|
BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION
|
Facility
|
OP
|
$1,128.77
|
|
|
Service Code
|
HCPCS J0666
|
| Hospital Charge Code |
155788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1,015.89 |
| Rate for Payer: Aetna American Axle |
$733.70
|
| Rate for Payer: Aetna American Axle |
$733.75
|
| Rate for Payer: Aetna Commercial |
$959.51
|
| Rate for Payer: Aetna Commercial |
$959.45
|
| Rate for Payer: Aetna Medicare |
$1.48
|
| Rate for Payer: Aetna Medicare |
$1.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.78
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$1.42
|
| Rate for Payer: BCBS MAPPO |
$1.42
|
| Rate for Payer: BCBS Trust/PPO |
$3.86
|
| Rate for Payer: BCBS Trust/PPO |
$3.86
|
| Rate for Payer: BCN Commercial |
$3.86
|
| Rate for Payer: BCN Commercial |
$3.86
|
| Rate for Payer: BCN Medicare Advantage |
$1.42
|
| Rate for Payer: BCN Medicare Advantage |
$1.42
|
| Rate for Payer: Cash Price |
$903.07
|
| Rate for Payer: Cash Price |
$903.02
|
| Rate for Payer: Cash Price |
$903.07
|
| Rate for Payer: Cash Price |
$903.02
|
| Rate for Payer: Cofinity Commercial |
$790.19
|
| Rate for Payer: Cofinity Commercial |
$790.14
|
| Rate for Payer: Cofinity Commercial |
$970.74
|
| Rate for Payer: Cofinity Commercial |
$970.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$790.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$903.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.42
|
| Rate for Payer: Healthscope Commercial |
$1,015.89
|
| Rate for Payer: Healthscope Commercial |
$1,015.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$790.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$790.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$846.63
|
| Rate for Payer: Mclaren Medicaid |
$0.76
|
| Rate for Payer: Mclaren Medicaid |
$0.76
|
| Rate for Payer: Mclaren Medicare |
$1.42
|
| Rate for Payer: Mclaren Medicare |
$1.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.49
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: Meridian Medicaid |
$0.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$959.51
|
| Rate for Payer: Nomi Health Commercial |
$4.26
|
| Rate for Payer: Nomi Health Commercial |
$4.26
|
| Rate for Payer: PACE Medicare |
$1.35
|
| Rate for Payer: PACE Medicare |
$1.35
|
| Rate for Payer: PACE SWMI |
$1.42
|
| Rate for Payer: PACE SWMI |
$1.42
|
| Rate for Payer: PHP Commercial |
$959.45
|
| Rate for Payer: PHP Commercial |
$959.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.42
|
| Rate for Payer: PHP Medicare Advantage |
$1.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$733.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.18
|
| Rate for Payer: Priority Health Medicare |
$1.42
|
| Rate for Payer: Priority Health Medicare |
$1.42
|
| Rate for Payer: Priority Health Narrow Network |
$3.34
|
| Rate for Payer: Priority Health Narrow Network |
$3.34
|
| Rate for Payer: Priority Health SBD |
$711.13
|
| Rate for Payer: Priority Health SBD |
$711.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1.42
|
| Rate for Payer: Railroad Medicare Medicare |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.42
|
| Rate for Payer: UHC Exchange |
$2.71
|
| Rate for Payer: UHC Exchange |
$2.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.42
|
| Rate for Payer: UHC Medicare Advantage |
$1.42
|
| Rate for Payer: UHCCP Medicaid |
$0.76
|
| Rate for Payer: UHCCP Medicaid |
$0.76
|
| Rate for Payer: UMR Bronson Commercial |
$417.64
|
| Rate for Payer: UMR Bronson Commercial |
$417.67
|
| Rate for Payer: VA VA |
$1.42
|
| Rate for Payer: VA VA |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$846.63
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION (COA)
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
168930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| 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 |
$18.28
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| 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
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION (COA)
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
168930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.20
|
| 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 |
$18.28
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| 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
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$27.41
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$24.67 |
| Rate for Payer: Aetna American Axle |
$17.82
|
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna American Axle |
$18.98
|
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna American Axle |
$10.93
|
| Rate for Payer: Aetna American Axle |
$12.16
|
| Rate for Payer: Aetna American Axle |
$15.27
|
| Rate for Payer: Aetna American Axle |
$17.72
|
| Rate for Payer: Aetna Commercial |
$24.82
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$13.70
|
| Rate for Payer: Aetna Medicare |
$10.88
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Aetna Medicare |
$8.41
|
| Rate for Payer: Aetna Medicare |
$11.74
|
| Rate for Payer: Aetna Medicare |
$13.63
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$15.56
|
| Rate for Payer: Aetna Medicare |
$14.60
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.16
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS Complete |
$7.48
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$8.70
|
| Rate for Payer: BCBS Complete |
$6.73
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: BCBS Complete |
$11.68
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$23.36
|
| Rate for Payer: Cash Price |
