|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$213.12
|
|
|
Service Code
|
NDC 50268-130-15
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$191.81 |
| Rate for Payer: Aetna American Axle |
$138.53
|
| Rate for Payer: Aetna Commercial |
$181.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.53
|
| Rate for Payer: Cash Price |
$170.50
|
| Rate for Payer: Cofinity Commercial |
$149.18
|
| Rate for Payer: Cofinity Commercial |
$183.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.50
|
| Rate for Payer: Healthscope Commercial |
$191.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$149.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$181.15
|
| Rate for Payer: PHP Commercial |
$181.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.18
|
| Rate for Payer: Priority Health SBD |
$134.27
|
| Rate for Payer: UMR Bronson Commercial |
$93.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.84
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$299.25
|
|
|
Service Code
|
NDC 69238-1489-1
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$269.32 |
| Rate for Payer: Aetna American Axle |
$194.51
|
| Rate for Payer: Aetna Commercial |
$254.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.51
|
| Rate for Payer: Cash Price |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$209.48
|
| Rate for Payer: Cofinity Commercial |
$257.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.40
|
| Rate for Payer: Healthscope Commercial |
$269.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$209.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$224.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.36
|
| Rate for Payer: PHP Commercial |
$254.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.48
|
| Rate for Payer: Priority Health SBD |
$188.53
|
| Rate for Payer: UMR Bronson Commercial |
$131.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$224.44
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 50268-130-11
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna American Axle |
$2.78
|
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.63
|
| Rate for Payer: PHP Commercial |
$3.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.99
|
| Rate for Payer: Priority Health SBD |
$2.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.20
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 0185-0128-01
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.24 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$278.64
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$338.34
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.64
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$175.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 42799-120-01
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna American Axle |
$195.13
|
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.13
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$210.14
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.17
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.14
|
| Rate for Payer: Priority Health SBD |
$189.13
|
| Rate for Payer: UMR Bronson Commercial |
$132.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 0185-0129-01
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna American Axle |
$260.58
|
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$340.76
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.63
|
| Rate for Payer: Priority Health SBD |
$252.57
|
| Rate for Payer: UMR Bronson Commercial |
$176.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$387.36
|
|
|
Service Code
|
NDC 0904-7016-61
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.44 |
| Max. Negotiated Rate |
$348.62 |
| Rate for Payer: Aetna American Axle |
$251.78
|
| Rate for Payer: Aetna Commercial |
$329.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.78
|
| Rate for Payer: Cash Price |
$309.89
|
| Rate for Payer: Cofinity Commercial |
$271.15
|
| Rate for Payer: Cofinity Commercial |
$333.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.89
|
| Rate for Payer: Healthscope Commercial |
$348.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.26
|
| Rate for Payer: PHP Commercial |
$329.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.15
|
| Rate for Payer: Priority Health SBD |
$244.04
|
| Rate for Payer: UMR Bronson Commercial |
$170.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.52
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 69238-1490-1
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.49 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna American Axle |
$291.75
|
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.75
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$314.20
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$314.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.52
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.20
|
| Rate for Payer: Priority Health SBD |
$282.78
|
| Rate for Payer: UMR Bronson Commercial |
$197.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 0362-9011-50
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.80
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.37
|
| Rate for Payer: Priority Health SBD |
$10.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 31382-557-05
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.80
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.37
|
| Rate for Payer: Priority Health SBD |
$10.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$35.16
|
|
|
Service Code
|
NDC 0409-3812-01
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna American Axle |
$22.85
|
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.85
|
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Cofinity Commercial |
$24.61
|
| Rate for Payer: Cofinity Commercial |
$30.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$31.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.61
|
| Rate for Payer: Priority Health SBD |
$22.15
|
| Rate for Payer: UMR Bronson Commercial |
$15.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.37
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$64.75
|
|
|
Service Code
|
NDC 63323-461-57
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$58.28 |
| Rate for Payer: Aetna American Axle |
$42.09
|
| Rate for Payer: Aetna Commercial |
$55.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: Cash Price |
$51.80
|
| Rate for Payer: Cofinity Commercial |
$45.32
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.80
|
| Rate for Payer: Healthscope Commercial |
$58.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.04
|
| Rate for Payer: PHP Commercial |
$55.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.32
|
| Rate for Payer: Priority Health SBD |
$40.79
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.56
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$35.16
|
|
|
Service Code
|
NDC 0409-1752-50
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$31.64 |
| Rate for Payer: Aetna American Axle |
$22.85
