|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$31.64
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Aetna American Axle |
$20.57
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.57
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cofinity Advantage |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.31
|
| Rate for Payer: Healthscope Commercial |
$28.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.73
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: Priority Health SBD |
$19.93
|
| Rate for Payer: UMR Bronson Commercial |
$13.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.73
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$50.07
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.03 |
| Max. Negotiated Rate |
$45.06 |
| Rate for Payer: Aetna American Axle |
$32.55
|
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Advantage |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$43.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.55
|
| Rate for Payer: PHP Commercial |
$42.56
|
| Rate for Payer: Priority Health SBD |
$31.54
|
| Rate for Payer: UMR Bronson Commercial |
$22.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.55
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$24.57
|
|
|
Service Code
|
NDC 00409174610
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna American Axle |
$15.97
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.97
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cofinity Advantage |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$21.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.43
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health SBD |
$15.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.57
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna American Axle |
$14.67
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Advantage |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health SBD |
$14.22
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$52.60
|
|
|
Service Code
|
NDC 00409904217
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.46 |
| Max. Negotiated Rate |
$47.34 |
| Rate for Payer: Aetna American Axle |
$34.19
|
| Rate for Payer: Aetna Commercial |
$44.71
|
| Rate for Payer: Aetna Medicare |
$26.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.19
|
| Rate for Payer: BCBS Complete |
$21.04
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cofinity Advantage |
$36.82
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.08
|
| Rate for Payer: Healthscope Commercial |
$47.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.45
|
| Rate for Payer: PHP Commercial |
$44.71
|
| Rate for Payer: Priority Health SBD |
$33.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.19
|
| Rate for Payer: UHC Core |
$27.40
|
| Rate for Payer: UHC Exchange |
$20.67
|
| Rate for Payer: UMR Bronson Commercial |
$19.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.45
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$24.57
|
|
|
Service Code
|
NDC 00409174670
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.81 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna American Axle |
$15.97
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.97
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cofinity Advantage |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$21.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.43
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health SBD |
$15.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.57
|
|
|
Service Code
|
NDC 00409174671
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.93 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna American Axle |
$14.67
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Advantage |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health SBD |
$14.22
|
| Rate for Payer: UMR Bronson Commercial |
$9.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$33.02
|
|
|
Service Code
|
NDC 00409904201
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$29.72 |
| Rate for Payer: Aetna American Axle |
$21.46
|
| Rate for Payer: Aetna Commercial |
$28.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.46
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Advantage |
$23.11
|
| Rate for Payer: Cofinity Commercial |
$28.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$29.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: PHP Commercial |
$28.07
|
| Rate for Payer: Priority Health SBD |
$20.80
|
| Rate for Payer: UMR Bronson Commercial |
$14.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$22.57
|
|
|
Service Code
|
NDC 00409174671
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna American Axle |
$14.67
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Advantage |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health SBD |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.67
|
| Rate for Payer: UHC Core |
$11.76
|
| Rate for Payer: UHC Exchange |
$8.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$33.02
|
|
|
Service Code
|
NDC 00409904201
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$29.72 |
| Rate for Payer: Aetna American Axle |
$21.46
|
| Rate for Payer: Aetna Commercial |
$28.07
|
| Rate for Payer: Aetna Medicare |
$16.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.46
|
| Rate for Payer: BCBS Complete |
$13.21
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cofinity Advantage |
$23.11
|
| Rate for Payer: Cofinity Commercial |
$28.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.42
|
| Rate for Payer: Healthscope Commercial |
$29.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.77
|
| Rate for Payer: PHP Commercial |
$28.07
|
| Rate for Payer: Priority Health SBD |
$20.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.46
|
| Rate for Payer: UHC Core |
$17.20
|
| Rate for Payer: UHC Exchange |
$12.98
|
| Rate for Payer: UMR Bronson Commercial |
$12.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.77
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$50.07
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$45.06 |
| Rate for Payer: Aetna American Axle |
$32.55
|
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna Medicare |
$25.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.55
|
| Rate for Payer: BCBS Complete |
$20.03
|
| Rate for Payer: Cash Price |
$40.06
|
| Rate for Payer: Cofinity Advantage |
$35.05
|
| Rate for Payer: Cofinity Commercial |
$43.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.06
|
| Rate for Payer: Healthscope Commercial |
$45.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.55
|
| Rate for Payer: PHP Commercial |
$42.56
|
| Rate for Payer: Priority Health SBD |
$31.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.55
|
| Rate for Payer: UHC Core |
$26.09
|
| Rate for Payer: UHC Exchange |
$19.68
|
| Rate for Payer: UMR Bronson Commercial |
$18.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.55
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$24.57
|
|
|
Service Code
|
NDC 00409174610
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna American Axle |
$15.97
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.97
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cofinity Advantage |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$21.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.43
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health SBD |
$15.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.97
|
| Rate for Payer: UHC Core |
$12.80
|
| Rate for Payer: UHC Exchange |
$9.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$24.57
|
|
|
Service Code
|
NDC 00409174670
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna American Axle |
$15.97
|
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$12.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.97
|
| Rate for Payer: BCBS Complete |
$9.83
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cofinity Advantage |
$17.20
|
| Rate for Payer: Cofinity Commercial |
$21.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.43
