|
BUMETANIDE 0.25 MG/ML INJ SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Aetna Commercial |
$17.15
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: Cigna All Commercial |
$17.13
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$18.46
|
| Rate for Payer: Coventry All Commercial |
$17.47
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$18.27
|
| Rate for Payer: Frontpath All Commercial |
$18.26
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana ChoiceCare |
$17.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.87
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHCS All Commercial |
$14.89
|
| Rate for Payer: PHP All Commercial |
$15.06
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Sagamore Health Network All Products |
$15.33
|
| Rate for Payer: Signature Care EPO |
$16.48
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$17.47
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$15.64
|
|
|
BUMETANIDE 0.25 MG/ML INJ SOLN
|
Facility
|
OP
|
$19.85
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$18.46 |
| Rate for Payer: Aetna Commercial |
$16.76
|
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Aetna Medicare |
$6.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.21
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Centivo All Commercial |
$10.12
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$17.13
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$18.46
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$17.47
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$18.27
|
| Rate for Payer: Frontpath All Commercial |
$18.26
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$17.15
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$10.12
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$10.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.87
|
| Rate for Payer: PHCS All Commercial |
$14.89
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$15.06
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Sagamore Health Network All Products |
$15.33
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care EPO |
$16.48
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$17.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$15.64
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
| Rate for Payer: United Healthcare Medicare |
$6.55
|
|
|
BUMETANIDE 1 MG ORAL TAB
|
Facility
|
OP
|
$6.42
|
|
|
Service Code
|
NDC 60687038401
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna Commercial |
$5.42
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.33
|
| Rate for Payer: Cash Price |
$3.98
|
| Rate for Payer: Centivo All Commercial |
$3.27
|
| Rate for Payer: Cigna All Commercial |
$5.54
|
| Rate for Payer: CORVEL All Commercial |
$5.97
|
| Rate for Payer: Coventry All Commercial |
$5.65
|
| Rate for Payer: Encore All Commercial |
$5.91
|
| Rate for Payer: Frontpath All Commercial |
$5.91
|
| Rate for Payer: Humana ChoiceCare |
$5.54
|
| Rate for Payer: Humana Medicare |
$3.27
|
| Rate for Payer: Lucent All Commercial |
$3.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.78
|
| Rate for Payer: PHCS All Commercial |
$4.81
|
| Rate for Payer: PHP All Commercial |
$4.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.50
|
| Rate for Payer: Sagamore Health Network All Products |
$4.96
|
| Rate for Payer: Signature Care EPO |
$5.33
|
| Rate for Payer: Signature Care PPO |
$5.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.46
|
| Rate for Payer: United Healthcare Commercial |
$5.06
|
| Rate for Payer: United Healthcare Medicare |
$2.12
|
|
|
BUMETANIDE 1 MG ORAL TAB
|
Facility
|
IP
|
$6.42
|
|
|
Service Code
|
NDC 60687038401
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$5.97 |
| Rate for Payer: Aetna Commercial |
$5.55
|
| Rate for Payer: Cash Price |
$3.98
|
| Rate for Payer: Cigna All Commercial |
$5.54
|
| Rate for Payer: CORVEL All Commercial |
$5.97
|
| Rate for Payer: Coventry All Commercial |
$5.65
|
| Rate for Payer: Encore All Commercial |
$5.91
|
| Rate for Payer: Frontpath All Commercial |
$5.91
|
| Rate for Payer: Humana ChoiceCare |
