|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
OP
|
$27.90
|
|
|
Service Code
|
NDC 63323047302
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Medicare |
$13.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: BCBS Complete |
$11.16
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Advantage |
$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 |
$20.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: PHP Commercial |
$23.71
|
| Rate for Payer: Priority Health SBD |
$17.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.14
|
| Rate for Payer: UHC Core |
$14.54
|
| Rate for Payer: UHC Exchange |
$10.96
|
| Rate for Payer: UMR Bronson Commercial |
$10.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.93
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
|
IP
|
$27.90
|
|
|
Service Code
|
NDC 63323047302
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna American Axle |
$18.14
|
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Advantage |
$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 |
$20.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.93
|
| Rate for Payer: PHP Commercial |
$23.71
|
| 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 |
$20.93
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$18.74
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$16.87 |
| Rate for Payer: Aetna American Axle |
$12.18
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna American Axle |
$13.71
|
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna American Axle |
$10.68
|
| Rate for Payer: Aetna American Axle |
$22.13
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$28.94
|
| Rate for Payer: Aetna Medicare |
$9.37
|
| Rate for Payer: Aetna Medicare |
$8.77
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna Medicare |
$8.21
|
| Rate for Payer: Aetna Medicare |
$17.02
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$15.36
|
| Rate for Payer: Aetna Medicare |
$11.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: BCBS Complete |
$7.02
|
| Rate for Payer: BCBS Complete |
$7.50
|
| Rate for Payer: BCBS Complete |
$9.22
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Complete |
$8.44
|
| Rate for Payer: BCBS Complete |
$13.62
|
| Rate for Payer: BCBS Complete |
$12.28
|
| Rate for Payer: BCBS Complete |
$6.57
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$27.24
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$27.24
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Advantage |
$12.28
|
| Rate for Payer: Cofinity Advantage |
$13.12
|
| Rate for Payer: Cofinity Advantage |
$11.50
|
| Rate for Payer: Cofinity Advantage |
$13.83
|
| Rate for Payer: Cofinity Advantage |
$14.76
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Advantage |
$21.50
|
| Rate for Payer: Cofinity Advantage |
$23.84
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$29.28
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Healthscope Commercial |
$30.64
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$17.93
|
| Rate for Payer: PHP Commercial |
$28.94
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health SBD |
$13.29
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$21.45
|
| Rate for Payer: Priority Health SBD |
$10.35
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| 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 Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Core |
$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: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$8.53
|
| Rate for Payer: UMR Bronson Commercial |
$6.93
|
| Rate for Payer: UMR Bronson Commercial |
$7.80
|
| Rate for Payer: UMR Bronson Commercial |
$10.19
|
| Rate for Payer: UMR Bronson Commercial |
$11.36
|
| Rate for Payer: UMR Bronson Commercial |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$6.08
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: UMR Bronson Commercial |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$34.05
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$30.64 |
| Rate for Payer: Aetna American Axle |
$22.13
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna American Axle |
$10.68
|
| Rate for Payer: Aetna American Axle |
$17.89
|
| Rate for Payer: Aetna American Axle |
$14.99
|
| Rate for Payer: Aetna American Axle |
$13.71
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$12.18
|
| Rate for Payer: Aetna American Axle |
$11.40
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$14.91
|
| Rate for Payer: Aetna Commercial |
$13.97
|
| Rate for Payer: Aetna Commercial |
$28.94
|
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Aetna Commercial |
$17.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.13
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$27.24
|
| Rate for Payer: Cash Price |
$16.87
|
| Rate for Payer: Cash Price |
$14.03
|
| Rate for Payer: Cash Price |
$14.99
|
| Rate for Payer: Cash Price |
$13.14
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cofinity Advantage |
$13.12
|
| Rate for Payer: Cofinity Advantage |
$13.83
|
| Rate for Payer: Cofinity Advantage |
$14.76
|
| Rate for Payer: Cofinity Advantage |
$12.28
|
| Rate for Payer: Cofinity Advantage |
$23.84
|
| Rate for Payer: Cofinity Advantage |
$19.27
|
| Rate for Payer: Cofinity Advantage |
$16.14
|
