|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$31.41
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.79 |
| Max. Negotiated Rate |
$28.27 |
| Rate for Payer: Aetna Commercial |
$26.70
|
| Rate for Payer: Aetna Commercial |
$6.37
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.74
|
| Rate for Payer: Cash Price |
$25.13
|
| Rate for Payer: Cash Price |
$5.99
|
| Rate for Payer: Cash Price |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$21.99
|
| Rate for Payer: Cofinity Commercial |
$27.01
|
| Rate for Payer: Cofinity Commercial |
$7.59
|
| Rate for Payer: Cofinity Commercial |
$5.24
|
| Rate for Payer: Cofinity Commercial |
$6.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.06
|
| Rate for Payer: Healthscope Commercial |
$6.74
|
| Rate for Payer: Healthscope Commercial |
$7.95
|
| Rate for Payer: Healthscope Commercial |
$28.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.51
|
| Rate for Payer: PHP Commercial |
$7.51
|
| Rate for Payer: PHP Commercial |
$26.70
|
| Rate for Payer: PHP Commercial |
$6.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.87
|
| Rate for Payer: Priority Health SBD |
$5.56
|
| Rate for Payer: Priority Health SBD |
$19.79
|
| Rate for Payer: Priority Health SBD |
$4.72
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$10.27
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$9.24 |
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$27.30
|
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Aetna Medicare |
$18.49
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.86
|
| Rate for Payer: BCBS Complete |
$14.79
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$12.85
|
| Rate for Payer: BCBS Complete |
$4.11
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cofinity Commercial |
$27.62
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$28.91
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$27.30
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.41
|
| Rate for Payer: Priority Health Narrow Network |
$1.13
|
| Rate for Payer: Priority Health Narrow Network |
$1.13
|
| Rate for Payer: Priority Health Narrow Network |
$1.13
|
| Rate for Payer: Priority Health Narrow Network |
$1.13
|
| Rate for Payer: Priority Health Narrow Network |
$1.13
|
| Rate for Payer: Priority Health SBD |
$20.24
|
| Rate for Payer: Priority Health SBD |
$6.47
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: Priority Health SBD |
$7.62
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$10.27
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$9.24 |
| Rate for Payer: Aetna Commercial |
$8.73
|
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Commercial |
$27.30
|
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.86
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$29.58
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Cofinity Commercial |
$7.19
|
| Rate for Payer: Cofinity Commercial |
$8.83
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Commercial |
$5.52
|
| Rate for Payer: Cofinity Commercial |
$8.47
|
| Rate for Payer: Cofinity Commercial |
$31.80
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Cofinity Commercial |
$27.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.31
|
| Rate for Payer: Healthscope Commercial |
$28.91
|
| Rate for Payer: Healthscope Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$33.28
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.73
|
| Rate for Payer: PHP Commercial |
$31.43
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$27.30
|
| Rate for Payer: PHP Commercial |
$10.28
|
| Rate for Payer: PHP Commercial |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.04
|
| Rate for Payer: Priority Health SBD |
$23.30
|
| Rate for Payer: Priority Health SBD |
$7.62
|
| Rate for Payer: Priority Health SBD |
$20.24
|
| Rate for Payer: Priority Health SBD |
$6.47
|
| Rate for Payer: Priority Health SBD |
$4.97
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
IP
|
$317.76
|
|
|
Service Code
|
NDC 65162077810
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.19 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.54
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Commercial |
$222.43
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.54
|
| Rate for Payer: Priority Health SBD |
$200.19
|
|
|
BUDESONIDE DR - ER 3 MG CAPSULE,DELAYED,EXTENDED RELEASE
|
Facility
|
OP
|
$317.76
|
|
|
Service Code
|
NDC 65162077810
|
| Hospital Charge Code |
31576
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.10 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna Medicare |
$158.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.54
|
| Rate for Payer: BCBS Complete |
$127.10
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Commercial |
$222.43
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.54
|
| Rate for Payer: Priority Health SBD |
$200.19
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$96.60
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
300057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Aetna Medicare |
$48.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.79
|
| Rate for Payer: BCBS Complete |
$38.64
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Cofinity Commercial |
$67.62
|
| Rate for Payer: Cofinity Commercial |
$83.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.28
|
| Rate for Payer: Healthscope Commercial |
$86.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.11
|
| Rate for Payer: PHP Commercial |
$82.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.79
|
| Rate for Payer: Priority Health SBD |
$60.86
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$96.60
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
300057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.79
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Cofinity Commercial |
$67.62
|
| Rate for Payer: Cofinity Commercial |
$83.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.28
|
| Rate for Payer: Healthscope Commercial |
$86.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.11
|
| Rate for Payer: PHP Commercial |
$82.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.79
|
| Rate for Payer: Priority Health SBD |
$60.86
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$96.60