$5.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.78
|
| Rate for Payer: PHCS All Commercial |
$4.81
|
| Rate for Payer: PHP All Commercial |
$4.87
|
| Rate for Payer: Sagamore Health Network All Products |
$4.96
|
| Rate for Payer: Signature Care EPO |
$5.33
|
| Rate for Payer: Signature Care PPO |
$5.65
|
| Rate for Payer: United Healthcare Commercial |
$5.06
|
|
|
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJ SOLN
|
Facility
|
IP
|
$145.25
|
|
|
Service Code
|
NDC 63323046101
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.94 |
| Max. Negotiated Rate |
$135.08 |
| Rate for Payer: Aetna Commercial |
$125.50
|
| Rate for Payer: Cash Price |
$90.06
|
| Rate for Payer: Cigna All Commercial |
$125.35
|
| Rate for Payer: CORVEL All Commercial |
$135.08
|
| Rate for Payer: Coventry All Commercial |
$127.82
|
| Rate for Payer: Encore All Commercial |
$133.70
|
| Rate for Payer: Frontpath All Commercial |
$133.63
|
| Rate for Payer: Humana ChoiceCare |
$125.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.72
|
| Rate for Payer: PHCS All Commercial |
$108.94
|
| Rate for Payer: PHP All Commercial |
$110.16
|
| Rate for Payer: Sagamore Health Network All Products |
$112.13
|
| Rate for Payer: Signature Care EPO |
$120.56
|
| Rate for Payer: Signature Care PPO |
$127.82
|
| Rate for Payer: United Healthcare Commercial |
$114.46
|
|
|
BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJ SOLN
|
Facility
|
OP
|
$145.25
|
|
|
Service Code
|
NDC 63323046101
|
| Hospital Charge Code |
14983
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$135.08 |
| Rate for Payer: Aetna Commercial |
$122.59
|
| Rate for Payer: Aetna Medicare |
$47.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.73
|
| Rate for Payer: Cash Price |
$90.06
|
| Rate for Payer: Cash Price |
$90.06
|
| Rate for Payer: Centivo All Commercial |
$74.08
|
| Rate for Payer: Cigna All Commercial |
$125.35
|
| Rate for Payer: CORVEL All Commercial |
$135.08
|
| Rate for Payer: Coventry All Commercial |
$127.82
|
| Rate for Payer: Encore All Commercial |
$133.70
|
| Rate for Payer: Frontpath All Commercial |
$133.63
|
| Rate for Payer: Humana ChoiceCare |
$125.45
|
| Rate for Payer: Humana Medicare |
$74.08
|
| Rate for Payer: Lucent All Commercial |
$74.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.72
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$108.94
|
| Rate for Payer: PHP All Commercial |
$110.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.65
|
| Rate for Payer: Sagamore Health Network All Products |
$112.13
|
| Rate for Payer: Signature Care EPO |
$120.56
|
| Rate for Payer: Signature Care PPO |
$127.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.46
|
| Rate for Payer: United Healthcare Commercial |
$114.46
|
| Rate for Payer: United Healthcare Medicare |
$47.93
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN
|
Facility
|
IP
|
$57.33
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$53.32 |
| Rate for Payer: Aetna Commercial |
$49.53
|
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: Cigna All Commercial |
$49.48
|
| Rate for Payer: CORVEL All Commercial |
$53.32
|
| Rate for Payer: Coventry All Commercial |
$50.45
|
| Rate for Payer: Encore All Commercial |
$52.77
|
| Rate for Payer: Frontpath All Commercial |
$52.74
|
| Rate for Payer: Humana ChoiceCare |
$49.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.60
|
| Rate for Payer: PHCS All Commercial |
$43.00
|
| Rate for Payer: PHP All Commercial |
$43.48
|
| Rate for Payer: Sagamore Health Network All Products |
$44.26
|
| Rate for Payer: Signature Care EPO |
$47.58
|
| Rate for Payer: Signature Care PPO |
$50.45
|
| Rate for Payer: United Healthcare Commercial |
$45.18
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN
|
Facility
|
IP
|
$81.27
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.95 |
| Max. Negotiated Rate |
$75.58 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Cash Price |
$50.39
|
| Rate for Payer: Cigna All Commercial |
$70.14
|
| Rate for Payer: CORVEL All Commercial |
$75.58
|
| Rate for Payer: Coventry All Commercial |
$71.52
|
| Rate for Payer: Encore All Commercial |
