|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| 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 Advantage |
$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 Commercial |
$340.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.68
|
| Rate for Payer: PHP Commercial |
$340.76
|
| 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
|
|
|
BUPIVACAINE 0.25 % (2.5 MG/ML) INJECTION SOLUTION WRAPPER
|
Facility
|
IP
|
$22.20
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
301326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna American Axle |
$18.19
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cofinity Advantage |
$19.59
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.99
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$9.77
|
| Rate for Payer: UMR Bronson Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.99
|
|
|
BUPIVACAINE 0.25 % (2.5 MG/ML) INJECTION SOLUTION WRAPPER
|
Facility
|
OP
|
$22.20
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
301326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$19.98 |
| Rate for Payer: Aetna American Axle |
$14.43
|
| Rate for Payer: Aetna American Axle |
$18.19
|
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Commercial |
$23.79
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna Medicare |
$13.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.19
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS Complete |
$8.88
|
| 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: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$22.39
|
| Rate for Payer: Cofinity Advantage |
$15.54
|
| Rate for Payer: Cofinity Advantage |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.39
|
| Rate for Payer: Healthscope Commercial |
$19.98
|
| Rate for Payer: Healthscope Commercial |
$25.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Commercial |
$23.79
|
| Rate for Payer: Priority Health SBD |
$13.99
|
| Rate for Payer: Priority Health SBD |
$17.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.21
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.99
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 00362901150
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health SBD |
$10.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC Core |
$8.46
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$6.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 31382055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna American Axle |
$10.56
|
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health SBD |
$10.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.56
|
| Rate for Payer: UHC Core |
$8.46
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$6.01
|
| 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 00362901150
|
| 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 Advantage |
$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 Commercial |
$13.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: PHP Commercial |
$13.80
|
| 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 31382055705
|
| 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 Advantage |
$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 Commercial |
$13.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: PHP Commercial |
$13.80
|
| 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
|
$36.94
|
|
|
Service Code
|
NDC 00409175250
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna American Axle |
$24.01
|
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: Cash Price |
$29.55
|
| Rate for Payer: Cofinity Advantage |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.70
|
| Rate for Payer: PHP Commercial |
$31.40
|
| Rate for Payer: Priority Health SBD |
$23.27
|
| Rate for Payer: UMR Bronson Commercial |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$36.94
|
|
|
Service Code
|
NDC 00409381201
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna American Axle |
$24.01
|
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna Medicare |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: BCBS Complete |
$14.78
|
| Rate for Payer: Cash Price |
$29.55
|
| Rate for Payer: Cofinity Advantage |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.70
|
| Rate for Payer: PHP Commercial |
$31.40
|
| Rate for Payer: Priority Health SBD |
$23.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.01
|
| Rate for Payer: UHC Core |
$19.25
|
| Rate for Payer: UHC Exchange |
$14.52
|
| Rate for Payer: UMR Bronson Commercial |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$80.33
|
|
|
Service Code
|
NDC 63323046157
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Advantage |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.25
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.21
|
| Rate for Payer: UHC Core |
$41.85
|
| Rate for Payer: UHC Exchange |
$31.57
|
| Rate for Payer: UMR Bronson Commercial |
$29.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$36.94
|
|
|
Service Code
|
NDC 00409175250
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.67 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna American Axle |
$24.01
|
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna Medicare |
$18.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: BCBS Complete |
$14.78
|
| Rate for Payer: Cash Price |
$29.55
|
| Rate for Payer: Cofinity Advantage |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.70
|
| Rate for Payer: PHP Commercial |
