|
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
|
$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) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 0409-1749-71
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna American Axle |
$12.42
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$26.17
|
|
|
Service Code
|
NDC 63323-462-17
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna American Axle |
$17.01
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.01
|
| Rate for Payer: Cash Price |
$20.94
|
| Rate for Payer: Cofinity Commercial |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$23.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health SBD |
$16.49
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.63
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 0409-1749-10
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$19.10
|
|
|
Service Code
|
NDC 0409-1749-29
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna American Axle |
$12.42
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 0409-8126-01
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 0409-1749-70
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$43.39
|
|
|
Service Code
|
NDC 63323-462-37
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$39.05 |
| Rate for Payer: Aetna American Axle |
$28.20
|
| Rate for Payer: Aetna Commercial |
$36.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.20
|
| Rate for Payer: Cash Price |
$34.71
|
| Rate for Payer: Cofinity Commercial |
$30.37
|
| Rate for Payer: Cofinity Commercial |
$37.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$39.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.88
|
| Rate for Payer: PHP Commercial |
$36.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.37
|
| Rate for Payer: Priority Health SBD |
$27.34
|
| Rate for Payer: UMR Bronson Commercial |
$19.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.54
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
NDC 0409-8126-10
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna American Axle |
$13.76
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.76
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.82
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health SBD |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$26.17
|
|
|
Service Code
|
NDC 63323-462-04
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.51 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna American Axle |
$17.01
|
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.01
|
| Rate for Payer: Cash Price |
$20.94
|
| Rate for Payer: Cofinity Commercial |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$23.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health SBD |
$16.49
|
| Rate for Payer: UMR Bronson Commercial |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.63
|
|
|
BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$47.84
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
108351
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna American Axle |
$31.10
|
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna Commercial |
$40.66
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.10
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$38.27
|
| Rate for Payer: Cofinity Commercial |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$33.49
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.27
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.66
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$40.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.49
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: Priority Health SBD |
$30.14
|
| Rate for Payer: UMR Bronson Commercial |
$21.05
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.88
|
|
|
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$53.40
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$48.06 |
| Rate for Payer: Aetna American Axle |
$34.71
|
| Rate for Payer: Aetna Commercial |
$45.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.71
|
| Rate for Payer: Cash Price |
$42.72
|
| Rate for Payer: Cofinity Commercial |
$37.38
|
| Rate for Payer: Cofinity Commercial |
$45.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.72
|
| Rate for Payer: Healthscope Commercial |
$48.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.39
|
| Rate for Payer: PHP Commercial |
$45.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.38
|
| Rate for Payer: Priority Health SBD |
$33.64
|
| Rate for Payer: UMR Bronson Commercial |
$23.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.05
|
|
|
BUPIVACAINE LIPOSOME(PF) 1.3 %(13.3 MG/ML) SUSPENSION FOR INFILTRATION
|
Facility
|
IP
|
$1,203.59
|
|
|
Service Code
|
HCPCS C9290
|
| Hospital Charge Code |
155788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$529.58 |
| Max. Negotiated Rate |
$1,083.23 |
| Rate for Payer: Aetna American Axle |
$782.33
|
| Rate for Payer: Aetna Commercial |
$1,023.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.33
|
| Rate for Payer: Cash Price |
$962.87
|
| Rate for Payer: Cofinity Commercial |
$842.51
|
| Rate for Payer: Cofinity Commercial |
$1,035.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$962.87
|
| Rate for Payer: Healthscope Commercial |
$1,083.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$842.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$902.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,023.05
|
| Rate for Payer: PHP Commercial |
$1,023.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.51
|
| Rate for Payer: Priority Health SBD |
$758.26
|
| Rate for Payer: UMR Bronson Commercial |
$529.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$902.69
|
|
|
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: 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
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$31.11