$74.81
|
| Rate for Payer: Frontpath All Commercial |
$74.77
|
| Rate for Payer: Humana ChoiceCare |
$70.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.14
|
| Rate for Payer: PHCS All Commercial |
$60.95
|
| Rate for Payer: PHP All Commercial |
$61.64
|
| Rate for Payer: Sagamore Health Network All Products |
$62.74
|
| Rate for Payer: Signature Care EPO |
$67.45
|
| Rate for Payer: Signature Care PPO |
$71.52
|
| Rate for Payer: United Healthcare Commercial |
$64.04
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN
|
Facility
|
OP
|
$81.27
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.82 |
| Max. Negotiated Rate |
$75.58 |
| Rate for Payer: Aetna Commercial |
$68.59
|
| Rate for Payer: Aetna Medicare |
$26.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.50
|
| Rate for Payer: Cash Price |
$50.39
|
| Rate for Payer: Cash Price |
$50.39
|
| Rate for Payer: Centivo All Commercial |
$41.45
|
| Rate for Payer: Cigna All Commercial |
$70.14
|
| Rate for Payer: CORVEL All Commercial |
$75.58
|
| Rate for Payer: Coventry All Commercial |
$71.52
|
| Rate for Payer: Encore All Commercial |
$74.81
|
| Rate for Payer: Frontpath All Commercial |
$74.77
|
| Rate for Payer: Humana ChoiceCare |
$70.19
|
| Rate for Payer: Humana Medicare |
$41.45
|
| Rate for Payer: Lucent All Commercial |
$41.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.14
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$60.95
|
| Rate for Payer: PHP All Commercial |
$61.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.70
|
| Rate for Payer: Sagamore Health Network All Products |
$62.74
|
| Rate for Payer: Signature Care EPO |
$67.45
|
| Rate for Payer: Signature Care PPO |
$71.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$69.08
|
| Rate for Payer: United Healthcare Commercial |
$64.04
|
| Rate for Payer: United Healthcare Medicare |
$26.82
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN
|
Facility
|
OP
|
$57.33
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$53.32 |
| Rate for Payer: Aetna Commercial |
$48.39
|
| Rate for Payer: Aetna Medicare |
$18.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.81
|
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: Centivo All Commercial |
$29.24
|
| Rate for Payer: Cigna All Commercial |
$49.48
|
| Rate for Payer: CORVEL All Commercial |
$53.32
|
| Rate for Payer: Coventry All Commercial |
$50.45
|
| Rate for Payer: Encore All Commercial |
$52.77
|
| Rate for Payer: Frontpath All Commercial |
$52.74
|
| Rate for Payer: Humana ChoiceCare |
$49.52
|
| Rate for Payer: Humana Medicare |
$29.24
|
| Rate for Payer: Lucent All Commercial |
$29.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.60
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$43.00
|
| Rate for Payer: PHP All Commercial |
$43.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.36
|
| Rate for Payer: Sagamore Health Network All Products |
$44.26
|
| Rate for Payer: Signature Care EPO |
$47.58
|
| Rate for Payer: Signature Care PPO |
$50.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.73
|
| Rate for Payer: United Healthcare Commercial |
$45.18
|
| Rate for Payer: United Healthcare Medicare |
$18.92
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$90.81 |
| Rate for Payer: Aetna Commercial |
$82.42
|
| Rate for Payer: Aetna Medicare |
$32.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.45
|
| Rate for Payer: Cash Price |
$60.54
|
| Rate for Payer: Cash Price |
$60.54
|
| Rate for Payer: Centivo All Commercial |
$49.80
|
| Rate for Payer: Cigna All Commercial |
$84.27
|
| Rate for Payer: CORVEL All Commercial |
$90.81
|
| Rate for Payer: Coventry All Commercial |
$85.93
|
| Rate for Payer: Encore All Commercial |
$89.89
|
| Rate for Payer: Frontpath All Commercial |
$89.84
|
| Rate for Payer: Humana ChoiceCare |
$84.34
|
| Rate for Payer: Humana Medicare |
$49.80
|
| Rate for Payer: Lucent All Commercial |
$49.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.88
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$73.24
|
| Rate for Payer: PHP All Commercial |
$74.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.08