|
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.85
|
| Rate for Payer: Cash Price |
$28.13
|
| Rate for Payer: Cofinity Commercial |
$24.61
|
| Rate for Payer: Cofinity Commercial |
$30.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$31.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.89
|
| Rate for Payer: PHP Commercial |
$29.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.61
|
| Rate for Payer: Priority Health SBD |
$22.15
|
| Rate for Payer: UMR Bronson Commercial |
$15.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.37
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
NDC 0409-9043-01
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna American Axle |
$13.46
|
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.60
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$69.20
|
|
|
Service Code
|
NDC 63323-463-01
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$62.28 |
| Rate for Payer: Aetna American Axle |
$44.98
|
| Rate for Payer: Aetna Commercial |
$58.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.98
|
| Rate for Payer: Cash Price |
$55.36
|
| Rate for Payer: Cofinity Commercial |
$48.44
|
| Rate for Payer: Cofinity Commercial |
$59.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.36
|
| Rate for Payer: Healthscope Commercial |
$62.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.82
|
| Rate for Payer: PHP Commercial |
$58.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.44
|
| Rate for Payer: Priority Health SBD |
$43.60
|
| Rate for Payer: UMR Bronson Commercial |
$30.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.90
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
NDC 0409-9046-01
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$69.20
|
|
|
Service Code
|
NDC 63323-463-57
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$62.28 |
| Rate for Payer: Aetna American Axle |
$44.98
|
| Rate for Payer: Aetna Commercial |
$58.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.98
|
| Rate for Payer: Cash Price |
$55.36
|
| Rate for Payer: Cofinity Commercial |
$48.44
|
| Rate for Payer: Cofinity Commercial |
$59.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.36
|
| Rate for Payer: Healthscope Commercial |
$62.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.82
|
| Rate for Payer: PHP Commercial |
$58.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.44
|
| Rate for Payer: Priority Health SBD |
$43.60
|
| Rate for Payer: UMR Bronson Commercial |
$30.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.90
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$18.03
|
|
|
Service Code
|
NDC 0409-9046-11
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.33
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$41.39
|
|
|
Service Code
|
NDC 0409-1755-50
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$37.25 |
| Rate for Payer: Aetna American Axle |
$26.90
|
| Rate for Payer: Aetna Commercial |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.90
|
| Rate for Payer: Cash Price |
$33.11
|
| Rate for Payer: Cofinity Commercial |
$28.97
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.11
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.18
|
| Rate for Payer: PHP Commercial |
$35.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.97
|
| Rate for Payer: Priority Health SBD |
$26.08
|
| Rate for Payer: UMR Bronson Commercial |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.04
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$23.39
|
|
|
Service Code
|
NDC 0409-1746-70
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna American Axle |
$15.20
|
| Rate for Payer: Aetna Commercial |
$19.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.20
|
| Rate for Payer: Cash Price |
$18.71
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.71
|
| Rate for Payer: Healthscope Commercial |
$21.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.88
|
| Rate for Payer: PHP Commercial |
$19.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.37
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UMR Bronson Commercial |
$10.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.54
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$23.39
|
|
|
Service Code
|
NDC 0409-1746-10
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna American Axle |
$15.20
|
| Rate for Payer: Aetna Commercial |
$19.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.20
|
| Rate for Payer: Cash Price |
$18.71
|
| Rate for Payer: Cofinity Commercial |
$16.37
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.71
|
| Rate for Payer: Healthscope Commercial |
$21.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.88
|
| Rate for Payer: PHP Commercial |
$19.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.37
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: UMR Bronson Commercial |
$10.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.54
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
NDC 63323-468-17
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna American Axle |
$16.58
|
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.58
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.68
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.85
|
| Rate for Payer: Priority Health SBD |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$11.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.12
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$25.76
|
|
|
Service Code
|
NDC 0409-9042-01
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna American Axle |
$16.74
|
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.74
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.90
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health SBD |
$16.23
|
| Rate for Payer: UMR Bronson Commercial |
$11.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$40.32
|
|
|
Service Code
|
NDC 63323-468-37
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: Aetna American Axle |
$26.21
|
| Rate for Payer: Aetna Commercial |
$34.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.21
|
| Rate for Payer: Cash Price |
$32.26
|
| Rate for Payer: Cofinity Commercial |
$28.22
|
| Rate for Payer: Cofinity Commercial |
$34.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.26
|
| Rate for Payer: Healthscope Commercial |
$36.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.27
|
| Rate for Payer: PHP Commercial |
$34.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.22
|
| Rate for Payer: Priority Health SBD |
$25.40
|
| Rate for Payer: UMR Bronson Commercial |
$17.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.24
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
NDC 0409-1746-71
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| 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: 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 Multiplan/Beech St/PHCS |
$18.28
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.05
|
| 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
|
|