| Rate for Payer: Cofinity Advantage |
$21.50
|
| Rate for Payer: Cofinity Advantage |
$11.50
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$15.08
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$14.13
|
| Rate for Payer: Cofinity Commercial |
$29.28
|
| Rate for Payer: Cofinity Commercial |
$16.12
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$15.79
|
| Rate for Payer: Healthscope Commercial |
$16.87
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$14.79
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$30.64
|
| Rate for Payer: Healthscope Commercial |
$18.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.65
|
| Rate for Payer: PHP Commercial |
$14.91
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: PHP Commercial |
$17.93
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$28.94
|
| Rate for Payer: PHP Commercial |
$15.93
|
| Rate for Payer: PHP Commercial |
$13.97
|
| Rate for Payer: Priority Health SBD |
$14.53
|
| Rate for Payer: Priority Health SBD |
$13.29
|
| Rate for Payer: Priority Health SBD |
$21.45
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$11.05
|
| Rate for Payer: Priority Health SBD |
$10.35
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: UMR Bronson Commercial |
$7.23
|
| Rate for Payer: UMR Bronson Commercial |
$8.25
|
| Rate for Payer: UMR Bronson Commercial |
$10.15
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$12.11
|
| Rate for Payer: UMR Bronson Commercial |
$9.28
|
| Rate for Payer: UMR Bronson Commercial |
$14.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.72
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.54
|
|
|
BUPIVACAINE WITH EPINEPHRINE IN NS
|
Facility
|
IP
|
$4.50
|
|
|
Service Code
|
NDC 99000000204
|
| Hospital Charge Code |
158462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna American Axle |
$2.92
|
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.92
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$3.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.38
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: Priority Health SBD |
$2.83
|
| Rate for Payer: UMR Bronson Commercial |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
BUPIVACAINE WITH EPINEPHRINE IN NS
|
Facility
|
OP
|
$4.50
|
|
|
Service Code
|
NDC 99000000204
|
| Hospital Charge Code |
158462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Aetna American Axle |
$2.92
|
| Rate for Payer: Aetna Commercial |
$3.83
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.92
|
| Rate for Payer: BCBS Complete |
$1.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$3.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.38
|
| Rate for Payer: PHP Commercial |
$3.83
|
| Rate for Payer: Priority Health SBD |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.92
|
| Rate for Payer: UHC Core |
$2.34
|
| Rate for Payer: UHC Exchange |
$1.77
|
| Rate for Payer: UMR Bronson Commercial |
$1.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.38
|
|
|
BUPIVICAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION (OSC)
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
180415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.46 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.97
|
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.97
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| 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
|
|
|
BUPIVICAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION (OSC)
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
180415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna American Axle |
$13.97
|
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.97
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.02
|
| Rate for Payer: UHC Core |
$0.02
|
| Rate for Payer: UHC Exchange |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.12
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$187.28
|
|
|
Service Code
|
NDC 00093365721
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$168.55 |
| Rate for Payer: Aetna American Axle |
$121.73
|
| Rate for Payer: Aetna Commercial |
$159.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.73
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Advantage |
$131.10
|
| Rate for Payer: Cofinity Commercial |
$161.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.46
|
| Rate for Payer: PHP Commercial |
$159.19
|
| Rate for Payer: Priority Health SBD |
$117.99
|
| Rate for Payer: UMR Bronson Commercial |
$82.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.46
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$749.11
|
|
|
Service Code
|
NDC 00093365740
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.61 |
| Max. Negotiated Rate |
$674.20 |
| Rate for Payer: Aetna American Axle |
$486.92
|
| Rate for Payer: Aetna Commercial |
$636.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.92
|
| Rate for Payer: Cash Price |
$599.29
|
| Rate for Payer: Cofinity Advantage |
$524.38
|
| Rate for Payer: Cofinity Commercial |
$644.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.29
|
| Rate for Payer: Healthscope Commercial |
$674.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$524.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.83
|
| Rate for Payer: PHP Commercial |
$636.74
|