|
| Rate for Payer: Sagamore Health Network All Products |
$75.39
|
| Rate for Payer: Signature Care EPO |
$81.05
|
| Rate for Payer: Signature Care PPO |
$85.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.00
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
| Rate for Payer: United Healthcare Medicare |
$32.22
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN
|
Facility
|
OP
|
$58.73
|
|
|
Service Code
|
NDC 63323046217
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$54.62 |
| Rate for Payer: Aetna Commercial |
$49.57
|
| Rate for Payer: Aetna Medicare |
$19.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.32
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Centivo All Commercial |
$29.95
|
| Rate for Payer: Cigna All Commercial |
$50.68
|
| Rate for Payer: CORVEL All Commercial |
$54.62
|
| Rate for Payer: Coventry All Commercial |
$51.68
|
| Rate for Payer: Encore All Commercial |
$54.06
|
| Rate for Payer: Frontpath All Commercial |
$54.03
|
| Rate for Payer: Humana ChoiceCare |
$50.73
|
| Rate for Payer: Humana Medicare |
$29.95
|
| Rate for Payer: Lucent All Commercial |
$29.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.86
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$44.05
|
| Rate for Payer: PHP All Commercial |
$44.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.90
|
| Rate for Payer: Sagamore Health Network All Products |
$45.34
|
| Rate for Payer: Signature Care EPO |
$48.75
|
| Rate for Payer: Signature Care PPO |
$51.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.92
|
| Rate for Payer: United Healthcare Commercial |
$46.28
|
| Rate for Payer: United Healthcare Medicare |
$19.38
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.24 |
| Max. Negotiated Rate |
$90.81 |
| Rate for Payer: Aetna Commercial |
$84.37
|
| Rate for Payer: Cash Price |
$60.54
|
| Rate for Payer: Cigna All Commercial |
$84.27
|
| Rate for Payer: CORVEL All Commercial |
$90.81
|
| Rate for Payer: Coventry All Commercial |
$85.93
|
| Rate for Payer: Encore All Commercial |
$89.89
|
| Rate for Payer: Frontpath All Commercial |
$89.84
|
| Rate for Payer: Humana ChoiceCare |
$84.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$87.88
|
| Rate for Payer: PHCS All Commercial |
$73.24
|
| Rate for Payer: PHP All Commercial |
$74.06
|
| Rate for Payer: Sagamore Health Network All Products |
$75.39
|
| Rate for Payer: Signature Care EPO |
$81.05
|
| Rate for Payer: Signature Care PPO |
$85.93
|
| Rate for Payer: United Healthcare Commercial |
$76.95
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN
|
Facility
|
IP
|
$58.73
|
|
|
Service Code
|
NDC 63323046217
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.05 |
| Max. Negotiated Rate |
$54.62 |
| Rate for Payer: Aetna Commercial |
$50.74
|
| Rate for Payer: Cash Price |
$36.41
|
| Rate for Payer: Cigna All Commercial |
$50.68
|
| Rate for Payer: CORVEL All Commercial |
$54.62
|
| Rate for Payer: Coventry All Commercial |
$51.68
|
| Rate for Payer: Encore All Commercial |
$54.06
|
| Rate for Payer: Frontpath All Commercial |
$54.03
|
| Rate for Payer: Humana ChoiceCare |
$50.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.86
|
| Rate for Payer: PHCS All Commercial |
$44.05
|
| Rate for Payer: PHP All Commercial |
$44.54
|
| Rate for Payer: Sagamore Health Network All Products |
$45.34
|
| Rate for Payer: Signature Care EPO |
$48.75
|
| Rate for Payer: Signature Care PPO |
$51.68
|
| Rate for Payer: United Healthcare Commercial |
$46.28
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.75 %-1:200,000 INJ SOLN
|
Facility
|
OP
|
$85.26
|
|
|
Service Code
|
NDC 63323046037
|
| Hospital Charge Code |
114890
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.14 |
| Max. Negotiated Rate |
$79.29 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$28.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$48.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.95
|
| Rate for Payer: Cash Price |
$52.86
|
| Rate for Payer: Centivo All Commercial |
$43.48
|
| Rate for Payer: Cigna All Commercial |
$73.58
|
| Rate for Payer: CORVEL All Commercial |
$79.29
|
