|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$193.41
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.85 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Aetna Commercial |
$164.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.72
|
| Rate for Payer: Cash Price |
$154.73
|
| Rate for Payer: Cofinity Advantage |
$135.39
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.73
|
| Rate for Payer: Healthscope Commercial |
$174.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.06
|
| Rate for Payer: PHP Commercial |
$164.40
|
| Rate for Payer: Priority Health SBD |
$121.85
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$193.41
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.01 |
| Max. Negotiated Rate |
$174.07 |
| Rate for Payer: Aetna Commercial |
$164.40
|
| Rate for Payer: Aetna Medicare |
$96.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.72
|
| Rate for Payer: BCBS Complete |
$77.36
|
| Rate for Payer: Cash Price |
$154.73
|
| Rate for Payer: Cofinity Advantage |
$135.39
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.73
|
| Rate for Payer: Healthscope Commercial |
$174.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.06
|
| Rate for Payer: PHP Commercial |
$164.40
|
| Rate for Payer: Priority Health SBD |
$121.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.72
|
| Rate for Payer: UHC Core |
$100.77
|
| Rate for Payer: UHC Exchange |
$76.01
|
|
|
BUFFERED LIDOCAINE 1% WITH EPI
|
Facility
|
IP
|
$20.87
|
|
|
Service Code
|
NDC 09900001074
|
| Hospital Charge Code |
500548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$18.78 |
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$14.61
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$18.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: PHP Commercial |
$17.74
|
| Rate for Payer: Priority Health SBD |
$13.15
|
|
|
BUFFERED LIDOCAINE 1% WITH EPI
|
Facility
|
OP
|
$20.87
|
|
|
Service Code
|
NDC 09900001074
|
| Hospital Charge Code |
500548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$18.78 |
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.57
|
| Rate for Payer: BCBS Complete |
$8.35
|
| Rate for Payer: Cash Price |
$16.70
|
| Rate for Payer: Cofinity Advantage |
$14.61
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$18.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.65
|
| Rate for Payer: PHP Commercial |
$17.74
|
| Rate for Payer: Priority Health SBD |
$13.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.57
|
| Rate for Payer: UHC Core |
$10.87
|
| Rate for Payer: UHC Exchange |
$8.20
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$27.70
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Medicare |
$11.02
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna Medicare |
$11.95
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna Medicare |
$12.76
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: BCBS Complete |
$11.08
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Complete |
$9.56
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Complete |
$10.21
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: BCN Commercial |
$0.89
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Advantage |
$19.39
|
| Rate for Payer: Cofinity Advantage |
$17.86
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Advantage |
$15.43
|
| Rate for Payer: Cofinity Advantage |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.14
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Exchange |
$0.59
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.39
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.11 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Commercial |
$23.55
|
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$17.63
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cofinity Advantage |
$15.43
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Advantage |
$17.86
|
| Rate for Payer: Cofinity Advantage |
$16.73
|
| Rate for Payer: Cofinity Advantage |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$18.95
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.53
|
| Rate for Payer: PHP Commercial |
$23.55
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$18.73
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: Priority Health SBD |
$15.06
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$3.95
|
|
|
Service Code
|
NDC 50268013111
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.16
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: PHP Commercial |
$3.36
|
| Rate for Payer: Priority Health SBD |
$2.49
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.55 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna Medicare |
$200.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Advantage |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.68
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health SBD |
$252.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$260.58
|
| Rate for Payer: UHC Core |
$208.87
|
| Rate for Payer: UHC Exchange |
$157.55
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$2,004.50
|
|
|
Service Code
|
NDC 00185012905
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,262.84 |
| Max. Negotiated Rate |
$1,804.05 |
| Rate for Payer: Aetna Commercial |
$1,703.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.92
|
| Rate for Payer: Cash Price |
$1,603.60
|
| Rate for Payer: Cofinity Advantage |
$1,403.15
|
| Rate for Payer: Cofinity Commercial |
$1,723.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.60
|
| Rate for Payer: Healthscope Commercial |
$1,804.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,503.38
|