$23.36
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$20.44
|
| Rate for Payer: Cofinity Commercial |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Cofinity Commercial |
$15.22
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.36
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$16.84
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$26.28
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$24.82
|
| Rate for Payer: PHP Commercial |
$18.49
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health SBD |
$13.70
|
| Rate for Payer: Priority Health SBD |
$17.27
|
| Rate for Payer: Priority Health SBD |
$18.40
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$17.17
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: Priority Health SBD |
$11.79
|
| Rate for Payer: UMR Bronson Commercial |
$10.14
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: UMR Bronson Commercial |
$6.22
|
| Rate for Payer: UMR Bronson Commercial |
$6.92
|
| Rate for Payer: UMR Bronson Commercial |
$10.80
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.09
|
| Rate for Payer: UMR Bronson Commercial |
$8.05
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$23.49
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.34 |
| Max. Negotiated Rate |
$21.14 |
| Rate for Payer: Aetna American Axle |
$15.27
|
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$17.82
|
| Rate for Payer: Aetna American Axle |
$17.72
|
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna American Axle |
$12.16
|
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$10.93
|
| Rate for Payer: Aetna American Axle |
$18.98
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$24.82
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Commercial |
$14.30
|
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$14.97
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$23.36
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$21.93
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$21.81
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$25.11
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$15.22
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$20.44
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$19.53
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Cofinity Commercial |
$11.77
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$23.57
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$16.84
|
| Rate for Payer: Healthscope Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$24.53
|
| Rate for Payer: Healthscope Commercial |
$24.67
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Healthscope Commercial |
$26.28
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.49
|
| Rate for Payer: PHP Commercial |
$24.82
|
| Rate for Payer: PHP Commercial |
$18.49
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: PHP Commercial |
$15.90
|
| Rate for Payer: PHP Commercial |
$14.30
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$23.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.27
|
| Rate for Payer: Priority Health SBD |
$10.60
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$18.40
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: Priority Health SBD |
$11.79
|
| Rate for Payer: Priority Health SBD |
$17.17
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$17.27
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: Priority Health SBD |
$13.70
|
| Rate for Payer: UMR Bronson Commercial |
$9.46
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: UMR Bronson Commercial |
$11.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: UMR Bronson Commercial |
$12.85
|
| Rate for Payer: UMR Bronson Commercial |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$12.06
|
| Rate for Payer: UMR Bronson Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.62
|
|
|
BUPIVACAINE (PF) 0.25 % INJECTION (NO LABEL)
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
161537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| 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 |
$18.28
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| 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
|
|
|
BUPIVACAINE (PF) 0.25 % INJECTION (NO LABEL)
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
161537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.20
|
| 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 |
$18.28
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| 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
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Aetna American Axle |
$13.54
|
| Rate for Payer: Aetna American Axle |
$19.53
|
| Rate for Payer: Aetna American Axle |
$10.10
|
| Rate for Payer: Aetna American Axle |
$11.88
|
| Rate for Payer: Aetna American Axle |
$14.09
|
| Rate for Payer: Aetna American Axle |
$9.33
|
| Rate for Payer: Aetna American Axle |
$9.77
|
| Rate for Payer: Aetna American Axle |
$13.29
|
| Rate for Payer: Aetna American Axle |
$15.02
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$19.64
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$18.43
|
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna Medicare |
$10.84
|
| Rate for Payer: Aetna Medicare |
$9.14
|
| Rate for Payer: Aetna Medicare |
$7.52
|
| Rate for Payer: Aetna Medicare |
$7.18
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna Medicare |
$7.77
|
| Rate for Payer: Aetna Medicare |
$15.02
|
| Rate for Payer: Aetna Medicare |
$10.42
|
| Rate for Payer: Aetna Medicare |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: BCBS Complete |
$8.33
|
| Rate for Payer: BCBS Complete |