| Rate for Payer: Coventry All Commercial |
$75.03
|
| Rate for Payer: Encore All Commercial |
$78.48
|
| Rate for Payer: Frontpath All Commercial |
$78.44
|
| Rate for Payer: Humana ChoiceCare |
$73.64
|
| Rate for Payer: Humana Medicare |
$43.48
|
| Rate for Payer: Lucent All Commercial |
$43.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.73
|
| Rate for Payer: PHCS All Commercial |
$63.94
|
| Rate for Payer: PHP All Commercial |
$64.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.25
|
| Rate for Payer: Sagamore Health Network All Products |
$65.82
|
| Rate for Payer: Signature Care EPO |
$70.77
|
| Rate for Payer: Signature Care PPO |
$75.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.47
|
| Rate for Payer: United Healthcare Commercial |
$67.18
|
| Rate for Payer: United Healthcare Medicare |
$28.14
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.75 %-1:200,000 INJ SOLN
|
Facility
|
IP
|
$85.26
|
|
|
Service Code
|
NDC 63323046037
|
| Hospital Charge Code |
114890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.94 |
| Max. Negotiated Rate |
$79.29 |
| Rate for Payer: Aetna Commercial |
$73.66
|
| Rate for Payer: Cash Price |
$52.86
|
| Rate for Payer: Cigna All Commercial |
$73.58
|
| Rate for Payer: CORVEL All Commercial |
$79.29
|
| Rate for Payer: Coventry All Commercial |
$75.03
|
| Rate for Payer: Encore All Commercial |
$78.48
|
| Rate for Payer: Frontpath All Commercial |
$78.44
|
| Rate for Payer: Humana ChoiceCare |
$73.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.73
|
| Rate for Payer: PHCS All Commercial |
$63.94
|
| Rate for Payer: PHP All Commercial |
$64.66
|
| Rate for Payer: Sagamore Health Network All Products |
$65.82
|
| Rate for Payer: Signature Care EPO |
$70.77
|
| Rate for Payer: Signature Care PPO |
$75.03
|
| Rate for Payer: United Healthcare Commercial |
$67.18
|
|
|
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
BUPIVACAINE HCL 0.5 % (5 MG/ML) INJ SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1223
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$10.42
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$17.64
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$19.01
|
| Rate for Payer: Coventry All Commercial |
$17.99
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$18.82
|
| Rate for Payer: Frontpath All Commercial |
$18.80
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$17.65
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$10.42
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$10.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$15.33
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$15.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.97
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Sagamore Health Network All Products |
$15.78
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care EPO |
$16.97
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$17.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$16.11
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
| Rate for Payer: United Healthcare Medicare |
$6.75
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN
|
Facility
|
IP
|
$20.44
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.33 |
| Max. Negotiated Rate |
$19.01 |
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$12.67
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$17.64
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$19.01
|
| Rate for Payer: Coventry All Commercial |
$17.99
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$18.82
|
| Rate for Payer: Frontpath All Commercial |
$18.80
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana ChoiceCare |
$17.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.40
|
| Rate for Payer: PHCS All Commercial |
$15.33
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$15.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$15.78
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$16.97
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$17.99
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$16.11
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