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Aetna Medicare |
$48.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.79
|
| Rate for Payer: BCBS Complete |
$38.64
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Cofinity Commercial |
$67.62
|
| Rate for Payer: Cofinity Commercial |
$83.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.28
|
| Rate for Payer: Healthscope Commercial |
$86.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.11
|
| Rate for Payer: PHP Commercial |
$82.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.79
|
| Rate for Payer: Priority Health SBD |
$60.86
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$96.60
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$82.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.79
|
| Rate for Payer: Cash Price |
$77.28
|
| Rate for Payer: Cofinity Commercial |
$67.62
|
| Rate for Payer: Cofinity Commercial |
$83.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.28
|
| Rate for Payer: Healthscope Commercial |
$86.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.11
|
| Rate for Payer: PHP Commercial |
$82.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.79
|
| Rate for Payer: Priority Health SBD |
$60.86
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$193.41
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
300059
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.36 |
| 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 Commercial |
$135.39
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.39
|
| 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: PHP Commercial |
$164.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.72
|
| Rate for Payer: Priority Health SBD |
$121.85
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$193.41
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
300059
|
|
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 Commercial |
$135.39
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.39
|
| 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: PHP Commercial |
$164.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.72
|
| 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 |
$77.36 |
| 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 Commercial |
$135.39
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.39
|
| 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: PHP Commercial |
$164.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.72
|
| Rate for Payer: Priority Health SBD |
$121.85
|
|
|
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 Commercial |
$135.39
|
| Rate for Payer: Cofinity Commercial |
$166.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.39
|
| 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: PHP Commercial |
$164.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.72
|
| Rate for Payer: Priority Health SBD |
$121.85
|
|
|
BUFFERED LIDOCAINE 1% WITH EPI
|
Facility
|
OP
|
$20.87
|
|
|
Service Code
|
NDC 09900001074
|
| Hospital Charge Code |
500548
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.35 |
| 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 Commercial |
$14.61
|
| Rate for Payer: Cofinity Commercial |
$17.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.61
|
| 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: PHP Commercial |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health SBD |
$13.15
|
|
|
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 Commercial |
$17.95
|
| Rate for Payer: Cofinity Commercial |
$14.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.61
|
| 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: PHP Commercial |
$17.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.57
|
| Rate for Payer: Priority Health SBD |
$13.15
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.70
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.45 |
| Max. Negotiated Rate |
$24.93 |
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$19.57
|
| Rate for Payer: Aetna Commercial |
$20.46
|
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$19.26
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$19.80
|
| Rate for Payer: Cofinity Commercial |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$16.85
|
| Rate for Payer: Cofinity Commercial |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| 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 |
$22.16
|
| Rate for Payer: Healthscope Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Healthscope Commercial |
$21.66
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.45
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Commercial |
$20.46
|
| Rate for Payer: PHP Commercial |
$19.57
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.96
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$14.50
|
| Rate for Payer: Priority Health SBD |
$18.13
|
| Rate for Payer: Priority Health SBD |
$13.63
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: Priority Health SBD |
$15.16
|
| Rate for Payer: Priority Health SBD |
$17.45
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.07
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$21.66 |
| Rate for Payer: Aetna Commercial |
$20.46
|
| Rate for Payer: Aetna Commercial |
$20.32
|
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Commercial |
$23.54
|
| Rate for Payer: Aetna Commercial |
$19.57
|
| Rate for Payer: Aetna Commercial |
$18.39
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Aetna Medicare |
$0.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.73
|
| Rate for Payer: BCBS Complete |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.33
|
| Rate for Payer: BCBS Complete |
$0.33
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Commercial |
$1.75
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: BCN Medicare Advantage |
$0.58
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$19.26
|
| Rate for Payer: Cash Price |
$19.26
|
| Rate for Payer: Cash Price |
$18.42
|
| Rate for Payer: Cash Price |
$17.31
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$20.70
|
| Rate for Payer: Cofinity Commercial |
$16.73
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Cofinity Commercial |
$20.14
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$19.80
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$18.61
|