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.69 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna American Axle |
$14.14
|
| Rate for Payer: Aetna American Axle |
$18.38
|
| Rate for Payer: Aetna American Axle |
$13.42
|
| Rate for Payer: Aetna American Axle |
$17.65
|
| Rate for Payer: Aetna American Axle |
$16.55
|
| Rate for Payer: Aetna American Axle |
$16.40
|
| Rate for Payer: Aetna American Axle |
$7.31
|
| Rate for Payer: Aetna American Axle |
$16.21
|
| Rate for Payer: Aetna American Axle |
$11.72
|
| Rate for Payer: Aetna American Axle |
$13.98
|
| Rate for Payer: Aetna American Axle |
$15.27
|
| Rate for Payer: Aetna Commercial |
$18.28
|
| Rate for Payer: Aetna Commercial |
$9.56
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$24.04
|
| Rate for Payer: Aetna Commercial |
$23.08
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Commercial |
$21.45
|
| Rate for Payer: Aetna Commercial |
$21.20
|
| Rate for Payer: Aetna Commercial |
$15.33
|
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$21.72
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$16.52
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$21.70
|
| Rate for Payer: Cofinity Commercial |
$17.66
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$15.22
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$16.44
|
| Rate for Payer: Cofinity Commercial |
$12.62
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Cofinity Commercial |
$24.32
|
| Rate for Payer: Cofinity Commercial |
$19.80
|
| Rate for Payer: Cofinity Commercial |
$9.68
|
| Rate for Payer: Cofinity Commercial |
$23.35
|
| Rate for Payer: Cofinity Commercial |
$14.46
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| 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: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| 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 |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.62
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Healthscope Commercial |
$22.71
|
| Rate for Payer: Healthscope Commercial |
$25.45
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$18.58
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$16.23
|
| Rate for Payer: Healthscope Commercial |
$10.12
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.88
|
| 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 |
$17.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.28
|
| Rate for Payer: PHP Commercial |
$21.20
|
| Rate for Payer: PHP Commercial |
$24.04
|
| Rate for Payer: PHP Commercial |
$17.55
|
| Rate for Payer: PHP Commercial |
$9.56
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$21.45
|
| Rate for Payer: PHP Commercial |
$21.64
|
| Rate for Payer: PHP Commercial |
$18.28
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: PHP Commercial |
$23.08
|
| Rate for Payer: PHP Commercial |
$18.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.05
|
| Rate for Payer: Priority Health SBD |
$16.04
|
| Rate for Payer: Priority Health SBD |
$11.36
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health SBD |
$15.89
|
| Rate for Payer: Priority Health SBD |
$13.70
|
| Rate for Payer: Priority Health SBD |
$17.10
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: Priority Health SBD |
$15.71
|
| Rate for Payer: Priority Health SBD |
$14.80
|
| Rate for Payer: Priority Health SBD |
$17.82
|
| Rate for Payer: Priority Health SBD |
$7.09
|
| Rate for Payer: Priority Health SBD |
$13.01
|
| Rate for Payer: UMR Bronson Commercial |
$11.20
|
| Rate for Payer: UMR Bronson Commercial |
$11.95
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: UMR Bronson Commercial |
$10.97
|
| Rate for Payer: UMR Bronson Commercial |
$9.57
|
| Rate for Payer: UMR Bronson Commercial |
$11.10
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: UMR Bronson Commercial |
$4.95
|
| Rate for Payer: UMR Bronson Commercial |
$10.34
|
| Rate for Payer: UMR Bronson Commercial |
$9.46
|
| Rate for Payer: UMR Bronson Commercial |
$12.44
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
| 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 |
$8.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
|
|
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: 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
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$23.10
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$20.79 |
| Rate for Payer: Aetna American Axle |
$15.02
|
| Rate for Payer: Aetna American Axle |
$14.09
|
| Rate for Payer: Aetna American Axle |
$18.10
|
| Rate for Payer: Aetna American Axle |
$9.33
|
| Rate for Payer: Aetna American Axle |
$12.42
|
| Rate for Payer: Aetna American Axle |
$17.63
|
| Rate for Payer: Aetna American Axle |
$11.16
|
| Rate for Payer: Aetna American Axle |
$19.53
|
| Rate for Payer: Aetna American Axle |
$13.29
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$12.21
|
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Commercial |
$14.59
|
| Rate for Payer: Aetna Commercial |
$19.64
|
| Rate for Payer: Aetna Commercial |
$25.53
|
| Rate for Payer: Aetna Commercial |
$18.43
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.16
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cash Price |
$13.74
|
| Rate for Payer: Cash Price |
$11.49
|
| Rate for Payer: Cash Price |
$18.48
|
| Rate for Payer: Cash Price |
$24.03
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$10.05
|
| Rate for Payer: Cofinity Commercial |
$12.35
|
| Rate for Payer: Cofinity Commercial |
$25.83
|
| Rate for Payer: Cofinity Commercial |
$12.02
|
| Rate for Payer: Cofinity Commercial |
$14.77
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Cofinity Commercial |
$13.37
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$15.18
|
| 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 |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$19.49
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$15.45