$7.31
|
| Rate for Payer: BCBS Complete |
$8.67
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Complete |
$12.02
|
| Rate for Payer: BCBS Complete |
$9.24
|
| Rate for Payer: BCBS Complete |
$6.22
|
| Rate for Payer: BCBS Complete |
$5.74
|
| Rate for Payer: BCBS Complete |
$6.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$14.58
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Cofinity Commercial |
$10.52
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Cofinity Commercial |
$10.05
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$12.93
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Healthscope Commercial |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$27.04
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.43
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: PHP Commercial |
$18.43
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$19.64
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.33
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$11.51
|
| Rate for Payer: Priority Health SBD |
$13.12
|
| Rate for Payer: Priority Health SBD |
$9.05
|
| Rate for Payer: Priority Health SBD |
$9.79
|
| Rate for Payer: Priority Health SBD |
$18.93
|
| Rate for Payer: Priority Health SBD |
$13.66
|
| Rate for Payer: Priority Health SBD |
$9.47
|
| Rate for Payer: Priority Health SBD |
$14.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.02
|
| Rate for Payer: UMR Bronson Commercial |
$5.75
|
| Rate for Payer: UMR Bronson Commercial |
$5.31
|
| Rate for Payer: UMR Bronson Commercial |
$7.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.76
|
| Rate for Payer: UMR Bronson Commercial |
$11.11
|
| Rate for Payer: UMR Bronson Commercial |
$5.56
|
| Rate for Payer: UMR Bronson Commercial |
$7.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.34
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$18.27
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.04 |
| Max. Negotiated Rate |
$16.44 |
| Rate for Payer: Aetna American Axle |
$15.02
|
| Rate for Payer: Aetna American Axle |
$13.29
|
| Rate for Payer: Aetna American Axle |
$14.09
|
| Rate for Payer: Aetna American Axle |
$13.54
|
| Rate for Payer: Aetna American Axle |
$9.33
|
| Rate for Payer: Aetna American Axle |
$9.77
|
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: Aetna Commercial |
$12.78
|
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Commercial |
$19.64
|
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$15.53
|
| Rate for Payer: Aetna Commercial |
$18.43
|
| Rate for Payer: Aetna American Axle |
$11.88
|
| Rate for Payer: Aetna American Axle |
$19.53
|
| Rate for Payer: Aetna American Axle |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Cash Price |
$14.62
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$12.43
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cofinity Commercial |
$13.36
|
| Rate for Payer: Cofinity Commercial |
$10.05
|
| Rate for Payer: Cofinity Commercial |
$15.71
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Cofinity Commercial |
$10.88
|
| Rate for Payer: Cofinity Commercial |
$10.52
|
| Rate for Payer: Cofinity Commercial |
$12.93
|
| Rate for Payer: Cofinity Commercial |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Cofinity Commercial |
$19.87
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| Rate for Payer: Cofinity Commercial |
$14.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.62
|
| Rate for Payer: Healthscope Commercial |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$27.04
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$18.75
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$16.44
|
| Rate for Payer: Healthscope Commercial |
$13.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$19.64
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$18.43
|
| Rate for Payer: PHP Commercial |
$13.21
|
| Rate for Payer: PHP Commercial |
$15.53
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: Priority Health SBD |
$9.05
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$11.51
|
| Rate for Payer: Priority Health SBD |
$18.93
|
| Rate for Payer: Priority Health SBD |
$13.66
|
| Rate for Payer: Priority Health SBD |
$9.79
|
| Rate for Payer: Priority Health SBD |
$9.47
|
| Rate for Payer: Priority Health SBD |
$13.12
|
| Rate for Payer: Priority Health SBD |
$14.55
|
| Rate for Payer: UMR Bronson Commercial |
$9.17
|
| Rate for Payer: UMR Bronson Commercial |
$10.16
|
| Rate for Payer: UMR Bronson Commercial |
$13.22
|
| Rate for Payer: UMR Bronson Commercial |
$6.61
|
| Rate for Payer: UMR Bronson Commercial |
$6.84
|
| Rate for Payer: UMR Bronson Commercial |
$6.32
|
| Rate for Payer: UMR Bronson Commercial |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$8.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.26
|
|
|
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 |
$23.72
|
| 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 |
$20.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: PHP Commercial |
$23.72
|
| 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 |
$20.92
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$19.75
|
|
|
Service Code
|
NDC 36000009201
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$17.78 |
| 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 |
$17.78
|
| 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
|
OP
|
$85.01
|
|
|
Service Code
|
NDC 09900001084
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.45 |
| Max. Negotiated Rate |
$76.51 |
| Rate for Payer: Aetna American Axle |
$55.26
|
| Rate for Payer: Aetna Commercial |
$72.26
|
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.26