| Rate for Payer: PHP Commercial |
$1,703.83
|
| Rate for Payer: Priority Health SBD |
$1,262.84
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$197.04
|
|
|
Service Code
|
NDC 50268013115
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.44 |
| Max. Negotiated Rate |
$177.34 |
| Rate for Payer: Aetna Commercial |
$167.48
|
| Rate for Payer: Aetna Medicare |
$98.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.08
|
| Rate for Payer: BCBS Complete |
$78.82
|
| Rate for Payer: Cash Price |
$157.63
|
| Rate for Payer: Cofinity Advantage |
$137.93
|
| Rate for Payer: Cofinity Commercial |
$169.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.63
|
| Rate for Payer: Healthscope Commercial |
$177.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.78
|
| Rate for Payer: PHP Commercial |
$167.48
|
| Rate for Payer: Priority Health SBD |
$124.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.08
|
| Rate for Payer: UHC Core |
$102.66
|
| Rate for Payer: UHC Exchange |
$77.44
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$2,004.50
|
|
|
Service Code
|
NDC 00185012905
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$787.77 |
| Max. Negotiated Rate |
$1,804.05 |
| Rate for Payer: Aetna Commercial |
$1,703.83
|
| Rate for Payer: Aetna Medicare |
$1,002.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.92
|
| Rate for Payer: BCBS Complete |
$801.80
|
| Rate for Payer: Cash Price |
$1,603.60
|
| Rate for Payer: Cofinity Advantage |
$1,403.15
|
| Rate for Payer: Cofinity Commercial |
$1,723.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,603.60
|
| Rate for Payer: Healthscope Commercial |
$1,804.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,603.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,503.38
|
| Rate for Payer: PHP Commercial |
$1,703.83
|
| Rate for Payer: Priority Health SBD |
$1,262.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,302.92
|
| Rate for Payer: UHC Core |
$1,044.34
|
| Rate for Payer: UHC Exchange |
$787.77
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.57 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Advantage |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.68
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health SBD |
$252.57
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$197.04
|
|
|
Service Code
|
NDC 50268013115
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$177.34 |
| Rate for Payer: Aetna Commercial |
$167.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.08
|
| Rate for Payer: Cash Price |
$157.63
|
| Rate for Payer: Cofinity Advantage |
$137.93
|
| Rate for Payer: Cofinity Commercial |
$169.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.63
|
| Rate for Payer: Healthscope Commercial |
$177.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.78
|
| Rate for Payer: PHP Commercial |
$167.48
|
| Rate for Payer: Priority Health SBD |
$124.14
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$260.30
|
|
|
Service Code
|
NDC 69238149001
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.30 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna Medicare |
$130.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.19
|
| Rate for Payer: BCBS Complete |
$104.12
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Advantage |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.22
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health SBD |
$163.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.19
|
| Rate for Payer: UHC Core |
$135.62
|
| Rate for Payer: UHC Exchange |
$102.30
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$178.80
|
|
|
Service Code
|
NDC 00904701606
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.64 |
| Max. Negotiated Rate |
$160.92 |
| Rate for Payer: Aetna Commercial |
$151.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.22
|
| Rate for Payer: Cash Price |
$143.04
|
| Rate for Payer: Cofinity Advantage |
$125.16
|
| Rate for Payer: Cofinity Commercial |
$153.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.04
|
| Rate for Payer: Healthscope Commercial |
$160.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.10
|
| Rate for Payer: PHP Commercial |
$151.98
|
| Rate for Payer: Priority Health SBD |
$112.64
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$178.80
|
|
|
Service Code
|
NDC 00904701606
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.27 |
| Max. Negotiated Rate |
$160.92 |
| Rate for Payer: Aetna Commercial |
$151.98
|
| Rate for Payer: Aetna Medicare |
$89.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.22
|
| Rate for Payer: BCBS Complete |
$71.52
|
| Rate for Payer: Cash Price |
$143.04
|
| Rate for Payer: Cofinity Advantage |
$125.16
|
| Rate for Payer: Cofinity Commercial |
$153.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.04
|
| Rate for Payer: Healthscope Commercial |
$160.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.10
|
| Rate for Payer: PHP Commercial |
$151.98
|
| Rate for Payer: Priority Health SBD |
$112.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.22
|
| Rate for Payer: UHC Core |
$93.15
|
| Rate for Payer: UHC Exchange |
$70.27
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$260.30
|
|
|
Service Code
|
NDC 69238149001
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.99 |
| Max. Negotiated Rate |
$234.27 |
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.19
|
| Rate for Payer: Cash Price |
$208.24
|
| Rate for Payer: Cofinity Advantage |
$182.21
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.24
|
| Rate for Payer: Healthscope Commercial |
$234.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.22