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health SBD |
$15.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.97
|
| Rate for Payer: UHC Core |
$12.80
|
| Rate for Payer: UHC Exchange |
$9.66
|
| Rate for Payer: UMR Bronson Commercial |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$52.60
|
|
|
Service Code
|
NDC 00409904217
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$47.34 |
| Rate for Payer: Aetna American Axle |
$34.19
|
| Rate for Payer: Aetna Commercial |
$44.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.19
|
| Rate for Payer: Cash Price |
$42.08
|
| Rate for Payer: Cofinity Advantage |
$36.82
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.08
|
| Rate for Payer: Healthscope Commercial |
$47.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.45
|
| Rate for Payer: PHP Commercial |
$44.71
|
| Rate for Payer: Priority Health SBD |
$33.14
|
| Rate for Payer: UMR Bronson Commercial |
$23.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.45
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$22.57
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna American Axle |
$14.67
|
| Rate for Payer: Aetna Commercial |
$19.18
|
| Rate for Payer: Aetna Medicare |
$11.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: BCBS Complete |
$9.03
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cofinity Advantage |
$15.80
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.06
|
| Rate for Payer: Healthscope Commercial |
$20.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.93
|
| Rate for Payer: PHP Commercial |
$19.18
|
| Rate for Payer: Priority Health SBD |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.67
|
| Rate for Payer: UHC Core |
$11.76
|
| Rate for Payer: UHC Exchange |
$8.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.93
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$31.64
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Aetna American Axle |
$20.57
|
| Rate for Payer: Aetna Commercial |
$26.89
|
| Rate for Payer: Aetna Medicare |
$15.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.57
|
| Rate for Payer: BCBS Complete |
$12.66
|
| Rate for Payer: Cash Price |
$25.31
|
| Rate for Payer: Cofinity Advantage |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$27.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.31
|
| Rate for Payer: Healthscope Commercial |
$28.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.73
|
| Rate for Payer: PHP Commercial |
$26.89
|
| Rate for Payer: Priority Health SBD |
$19.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.57
|
| Rate for Payer: UHC Core |
$16.48
|
| Rate for Payer: UHC Exchange |
$12.43
|
| Rate for Payer: UMR Bronson Commercial |
$11.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.73
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.03
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna American Axle |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$10.44
|
| Rate for Payer: UHC Exchange |
$7.87
|
| Rate for Payer: UMR Bronson Commercial |
$7.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$20.03
|
|
|
Service Code
|
NDC 00409174971
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.41 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna American Axle |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: BCBS Complete |
$8.01
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$10.44
|
| Rate for Payer: UHC Exchange |
$7.87
|
| Rate for Payer: UMR Bronson Commercial |
$7.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$53.94
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$48.55 |
| Rate for Payer: Aetna American Axle |
$35.06
|
| Rate for Payer: Aetna Commercial |
$45.85
|
| Rate for Payer: Aetna Medicare |
$26.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.06
|
| Rate for Payer: BCBS Complete |
$21.58
|
| Rate for Payer: Cash Price |
$43.15
|
| Rate for Payer: Cofinity Advantage |
$37.76
|
| Rate for Payer: Cofinity Commercial |
$46.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.15
|
| Rate for Payer: Healthscope Commercial |
$48.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.45
|
| Rate for Payer: PHP Commercial |
$45.85
|
| Rate for Payer: Priority Health SBD |
$33.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.06
|
| Rate for Payer: UHC Core |
$28.10
|
| Rate for Payer: UHC Exchange |
$21.20
|
| Rate for Payer: UMR Bronson Commercial |
$19.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.45
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$32.40
|
|
|
Service Code
|
NDC 63323046204
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna American Axle |
$21.06
|
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.06
|
| Rate for Payer: BCBS Complete |
$12.96
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cofinity Advantage |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.92
|
| Rate for Payer: Healthscope Commercial |
$29.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.30
|
| Rate for Payer: PHP Commercial |
$27.54
|
| Rate for Payer: Priority Health SBD |
$20.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.06
|
| Rate for Payer: UHC Core |
$16.88
|
| Rate for Payer: UHC Exchange |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$11.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.30
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$32.40
|
|
|
Service Code
|
NDC 63323046217
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna American Axle |
$21.06
|
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna Medicare |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.06
|
| Rate for Payer: BCBS Complete |
$12.96
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cofinity Advantage |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.92
|
| Rate for Payer: Healthscope Commercial |
$29.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.30
|
| Rate for Payer: PHP Commercial |
$27.54
|
| Rate for Payer: Priority Health SBD |
$20.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.06
|
| Rate for Payer: UHC Core |
$16.88
|
| Rate for Payer: UHC Exchange |
$12.73
|
| Rate for Payer: UMR Bronson Commercial |
$11.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.30
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
NDC 00409174971
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna American Axle |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$20.03
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$18.03 |
| Rate for Payer: Aetna American Axle |
$13.02
|
| Rate for Payer: Aetna Commercial |
$17.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.02
|
| Rate for Payer: Cash Price |
$16.02
|
| Rate for Payer: Cofinity Advantage |
$14.02
|
| Rate for Payer: Cofinity Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.02
|
| Rate for Payer: Healthscope Commercial |
$18.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.02
|
| Rate for Payer: PHP Commercial |
$17.03
|
| Rate for Payer: Priority Health SBD |
$12.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.02
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 00409174970
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna American Axle |
$14.48
|
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Advantage |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.71
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$32.40
|
|
|
Service Code
|
NDC 63323046217
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.26 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna American Axle |
$21.06
|
| Rate for Payer: Aetna Commercial |
$27.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.06
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Cofinity Advantage |
$22.68
|
| Rate for Payer: Cofinity Commercial |
$27.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.92
|
| Rate for Payer: Healthscope Commercial |
$29.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.30
|
| Rate for Payer: PHP Commercial |
$27.54
|
| Rate for Payer: Priority Health SBD |
$20.41
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.30
|
|
