|
bupivacaine 0.25% PF Inj Sol 30 mL [HMC]
|
Facility
|
OP
|
$30.39
|
|
|
Service Code
|
NDC 00409115910
|
| Hospital Charge Code |
3800377
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.16 |
| Max. Negotiated Rate |
$28.87 |
| Rate for Payer: Aetna Commercial |
$27.35
|
| Rate for Payer: Humana Medicare Advantage |
$12.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.16
|
| Rate for Payer: WPPA Medicare Advantage |
$18.23
|
|
|
bupivacaine 0.5% Inj Sol 50 mL [HMC]
|
Facility
|
IP
|
$37.84
|
|
|
Service Code
|
NDC 00409116301
|
| Hospital Charge Code |
3801008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.95
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine 0.5% Inj Sol 50 mL [HMC]
|
Facility
|
OP
|
$37.84
|
|
|
Service Code
|
NDC 00409116301
|
| Hospital Charge Code |
3801008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$35.95 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: Humana Medicare Advantage |
$15.89
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.14
|
| Rate for Payer: WPPA Medicare Advantage |
$22.70
|
|
|
bupivacaine 0.5% Inj Sol 50 mL [HMC]
|
Facility
|
IP
|
$50.91
|
|
|
Service Code
|
NDC 63323046757
|
| Hospital Charge Code |
3801008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$45.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$48.36
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine 0.5% Inj Sol 50 mL [HMC]
|
Facility
|
OP
|
$50.91
|
|
|
Service Code
|
NDC 63323046757
|
| Hospital Charge Code |
3801008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$48.36 |
| Rate for Payer: Aetna Commercial |
$45.82
|
| Rate for Payer: Humana Medicare Advantage |
$21.38
|
| Rate for Payer: UnitedHealthcare Commercial |
$48.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.36
|
| Rate for Payer: WPPA Medicare Advantage |
$30.55
|
|
|
bupivacaine 0.5% Inj Sol 50 mL [HMC]
|
Facility
|
OP
|
$42.32
|
|
|
Service Code
|
NDC 00409161050
|
| Hospital Charge Code |
3801008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$40.20 |
| Rate for Payer: Aetna Commercial |
$38.09
|
| Rate for Payer: Humana Medicare Advantage |
$17.77
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.93
|
| Rate for Payer: WPPA Medicare Advantage |
$25.39
|
|
|
bupivacaine 0.5% Inj Sol 50 mL [HMC]
|
Facility
|
IP
|
$42.32
|
|
|
Service Code
|
NDC 00409161050
|
| Hospital Charge Code |
3801008
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.09 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$38.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.20
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine 0.5% PF Inj Sol 10 mL [HMC]
|
Facility
|
IP
|
$33.86
|
|
|
Service Code
|
NDC 00409116201
|
| Hospital Charge Code |
3809727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.17
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine 0.5% PF Inj Sol 10 mL [HMC]
|
Facility
|
OP
|
$33.86
|
|
|
Service Code
|
NDC 00409116201
|
| Hospital Charge Code |
3809727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$32.17 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: Humana Medicare Advantage |
$14.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$32.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.54
|
| Rate for Payer: WPPA Medicare Advantage |
$20.32
|
|
|
bupivacaine 0.5% PF Inj Sol 10 mL [HMC]
|
Facility
|
OP
|
$37.08
|
|
|
Service Code
|
NDC 00409156010
|
| Hospital Charge Code |
3809727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$35.23 |
| Rate for Payer: Aetna Commercial |
$33.37
|
| Rate for Payer: Humana Medicare Advantage |
$15.57
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.83
|
| Rate for Payer: WPPA Medicare Advantage |
$22.25
|
|
|
bupivacaine 0.5% PF Inj Sol 10 mL [HMC]
|
Facility
|
IP
|
$37.08
|
|
|
Service Code
|
NDC 00409156010
|
| Hospital Charge Code |
3809727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.37 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$33.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$35.23
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine 0.5% PF Inj Sol 10 mL [HMC]
|
Facility
|
OP
|
$38.86
|
|
|
Service Code
|
NDC 63323046617
|
| Hospital Charge Code |
3809727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$36.92 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| Rate for Payer: Humana Medicare Advantage |
$16.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.54
|
| Rate for Payer: WPPA Medicare Advantage |
$23.32
|
|
|
bupivacaine 0.5% PF Inj Sol 10 mL [HMC]
|
Facility
|
IP
|
$38.86
|
|
|
Service Code
|
NDC 63323046617
|
| Hospital Charge Code |
3809727