$31.40
|
| Rate for Payer: Priority Health SBD |
$23.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.01
|
| Rate for Payer: UHC Core |
$19.25
|
| Rate for Payer: UHC Exchange |
$14.52
|
| Rate for Payer: UMR Bronson Commercial |
$13.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$36.94
|
|
|
Service Code
|
NDC 00409381201
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna American Axle |
$24.01
|
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.01
|
| Rate for Payer: Cash Price |
$29.55
|
| Rate for Payer: Cofinity Advantage |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.55
|
| Rate for Payer: Healthscope Commercial |
$33.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.70
|
| Rate for Payer: PHP Commercial |
$31.40
|
| Rate for Payer: Priority Health SBD |
$23.27
|
| Rate for Payer: UMR Bronson Commercial |
$16.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$84.33
|
|
|
Service Code
|
NDC 00409904301
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.11 |
| Max. Negotiated Rate |
$75.90 |
| Rate for Payer: Aetna American Axle |
$54.81
|
| Rate for Payer: Aetna Commercial |
$71.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.81
|
| Rate for Payer: Cash Price |
$67.46
|
| Rate for Payer: Cofinity Advantage |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$72.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.46
|
| Rate for Payer: Healthscope Commercial |
$75.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.25
|
| Rate for Payer: PHP Commercial |
$71.68
|
| Rate for Payer: Priority Health SBD |
$53.13
|
| Rate for Payer: UMR Bronson Commercial |
$37.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.25
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$84.33
|
|
|
Service Code
|
NDC 00409904301
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$75.90 |
| Rate for Payer: Aetna American Axle |
$54.81
|
| Rate for Payer: Aetna Commercial |
$71.68
|
| Rate for Payer: Aetna Medicare |
$42.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.81
|
| Rate for Payer: BCBS Complete |
$33.73
|
| Rate for Payer: Cash Price |
$67.46
|
| Rate for Payer: Cofinity Advantage |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$72.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.46
|
| Rate for Payer: Healthscope Commercial |
$75.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.25
|
| Rate for Payer: PHP Commercial |
$71.68
|
| Rate for Payer: Priority Health SBD |
$53.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.81
|
| Rate for Payer: UHC Core |
$43.94
|
| Rate for Payer: UHC Exchange |
$33.14
|
| Rate for Payer: UMR Bronson Commercial |
$31.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.25
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$80.33
|
|
|
Service Code
|
NDC 63323046157
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna American Axle |
$52.21
|
| Rate for Payer: Aetna Commercial |
$68.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.21
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Advantage |
$56.23
|
| Rate for Payer: Cofinity Commercial |
$69.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$72.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.25
|
| Rate for Payer: PHP Commercial |
$68.28
|
| Rate for Payer: Priority Health SBD |
$50.61
|
| Rate for Payer: UMR Bronson Commercial |
$35.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.25
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$85.89
|
|
|
Service Code
|
NDC 63323046357
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$77.30 |
| Rate for Payer: Aetna American Axle |
$55.83
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Medicare |
$42.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cofinity Advantage |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.42
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.83
|
| Rate for Payer: UHC Core |
$44.75
|
| Rate for Payer: UHC Exchange |
$33.75
|
| Rate for Payer: UMR Bronson Commercial |
$31.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$43.39
|
|
|
Service Code
|
NDC 00409175550
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$39.05 |
| Rate for Payer: Aetna American Axle |
$28.20
|
| Rate for Payer: Aetna Commercial |
$36.88
|
| Rate for Payer: Aetna Medicare |
$21.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.20
|
| Rate for Payer: BCBS Complete |
$17.36
|
| Rate for Payer: Cash Price |
$34.71
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$34.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.54
|
| Rate for Payer: PHP Commercial |
$36.88
|
| Rate for Payer: Priority Health SBD |
$27.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.20
|
| Rate for Payer: UHC Core |
$22.61
|
| Rate for Payer: UHC Exchange |
$17.05
|
| Rate for Payer: UMR Bronson Commercial |
$16.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.54
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$85.89
|
|
|
Service Code
|
NDC 63323046357
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$77.30 |
| Rate for Payer: Aetna American Axle |
$55.83
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cofinity Advantage |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.42
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: UMR Bronson Commercial |
$37.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$90.34
|
|
|
Service Code
|
NDC 00409904601
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$81.31 |