|
| Rate for Payer: Healthscope Commercial |
$27.04
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$20.79
|
| Rate for Payer: Healthscope Commercial |
$12.92
|
| Rate for Payer: Healthscope Commercial |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| 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 |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: PHP Commercial |
$12.21
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$19.64
|
| Rate for Payer: PHP Commercial |
$23.05
|
| Rate for Payer: PHP Commercial |
$18.43
|
| Rate for Payer: PHP Commercial |
$14.59
|
| Rate for Payer: PHP Commercial |
$25.53
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.05
|
| Rate for Payer: Priority Health SBD |
$12.03
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: Priority Health SBD |
$9.05
|
| Rate for Payer: Priority Health SBD |
$18.93
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$13.66
|
| Rate for Payer: Priority Health SBD |
$10.82
|
| Rate for Payer: Priority Health SBD |
$14.55
|
| Rate for Payer: Priority Health SBD |
$17.54
|
| Rate for Payer: UMR Bronson Commercial |
$9.00
|
| Rate for Payer: UMR Bronson Commercial |
$6.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.40
|
| Rate for Payer: UMR Bronson Commercial |
$9.54
|
| Rate for Payer: UMR Bronson Commercial |
$10.16
|
| Rate for Payer: UMR Bronson Commercial |
$11.93
|
| Rate for Payer: UMR Bronson Commercial |
$12.25
|
| Rate for Payer: UMR Bronson Commercial |
$13.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.53
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$19.75
|
|
|
Service Code
|
NDC 36000-092-10
|
| 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: 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 Multiplan/Beech St/PHCS |
$16.79
|
| Rate for Payer: PHP Commercial |
$16.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.82
|
| 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
|
IP
|
$85.01
|
|
|
Service Code
|
NDC 9900-0010-84
|
| 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: 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 Multiplan/Beech St/PHCS |
$72.26
|
| Rate for Payer: PHP Commercial |
$72.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.51
|
| Rate for Payer: Priority Health SBD |
$53.56
|
| Rate for Payer: UMR Bronson Commercial |
$37.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.76
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$28.17
|
|
|
Service Code
|
NDC 0409-1761-02
|
| 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: 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 Multiplan/Beech St/PHCS |
$23.94
|
| Rate for Payer: PHP Commercial |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.72
|
| 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
|
IP
|
$19.75
|
|
|
Service Code
|
NDC 36000-092-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$16.79
|
| Rate for Payer: PHP Commercial |
$16.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.82
|
| 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
|
IP
|
$27.90
|
|
|
Service Code
|
NDC 63323-473-02
|
| 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: 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 Multiplan/Beech St/PHCS |
$23.72
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| 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) INJECTION SOLUTION
|
Facility
|
IP
|
$23.06
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$16.02
|
| Rate for Payer: Aetna American Axle |
$18.31
|
| Rate for Payer: Aetna American Axle |
$18.52
|
| Rate for Payer: Aetna American Axle |
$18.66
|
| Rate for Payer: Aetna American Axle |
$20.22
|
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$20.95
|
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$24.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.31
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$22.97
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Cash Price |
$19.72
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$22.79
|
| Rate for Payer: Cofinity Commercial |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$17.26
|
| Rate for Payer: Cofinity Commercial |
$21.20
|
| Rate for Payer: Cofinity Commercial |
$19.72
|
| Rate for Payer: Cofinity Commercial |
$24.23
|
| Rate for Payer: Cofinity Commercial |
$19.94
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Cofinity Commercial |
$20.10
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Cofinity Commercial |
$21.78
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.79
|
| Rate for Payer: Healthscope Commercial |
$25.35
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$25.64
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.80
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$24.22
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$20.95
|
| Rate for Payer: PHP Commercial |
$23.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.94
|
| Rate for Payer: Priority Health SBD |
$17.95
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$15.53
|
| Rate for Payer: Priority Health SBD |
$17.75
|
| Rate for Payer: Priority Health SBD |
$18.09
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$10.15
|
| Rate for Payer: UMR Bronson Commercial |
$13.69
|
| Rate for Payer: UMR Bronson Commercial |
$12.39
|
| Rate for Payer: UMR Bronson Commercial |
$12.54
|
| Rate for Payer: UMR Bronson Commercial |
$10.85
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$12.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
|
|
BUPIVACAINE WITH EPINEPHRINE IN NS
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 9900-0002-04
|
| 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: 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 Multiplan/Beech St/PHCS |
$3.82
|
| Rate for Payer: PHP Commercial |
$3.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.15
|
| 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
|
|