| Rate for Payer: Priority Health SBD |
$471.94
|
| Rate for Payer: UMR Bronson Commercial |
$329.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.83
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$954.38
|
|
|
Service Code
|
NDC 59011075104
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.12 |
| Max. Negotiated Rate |
$858.94 |
| Rate for Payer: Aetna American Axle |
$620.35
|
| Rate for Payer: Aetna Commercial |
$811.22
|
| Rate for Payer: Aetna Medicare |
$477.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.35
|
| Rate for Payer: BCBS Complete |
$381.75
|
| Rate for Payer: Cash Price |
$763.50
|
| Rate for Payer: Cofinity Advantage |
$668.07
|
| Rate for Payer: Cofinity Commercial |
$820.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.50
|
| Rate for Payer: Healthscope Commercial |
$858.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$668.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$715.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$763.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$811.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.78
|
| Rate for Payer: PHP Commercial |
$811.22
|
| Rate for Payer: Priority Health SBD |
$601.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$620.35
|
| Rate for Payer: UHC Core |
$497.23
|
| Rate for Payer: UHC Exchange |
$375.07
|
| Rate for Payer: UMR Bronson Commercial |
$353.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$715.78
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$954.38
|
|
|
Service Code
|
NDC 59011075104
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$419.93 |
| Max. Negotiated Rate |
$858.94 |
| Rate for Payer: Aetna American Axle |
$620.35
|
| Rate for Payer: Aetna Commercial |
$811.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.35
|
| Rate for Payer: Cash Price |
$763.50
|
| Rate for Payer: Cofinity Advantage |
$668.07
|
| Rate for Payer: Cofinity Commercial |
$820.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$763.50
|
| Rate for Payer: Healthscope Commercial |
$858.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$668.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$715.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$811.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$715.78
|
| Rate for Payer: PHP Commercial |
$811.22
|
| Rate for Payer: Priority Health SBD |
$601.26
|
| Rate for Payer: UMR Bronson Commercial |
$419.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$715.78
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$749.11
|
|
|
Service Code
|
NDC 00093365740
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.17 |
| Max. Negotiated Rate |
$674.20 |
| Rate for Payer: Aetna American Axle |
$486.92
|
| Rate for Payer: Aetna Commercial |
$636.74
|
| Rate for Payer: Aetna Medicare |
$374.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.92
|
| Rate for Payer: BCBS Complete |
$299.64
|
| Rate for Payer: Cash Price |
$599.29
|
| Rate for Payer: Cofinity Advantage |
$524.38
|
| Rate for Payer: Cofinity Commercial |
$644.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$599.29
|
| Rate for Payer: Healthscope Commercial |
$674.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$524.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$561.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$599.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$636.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$561.83
|
| Rate for Payer: PHP Commercial |
$636.74
|
| Rate for Payer: Priority Health SBD |
$471.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.92
|
| Rate for Payer: UHC Core |
$390.29
|
| Rate for Payer: UHC Exchange |
$294.40
|
| Rate for Payer: UMR Bronson Commercial |
$277.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$561.83
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$1,093.33
|
|
|
Service Code
|
NDC 69238120302
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$404.53 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna American Axle |
$710.66
|
| Rate for Payer: Aetna Commercial |
$929.33
|
| Rate for Payer: Aetna Medicare |
$546.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.66
|
| Rate for Payer: BCBS Complete |
$437.33
|
| Rate for Payer: Cash Price |
$874.66
|
| Rate for Payer: Cofinity Advantage |
$765.33
|
| Rate for Payer: Cofinity Commercial |
$940.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.66
|
| Rate for Payer: Healthscope Commercial |
$984.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$765.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$874.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$820.00
|
| Rate for Payer: PHP Commercial |
$929.33
|
| Rate for Payer: Priority Health SBD |
$688.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$710.66
|
| Rate for Payer: UHC Core |
$569.62
|
| Rate for Payer: UHC Exchange |
$429.68
|
| Rate for Payer: UMR Bronson Commercial |
$404.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.00
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$187.28
|
|
|
Service Code
|
NDC 00093365721
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.29 |
| Max. Negotiated Rate |
$168.55 |
| Rate for Payer: Aetna American Axle |
$121.73
|
| Rate for Payer: Aetna Commercial |
$159.19
|
| Rate for Payer: Aetna Medicare |