| Rate for Payer: Aetna American Axle |
$58.72
|
| Rate for Payer: Aetna Commercial |
$76.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.72
|
| Rate for Payer: Cash Price |
$72.27
|
| Rate for Payer: Cofinity Advantage |
$63.24
|
| Rate for Payer: Cofinity Commercial |
$77.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.27
|
| Rate for Payer: Healthscope Commercial |
$81.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.75
|
| Rate for Payer: PHP Commercial |
$76.79
|
| Rate for Payer: Priority Health SBD |
$56.91
|
| Rate for Payer: UMR Bronson Commercial |
$39.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.75
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$90.34
|
|
|
Service Code
|
NDC 00409904601
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$81.31 |
| Rate for Payer: Aetna American Axle |
$58.72
|
| Rate for Payer: Aetna Commercial |
$76.79
|
| Rate for Payer: Aetna Medicare |
$45.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.72
|
| Rate for Payer: BCBS Complete |
$36.14
|
| Rate for Payer: Cash Price |
$72.27
|
| Rate for Payer: Cofinity Advantage |
$63.24
|
| Rate for Payer: Cofinity Commercial |
$77.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.27
|
| Rate for Payer: Healthscope Commercial |
$81.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.75
|
| Rate for Payer: PHP Commercial |
$76.79
|
| Rate for Payer: Priority Health SBD |
$56.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.72
|
| Rate for Payer: UHC Core |
$47.07
|
| Rate for Payer: UHC Exchange |
$35.50
|
| Rate for Payer: UMR Bronson Commercial |
$33.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.75
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$90.34
|
|
|
Service Code
|
NDC 00409904611
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$81.31 |
| Rate for Payer: Aetna American Axle |
$58.72
|
| Rate for Payer: Aetna Commercial |
$76.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.72
|
| Rate for Payer: Cash Price |
$72.27
|
| Rate for Payer: Cofinity Advantage |
$63.24
|
| Rate for Payer: Cofinity Commercial |
$77.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.27
|
| Rate for Payer: Healthscope Commercial |
$81.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.75
|
| Rate for Payer: PHP Commercial |
$76.79
|
| Rate for Payer: Priority Health SBD |
$56.91
|
| Rate for Payer: UMR Bronson Commercial |
$39.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.75
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$90.34
|
|
|
Service Code
|
NDC 00409904611
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$81.31 |
| Rate for Payer: Aetna American Axle |
$58.72
|
| Rate for Payer: Aetna Commercial |
$76.79
|
| Rate for Payer: Aetna Medicare |
$45.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.72
|
| Rate for Payer: BCBS Complete |
$36.14
|
| Rate for Payer: Cash Price |
$72.27
|
| Rate for Payer: Cofinity Advantage |
$63.24
|
| Rate for Payer: Cofinity Commercial |
$77.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.27
|
| Rate for Payer: Healthscope Commercial |
$81.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$63.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$67.75
|
| Rate for Payer: PHP Commercial |
$76.79
|
| Rate for Payer: Priority Health SBD |
$56.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.72
|
| Rate for Payer: UHC Core |
$47.07
|
| Rate for Payer: UHC Exchange |
$35.50
|
| Rate for Payer: UMR Bronson Commercial |
$33.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.75
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$85.89
|
|
|
Service Code
|
NDC 63323046301
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$77.30 |
| Rate for Payer: Aetna American Axle |
$55.83
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Medicare |
$42.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cofinity Advantage |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.42
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.83
|
| Rate for Payer: UHC Core |
$44.75
|
| Rate for Payer: UHC Exchange |
$33.75
|
| Rate for Payer: UMR Bronson Commercial |
$31.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
|
|
BUPIVACAINE-EPINEPHRINE 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$43.39
|
|
|
Service Code
|
NDC 00409175550
|
| Hospital Charge Code |
14984
|
|
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 Advantage |
$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 Commercial |
$36.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.54
|
| Rate for Payer: PHP Commercial |
$36.88
|
| 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 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$85.89
|
|
|
Service Code
|
NDC 63323046301
|
| Hospital Charge Code |
14984
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$77.30 |
| Rate for Payer: Aetna American Axle |
$55.83
|
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.83
|
| Rate for Payer: Cash Price |
$68.71
|
| Rate for Payer: Cofinity Advantage |
$60.12
|
| Rate for Payer: Cofinity Commercial |
$73.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.71
|
| Rate for Payer: Healthscope Commercial |
$77.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.42
|
| Rate for Payer: PHP Commercial |
$73.01
|
| Rate for Payer: Priority Health SBD |
$54.11
|
| Rate for Payer: UMR Bronson Commercial |
$37.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.42
|
|