|
| Rate for Payer: PHP Commercial |
$221.25
|
| Rate for Payer: Priority Health SBD |
$163.99
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$3.95
|
|
|
Service Code
|
NDC 50268013111
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.57
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cofinity Advantage |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$3.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.16
|
| Rate for Payer: Healthscope Commercial |
$3.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: PHP Commercial |
$3.36
|
| Rate for Payer: Priority Health SBD |
$2.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.57
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$1.55
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$375.84
|
|
|
Service Code
|
NDC 00185013001
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.78 |
| Max. Negotiated Rate |
$338.26 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.30
|
| Rate for Payer: Cash Price |
$300.67
|
| Rate for Payer: Cofinity Advantage |
$263.09
|
| Rate for Payer: Cofinity Commercial |
$323.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.67
|
| Rate for Payer: Healthscope Commercial |
$338.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.88
|
| Rate for Payer: PHP Commercial |
$319.46
|
| Rate for Payer: Priority Health SBD |
$236.78
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
OP
|
$7.41
|
|
|
Service Code
|
NDC 60687053511
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$6.67 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.82
|
| Rate for Payer: BCBS Complete |
$2.96
|
| Rate for Payer: Cash Price |
$5.93
|
| Rate for Payer: Cofinity Advantage |
$5.19
|
| Rate for Payer: Cofinity Commercial |
$6.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.93
|
| Rate for Payer: Healthscope Commercial |
$6.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.56
|
| Rate for Payer: PHP Commercial |
$6.30
|
| Rate for Payer: Priority Health SBD |
$4.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.82
|
| Rate for Payer: UHC Core |
$3.86
|
| Rate for Payer: UHC Exchange |
$2.91
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$6.73
|
|
|
Service Code
|
NDC 50268013211
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.37
|
| Rate for Payer: Cash Price |
$5.38
|
| Rate for Payer: Cofinity Advantage |
$4.71
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$6.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.05
|
| Rate for Payer: PHP Commercial |
$5.72
|
| Rate for Payer: Priority Health SBD |
$4.24
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$662.40
|
|
|
Service Code
|
NDC 60687053501
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$417.31 |
| Max. Negotiated Rate |
$596.16 |
| Rate for Payer: Aetna Commercial |
$563.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.56
|
| Rate for Payer: Cash Price |
$529.92
|
| Rate for Payer: Cofinity Advantage |
$463.68
|
| Rate for Payer: Cofinity Commercial |
$569.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.92
|
| Rate for Payer: Healthscope Commercial |
$596.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.80
|
| Rate for Payer: PHP Commercial |
$563.04
|
| Rate for Payer: Priority Health SBD |
$417.31
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$370.08
|
|
|
Service Code
|
NDC 60687053565
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.15 |
| Max. Negotiated Rate |
$333.07 |
| Rate for Payer: Aetna Commercial |
$314.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.55
|
| Rate for Payer: Cash Price |
$296.06
|
| Rate for Payer: Cofinity Advantage |
$259.06
|
| Rate for Payer: Cofinity Commercial |
$318.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$296.06
|
| Rate for Payer: Healthscope Commercial |
$333.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.56
|
| Rate for Payer: PHP Commercial |
$314.57
|
| Rate for Payer: Priority Health SBD |
$233.15
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
OP
|
$662.40
|
|
|
Service Code
|
NDC 60687053501
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.32 |
| Max. Negotiated Rate |
$596.16 |
| Rate for Payer: Aetna Commercial |
$563.04
|
| Rate for Payer: Aetna Medicare |
$331.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.56
|
| Rate for Payer: BCBS Complete |
$264.96
|
| Rate for Payer: Cash Price |
$529.92
|
| Rate for Payer: Cofinity Advantage |
$463.68
|
| Rate for Payer: Cofinity Commercial |
$569.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$529.92
|
| Rate for Payer: Healthscope Commercial |
$596.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$529.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$496.80
|
| Rate for Payer: PHP Commercial |
$563.04
|
| Rate for Payer: Priority Health SBD |
$417.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$430.56
|
| Rate for Payer: UHC Core |
$345.11
|
| Rate for Payer: UHC Exchange |
$260.32
|
|
|
BUMETANIDE 2 MG TABLET
|
Facility
|
IP
|
$425.60
|
|
|
Service Code
|
NDC 69238149101
|
| Hospital Charge Code |
9311
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.13 |
| Max. Negotiated Rate |
$383.04 |
| Rate for Payer: Aetna Commercial |
$361.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.64
|
| Rate for Payer: Cash Price |
$340.48
|
| Rate for Payer: Cofinity Advantage |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$366.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.48
|
| Rate for Payer: Healthscope Commercial |
$383.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.20
|
| Rate for Payer: PHP Commercial |
$361.76
|
| Rate for Payer: Priority Health SBD |
$268.13
|
|