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.97 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$34.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$36.92
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine 0.75%-D8.25% 2 mL preservative-free Spinal [HMC]
|
Facility
|
OP
|
$6.84
|
|
|
Service Code
|
NDC 00409361301
|
| Hospital Charge Code |
3803553
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.74 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: Humana Medicare Advantage |
$2.87
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.74
|
| Rate for Payer: WPPA Medicare Advantage |
$4.10
|
|
|
bupivacaine 0.75%-D8.25% 2 mL preservative-free Spinal [HMC]
|
Facility
|
IP
|
$6.84
|
|
|
Service Code
|
NDC 00409361301
|
| Hospital Charge Code |
3803553
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.16
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.50
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
BUPivacaine 0.75%-D8.25% preservative-free Sol [HMC]
|
Facility
|
OP
|
$12.49
|
|
|
Service Code
|
NDC 71351002210
|
| Hospital Charge Code |
3803553
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$11.87 |
| Rate for Payer: Aetna Commercial |
$11.24
|
| Rate for Payer: Humana Medicare Advantage |
$5.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.00
|
| Rate for Payer: WPPA Medicare Advantage |
$7.49
|
|
|
BUPivacaine 0.75%-D8.25% preservative-free Sol [HMC]
|
Facility
|
IP
|
$12.49
|
|
|
Service Code
|
NDC 71351002210
|
| Hospital Charge Code |
3803553
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$11.24
|
| Rate for Payer: UnitedHealthcare Commercial |
$11.87
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 10 mL [HMC]
|
Facility
|
OP
|
$36.69
|
|
|
Service Code
|
NDC 00409174610
|
| Hospital Charge Code |
3800849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$34.86 |
| Rate for Payer: Aetna Commercial |
$33.02
|
| Rate for Payer: Humana Medicare Advantage |
$15.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.68
|
| Rate for Payer: WPPA Medicare Advantage |
$22.01
|
|
|
bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 10 mL [HMC]
|
Facility
|
IP
|
$44.16
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
3800849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.74 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$39.74
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.95
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 10 mL [HMC]
|
Facility
|
IP
|
$36.69
|
|
|
Service Code
|
NDC 00409573810
|
| Hospital Charge Code |
3800849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$33.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.86
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 10 mL [HMC]
|
Facility
|
OP
|
$44.16
|
|
|
Service Code
|
NDC 63323046817
|
| Hospital Charge Code |
3800849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.66 |
| Max. Negotiated Rate |
$41.95 |
| Rate for Payer: Aetna Commercial |
$39.74
|
| Rate for Payer: Humana Medicare Advantage |
$18.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$41.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.66
|
| Rate for Payer: WPPA Medicare Advantage |
$26.50
|
|
|
bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 10 mL [HMC]
|
Facility
|
IP
|
$36.69
|
|
|
Service Code
|
NDC 00409174610
|
| Hospital Charge Code |
3800849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$33.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.86
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 10 mL [HMC]
|
Facility
|
OP
|
$36.69
|
|
|
Service Code
|
NDC 00409573810
|
| Hospital Charge Code |
3800849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$34.86 |
| Rate for Payer: Aetna Commercial |
$33.02
|
| Rate for Payer: Humana Medicare Advantage |
$15.41
|
| Rate for Payer: UnitedHealthcare Commercial |
$34.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.68
|
| Rate for Payer: WPPA Medicare Advantage |
$22.01
|
|
|
bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 30 mL [HMC]
|
Facility
|
IP
|
$47.84
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
3800207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.06 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.45
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
bupivacaine-EPINEPHrine 0.25%-1:200,000 PF Inj Sol 30 mL [HMC]
|
Facility
|
OP
|
$47.84
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
3800207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$45.45 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Humana Medicare Advantage |
$20.09
|
| Rate for Payer: UnitedHealthcare Commercial |
$45.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.14
|
| Rate for Payer: WPPA Medicare Advantage |
$28.70
|
|