|
| Rate for Payer: BCBS Complete |
$34.00
|
| 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 |
$31.45
|
| 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
|
$19.75
|
|
|
Service Code
|
NDC 36000009201
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$17.78 |
| 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 |
$17.78
|
| 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
|
$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 |
$14.08
|
| 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
|
IP
|
$19.75
|
|
|
Service Code
|
NDC 36000009210
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$17.78 |
| 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 |
$17.78
|
| 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
|
$19.75
|
|
|
Service Code
|
NDC 36000009210
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$17.78 |
| 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 |
$17.78
|
| 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
|
$28.17
|
|
|
Service Code
|
NDC 00409176102
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna American Axle |
$18.31
|
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.31
|
| 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 |
$12.39
|
| 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
|
$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 |
$23.72
|
| 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 |
$20.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.72
|
| Rate for Payer: PHP Commercial |
$23.72
|
| 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 |
$20.92
|
|
|
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) 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 |
$14.06
|
| 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 |
$14.06
|
| 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
|
$31.11
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$17.61
|
| Rate for Payer: Aetna American Axle |
$10.44
|
| Rate for Payer: Aetna American Axle |
$12.18
|
| Rate for Payer: Aetna American Axle |
$10.68
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$23.03
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$8.22
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna Medicare |
$9.37
|
| Rate for Payer: Aetna Medicare |
$15.56
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna Medicare |
$8.03
|
| Rate for Payer: Aetna Medicare |
$13.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.68
|
| 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) |
$17.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: BCBS Complete |
$12.44
|
| Rate for Payer: BCBS Complete |
$10.84
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS Complete |
$6.42
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$23.30
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$11.24
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Commercial |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.24
|
| 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 |
$18.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| 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 |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.85
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$24.38
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| 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 |
$13.12
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| 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 |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$23.03
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$16.80
|
| 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 |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health 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 SBD |
$10.12
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$10.35
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: Priority Health SBD |
$17.07
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: UMR Bronson Commercial |
$10.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: UMR Bronson Commercial |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$6.08
|
| Rate for Payer: UMR Bronson Commercial |
$5.94
|
| Rate for Payer: UMR Bronson Commercial |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.06
|
| 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 |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
|
|
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 |
$3.82
|
| 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 |
$3.82
|
| Rate for Payer: PHP Commercial |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.84
|
| 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 |
$1.66 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna American Axle |
$2.92
|
| Rate for Payer: Aetna Commercial |
$3.82
|
| 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 |
$3.82
|
| Rate for Payer: PHP Commercial |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.92
|
| Rate for Payer: Priority Health SBD |
$2.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.66
|
| 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 |
$0.03 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.20
|
| 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 |
$18.28
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| 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 |
$13.98
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| 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 |
$18.28
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.98
|
| 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
|
|