$93.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.73
|
| Rate for Payer: BCBS Complete |
$74.91
|
| Rate for Payer: Cash Price |
$149.82
|
| Rate for Payer: Cofinity Advantage |
$131.10
|
| Rate for Payer: Cofinity Commercial |
$161.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.82
|
| Rate for Payer: Healthscope Commercial |
$168.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$149.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.46
|
| Rate for Payer: PHP Commercial |
$159.19
|
| Rate for Payer: Priority Health SBD |
$117.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.73
|
| Rate for Payer: UHC Core |
$97.57
|
| Rate for Payer: UHC Exchange |
$73.60
|
| Rate for Payer: UMR Bronson Commercial |
$69.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.46
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,093.33
|
|
|
Service Code
|
NDC 69238120302
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$481.07 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna American Axle |
$710.66
|
| Rate for Payer: Aetna Commercial |
$929.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.66
|
| Rate for Payer: Cash Price |
$874.66
|
| Rate for Payer: Cofinity Advantage |
$765.33
|
| Rate for Payer: Cofinity Commercial |
$940.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$874.66
|
| Rate for Payer: Healthscope Commercial |
$984.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$765.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$820.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$929.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$820.00
|
| Rate for Payer: PHP Commercial |
$929.33
|
| Rate for Payer: Priority Health SBD |
$688.80
|
| Rate for Payer: UMR Bronson Commercial |
$481.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$820.00
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$1,735.97
|
|
|
Service Code
|
NDC 00093365940
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$642.31 |
| Max. Negotiated Rate |
$1,562.37 |
| Rate for Payer: Aetna American Axle |
$1,128.38
|
| Rate for Payer: Aetna Commercial |
$1,475.57
|
| Rate for Payer: Aetna Medicare |
$867.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,128.38
|
| Rate for Payer: BCBS Complete |
$694.39
|
| Rate for Payer: Cash Price |
$1,388.78
|
| Rate for Payer: Cofinity Advantage |
$1,215.18
|
| Rate for Payer: Cofinity Commercial |
$1,492.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.78
|
| Rate for Payer: Healthscope Commercial |
$1,562.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,215.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,301.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,388.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,475.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,301.98
|
| Rate for Payer: PHP Commercial |
$1,475.57
|
| Rate for Payer: Priority Health SBD |
$1,093.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,128.38
|
| Rate for Payer: UHC Core |
$904.44
|
| Rate for Payer: UHC Exchange |
$682.24
|
| Rate for Payer: UMR Bronson Commercial |
$642.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,301.98
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
NDC 00093365921
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.58 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna American Axle |
$282.10
|
| Rate for Payer: Aetna Commercial |
$368.90
|
| Rate for Payer: Aetna Medicare |
$217.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.10
|
| Rate for Payer: BCBS Complete |
$173.60
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cofinity Advantage |
$303.80
|
| Rate for Payer: Cofinity Commercial |
$373.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.20
|
| Rate for Payer: Healthscope Commercial |
$390.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.50
|
| Rate for Payer: PHP Commercial |
$368.90
|
| Rate for Payer: Priority Health SBD |
$273.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.10
|
| Rate for Payer: UHC Core |
$226.11
|
| Rate for Payer: UHC Exchange |
$170.56
|
| Rate for Payer: UMR Bronson Commercial |
$160.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.50
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
NDC 00093365921
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.96 |
| Max. Negotiated Rate |
$390.60 |
| Rate for Payer: Aetna American Axle |
$282.10
|
| Rate for Payer: Aetna Commercial |
$368.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.10
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cofinity Advantage |
$303.80
|
| Rate for Payer: Cofinity Commercial |
$373.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.20
|
| Rate for Payer: Healthscope Commercial |
$390.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$325.50
|
| Rate for Payer: PHP Commercial |
$368.90
|
| Rate for Payer: Priority Health SBD |
$273.42
|
| Rate for Payer: UMR Bronson Commercial |
$190.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.50
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,735.97
|
|
|
Service Code
|
NDC 00093365940
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$763.83 |
| Max. Negotiated Rate |
$1,562.37 |
| Rate for Payer: Aetna American Axle |
$1,128.38
|
| Rate for Payer: Aetna Commercial |
