Bronson Commercial |
$9.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$182.93
|
|
|
Service Code
|
NDC 00093365721
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$164.64 |
| Rate for Payer: Aetna American Axle |
$118.90
|
| Rate for Payer: Aetna Commercial |
$155.49
|
| Rate for Payer: Aetna Medicare |
$91.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.90
|
| Rate for Payer: BCBS Complete |
$73.17
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Cofinity Commercial |
$128.05
|
| Rate for Payer: Cofinity Commercial |
$157.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.34
|
| Rate for Payer: Healthscope Commercial |
$164.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.49
|
| Rate for Payer: PHP Commercial |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.90
|
| Rate for Payer: Priority Health SBD |
$115.25
|
| Rate for Payer: UMR Bronson Commercial |
$67.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.20
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$182.93
|
|
|
Service Code
|
NDC 00093365721
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$164.64 |
| Rate for Payer: Aetna American Axle |
$118.90
|
| Rate for Payer: Aetna Commercial |
$155.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.90
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Cofinity Commercial |
$128.05
|
| Rate for Payer: Cofinity Commercial |
$157.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.34
|
| Rate for Payer: Healthscope Commercial |
$164.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.49
|
| Rate for Payer: PHP Commercial |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.90
|
| Rate for Payer: Priority Health SBD |
$115.25
|
| Rate for Payer: UMR Bronson Commercial |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.20
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$731.69
|
|
|
Service Code
|
NDC 00093365740
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.73 |
| Max. Negotiated Rate |
$658.52 |
| Rate for Payer: Aetna American Axle |
$475.60
|
| Rate for Payer: Aetna Commercial |
$621.94
|
| Rate for Payer: Aetna Medicare |
$365.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.60
|
| Rate for Payer: BCBS Complete |
$292.68
|
| Rate for Payer: Cash Price |
$585.35
|
| Rate for Payer: Cofinity Commercial |
$512.18
|
| Rate for Payer: Cofinity Commercial |
$629.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$512.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.35
|
| Rate for Payer: Healthscope Commercial |
$658.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$512.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.94
|
| Rate for Payer: PHP Commercial |
$621.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.60
|
| Rate for Payer: Priority Health SBD |
$460.96
|
| Rate for Payer: UMR Bronson Commercial |
$270.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.77
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$731.69
|
|
|
Service Code
|
NDC 00093365740
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$658.52 |
| Rate for Payer: Aetna American Axle |
$475.60
|
| Rate for Payer: Aetna Commercial |
$621.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.60
|
| Rate for Payer: Cash Price |
$585.35
|
| Rate for Payer: Cofinity Commercial |
$512.18
|
| Rate for Payer: Cofinity Commercial |
$629.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$512.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.35
|
| Rate for Payer: Healthscope Commercial |
$658.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$512.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.94
|
| Rate for Payer: PHP Commercial |
$621.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.60
|
| Rate for Payer: Priority Health SBD |
$460.96
|
| Rate for Payer: UMR Bronson Commercial |
$321.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.77
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$428.58
|
|
|
Service Code
|
NDC 00093365921
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.57 |
| Max. Negotiated Rate |
$385.72 |
| Rate for Payer: Aetna American Axle |
$278.58
|
| Rate for Payer: Aetna Commercial |
$364.29
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.58
|
| Rate for Payer: BCBS Complete |
$171.43
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Cofinity Commercial |
$300.01
|
| Rate for Payer: Cofinity Commercial |
$368.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.86
|
| Rate for Payer: Healthscope Commercial |
$385.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.29
|
| Rate for Payer: PHP Commercial |
$364.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.58
|
| Rate for Payer: Priority Health SBD |
$270.01
|
| Rate for Payer: UMR Bronson Commercial |
$158.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.44
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,714.29
|
|
|
Service Code
|
NDC 00093365940
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$754.29 |
| Max. Negotiated Rate |
$1,542.86 |
| Rate for Payer: Aetna American Axle |
$1,114.29
|
| Rate for Payer: Aetna Commercial |
$1,457.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,114.29
|
| Rate for Payer: Cash Price |
$1,371.43
|
| Rate for Payer: Cofinity Commercial |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,474.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,200.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,371.43
|
| Rate for Payer: Healthscope Commercial |
$1,542.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,200.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,285.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,457.15
|
| Rate for Payer: PHP Commercial |
$1,457.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,114.29