$1,475.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,128.38
|
| Rate for Payer: Cash Price |
$1,388.78
|
| Rate for Payer: Cofinity Advantage |
$1,215.18
|
| Rate for Payer: Cofinity Commercial |
$1,492.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,388.78
|
| Rate for Payer: Healthscope Commercial |
$1,562.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,215.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,301.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,475.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,301.98
|
| Rate for Payer: PHP Commercial |
$1,475.57
|
| Rate for Payer: Priority Health SBD |
$1,093.66
|
| Rate for Payer: UMR Bronson Commercial |
$763.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,301.98
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$462.74
|
|
|
Service Code
|
NDC 50268014415
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.61 |
| Max. Negotiated Rate |
$416.47 |
| Rate for Payer: Aetna American Axle |
$300.78
|
| Rate for Payer: Aetna Commercial |
$393.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.78
|
| Rate for Payer: Cash Price |
$370.19
|
| Rate for Payer: Cofinity Advantage |
$323.92
|
| Rate for Payer: Cofinity Commercial |
$397.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.19
|
| Rate for Payer: Healthscope Commercial |
$416.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.06
|
| Rate for Payer: PHP Commercial |
$393.33
|
| Rate for Payer: Priority Health SBD |
$291.53
|
| Rate for Payer: UMR Bronson Commercial |
$203.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.06
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$217.14
|
|
|
Service Code
|
NDC 65162041603
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$195.43 |
| Rate for Payer: Aetna American Axle |
$141.14
|
| Rate for Payer: Aetna Commercial |
$184.57
|
| Rate for Payer: Aetna Medicare |
$108.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.14
|
| Rate for Payer: BCBS Complete |
$86.86
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cofinity Advantage |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.71
|
| Rate for Payer: Healthscope Commercial |
$195.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$173.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.85
|
| Rate for Payer: PHP Commercial |
$184.57
|
| Rate for Payer: Priority Health SBD |
$136.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.14
|
| Rate for Payer: UHC Core |
$113.13
|
| Rate for Payer: UHC Exchange |
$85.34
|
| Rate for Payer: UMR Bronson Commercial |
$80.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.85
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$420.62
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.07 |
| Max. Negotiated Rate |
$378.56 |
| Rate for Payer: Aetna American Axle |
$273.40
|
| Rate for Payer: Aetna Commercial |
$357.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.40
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cofinity Advantage |
$294.43
|
| Rate for Payer: Cofinity Commercial |
$361.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.50
|
| Rate for Payer: Healthscope Commercial |
$378.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.46
|
| Rate for Payer: PHP Commercial |
$357.53
|
| Rate for Payer: Priority Health SBD |
$264.99
|
| Rate for Payer: UMR Bronson Commercial |
$185.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.46
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$462.74
|
|
|
Service Code
|
NDC 50268014415
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.21 |
| Max. Negotiated Rate |
$416.47 |
| Rate for Payer: Aetna American Axle |
$300.78
|
| Rate for Payer: Aetna Commercial |
$393.33
|
| Rate for Payer: Aetna Medicare |
$231.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.78
|
| Rate for Payer: BCBS Complete |
$185.10
|
| Rate for Payer: Cash Price |
$370.19
|
| Rate for Payer: Cofinity Advantage |
$323.92
|
| Rate for Payer: Cofinity Commercial |
$397.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.19
|
| Rate for Payer: Healthscope Commercial |
$416.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$347.06
|
| Rate for Payer: PHP Commercial |
$393.33
|
| Rate for Payer: Priority Health SBD |
$291.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.78
|
| Rate for Payer: UHC Core |
$241.09
|
| Rate for Payer: UHC Exchange |
$181.86
|
| Rate for Payer: UMR Bronson Commercial |
$171.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.06
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$180.81
|
|
|
Service Code
|
NDC 00054018813
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$162.73 |
| Rate for Payer: Aetna American Axle |
$117.53
|
| Rate for Payer: Aetna Commercial |
$153.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.53
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Cofinity Advantage |
$126.57
|
| Rate for Payer: Cofinity Commercial |
$155.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.65
|
| Rate for Payer: Healthscope Commercial |
$162.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.61
|
| Rate for Payer: PHP Commercial |
$153.69
|
| Rate for Payer: Priority Health SBD |
$113.91
|
| Rate for Payer: UMR Bronson Commercial |
$79.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.61
|
|