|
| Rate for Payer: Priority Health SBD |
$1,080.00
|
| Rate for Payer: UMR Bronson Commercial |
$754.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,285.72
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$428.58
|
|
|
Service Code
|
NDC 00093365921
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.58 |
| Max. Negotiated Rate |
$385.72 |
| Rate for Payer: Aetna American Axle |
$278.58
|
| Rate for Payer: Aetna Commercial |
$364.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.58
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Cofinity Commercial |
$300.01
|
| Rate for Payer: Cofinity Commercial |
$368.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.86
|
| Rate for Payer: Healthscope Commercial |
$385.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.29
|
| Rate for Payer: PHP Commercial |
$364.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.58
|
| Rate for Payer: Priority Health SBD |
$270.01
|
| Rate for Payer: UMR Bronson Commercial |
$188.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.44
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$1,714.29
|
|
|
Service Code
|
NDC 00093365940
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$634.29 |
| Max. Negotiated Rate |
$1,542.86 |
| Rate for Payer: Aetna American Axle |
$1,114.29
|
| Rate for Payer: Aetna Commercial |
$1,457.15
|
| Rate for Payer: Aetna Medicare |
$857.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,114.29
|
| Rate for Payer: BCBS Complete |
$685.72
|
| Rate for Payer: Cash Price |
$1,371.43
|
| Rate for Payer: Cofinity Commercial |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,474.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,200.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,371.43
|
| Rate for Payer: Healthscope Commercial |
$1,542.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,200.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,285.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,457.15
|
| Rate for Payer: PHP Commercial |
$1,457.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,114.29
|
| Rate for Payer: Priority Health SBD |
$1,080.00
|
| Rate for Payer: UMR Bronson Commercial |
$634.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,285.72
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$180.81
|
|
|
Service Code
|
NDC 00054018813
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$162.73 |
| Rate for Payer: Aetna American Axle |
$117.53
|
| Rate for Payer: Aetna Commercial |
$153.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.53
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Cofinity Commercial |
$126.57
|
| Rate for Payer: Cofinity Commercial |
$155.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.65
|
| Rate for Payer: Healthscope Commercial |
$162.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.69
|
| Rate for Payer: PHP Commercial |
$153.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.53
|
| Rate for Payer: Priority Health SBD |
$113.91
|
| Rate for Payer: UMR Bronson Commercial |
$79.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.61
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$392.73
|
|
|
Service Code
|
NDC 50268014415
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$353.46 |
| Rate for Payer: Aetna American Axle |
$255.27
|
| Rate for Payer: Aetna Commercial |
$333.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.27
|
| Rate for Payer: Cash Price |
$314.18
|
| Rate for Payer: Cofinity Commercial |
$274.91
|
| Rate for Payer: Cofinity Commercial |
$337.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.18
|
| Rate for Payer: Healthscope Commercial |
$353.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.82
|
| Rate for Payer: PHP Commercial |
$333.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.27
|
| Rate for Payer: Priority Health SBD |
$247.42
|
| Rate for Payer: UMR Bronson Commercial |
$172.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.55
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.97 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna American Axle |
$416.55
|
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.55
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$448.60
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health SBD |
$403.74
|
| Rate for Payer: UMR Bronson Commercial |
$281.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.64
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.11 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna American Axle |
$416.55
|
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: Aetna Medicare |
$320.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.55
|
| Rate for Payer: BCBS Complete |
$256.34
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$448.60
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health SBD |
$403.74
|
| Rate for Payer: UMR Bronson Commercial |
$237.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.64
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$217.14
|
|
|
Service Code
|
NDC 65162041603
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.54 |
| Max. Negotiated Rate |
$195.43 |
| Rate for Payer: Aetna American Axle |
$141.14
|
| Rate for Payer: Aetna Commercial |
$184.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.14
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.71
|
| Rate for Payer: Healthscope Commercial |
$195.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.57
|
| Rate for Payer: PHP Commercial |
$184.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.14
|
| Rate for Payer: Priority Health SBD |
$136.80
|
| Rate for Payer: UMR Bronson Commercial |
$95.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.85
|
|