| Rate for Payer: Cofinity Commercial |
$15.15
|
| Rate for Payer: Cofinity Commercial |
$16.85
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Cofinity Commercial |
$17.86
|
| Rate for Payer: Cofinity Commercial |
$20.55
|
| Rate for Payer: Cofinity Commercial |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.58
|
| Rate for Payer: Healthscope Commercial |
$21.51
|
| Rate for Payer: Healthscope Commercial |
$21.66
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$24.93
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$0.31
|
| Rate for Payer: Mclaren Medicaid |
$0.31
|
| Rate for Payer: Mclaren Medicaid |
$0.31
|
| Rate for Payer: Mclaren Medicaid |
$0.31
|
| Rate for Payer: Mclaren Medicaid |
$0.31
|
| Rate for Payer: Mclaren Medicaid |
$0.31
|
| Rate for Payer: Mclaren Medicaid |
$0.31
|
| Rate for Payer: Mclaren Medicare |
$0.58
|
| Rate for Payer: Mclaren Medicare |
$0.58
|
| Rate for Payer: Mclaren Medicare |
$0.58
|
| Rate for Payer: Mclaren Medicare |
$0.58
|
| Rate for Payer: Mclaren Medicare |
$0.58
|
| Rate for Payer: Mclaren Medicare |
$0.58
|
| Rate for Payer: Mclaren Medicare |
$0.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.61
|
| Rate for Payer: Meridian Medicaid |
$0.33
|
| Rate for Payer: Meridian Medicaid |
$0.33
|
| Rate for Payer: Meridian Medicaid |
$0.33
|
| Rate for Payer: Meridian Medicaid |
$0.33
|
| Rate for Payer: Meridian Medicaid |
$0.33
|
| Rate for Payer: Meridian Medicaid |
$0.33
|
| Rate for Payer: Meridian Medicaid |
$0.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: Nomi Health Commercial |
$1.74
|
| Rate for Payer: PACE Medicare |
$0.55
|
| Rate for Payer: PACE Medicare |
$0.55
|
| Rate for Payer: PACE Medicare |
$0.55
|
| Rate for Payer: PACE Medicare |
$0.55
|
| Rate for Payer: PACE Medicare |
$0.55
|
| Rate for Payer: PACE Medicare |
$0.55
|
| Rate for Payer: PACE Medicare |
$0.55
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PACE SWMI |
$0.58
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: PHP Commercial |
$19.57
|
| Rate for Payer: PHP Commercial |
$20.32
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Commercial |
$18.39
|
| Rate for Payer: PHP Commercial |
$20.46
|
| Rate for Payer: PHP Commercial |
$23.54
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.80
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Medicare |
$0.58
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: Priority Health Narrow Network |
$1.44
|
| Rate for Payer: Priority Health SBD |
$15.06
|
| Rate for Payer: Priority Health SBD |
$16.08
|
| Rate for Payer: Priority Health SBD |
$13.63
|
| Rate for Payer: Priority Health SBD |
$17.45
|
| Rate for Payer: Priority Health SBD |
$18.13
|
| Rate for Payer: Priority Health SBD |
$15.16
|
| Rate for Payer: Priority Health SBD |
$14.50
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: Railroad Medicare Medicare |
$0.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHC Medicare Advantage |
$0.58
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
| Rate for Payer: VA VA |
$0.58
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.36 |
| 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 Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.63
|
| 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: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health SBD |
$252.57
|
|
|
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 Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.63
|
| 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: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health SBD |
$252.57
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$194.88
|
|
|
Service Code
|
NDC 50268013115
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$175.39 |
| Rate for Payer: Aetna Commercial |
$165.65
|
| Rate for Payer: Aetna Medicare |
$97.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.67
|
| Rate for Payer: BCBS Complete |
$77.95
|
| Rate for Payer: Cash Price |
$155.90
|
| Rate for Payer: Cofinity Commercial |
$136.42
|
| Rate for Payer: Cofinity Commercial |
$167.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.90
|
| Rate for Payer: Healthscope Commercial |
$175.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.65
|
| Rate for Payer: PHP Commercial |
$165.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.67
|
| Rate for Payer: Priority Health SBD |
$122.77
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$2,004.50
|
|
|
Service Code
|
NDC 00185012905
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$801.80 |
| Max. Negotiated Rate |
$1,804.05 |
| Rate for Payer: Aetna Commercial |
$1,703.82
|
| 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 Commercial |
$1,403.15
|
| Rate for Payer: Cofinity Commercial |
$1,723.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,403.15
|
| 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 |
$1,703.82
|
| Rate for Payer: PHP Commercial |
$1,703.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.92
|
| Rate for Payer: Priority Health SBD |
$1,262.84
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$178.80
|
|
|
Service Code
|
NDC 00904701606
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.52 |
| 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 Commercial |
$125.16
|
| Rate for Payer: Cofinity Commercial |
$153.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.16
|
| 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: PHP Commercial |
$151.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.22
|
| Rate for Payer: Priority Health SBD |
$112.64
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
NDC 50268013111
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.54
|
| Rate for Payer: BCBS Complete |
$1.56
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.32
|
| Rate for Payer: PHP Commercial |
$3.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: Priority Health SBD |
$2.46
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$194.88
|
|
|
Service Code
|
NDC 50268013115
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.77 |
| Max. Negotiated Rate |
$175.39 |
| Rate for Payer: Aetna Commercial |
$165.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.67
|
| Rate for Payer: Cash Price |
$155.90
|
| Rate for Payer: Cofinity Commercial |
$136.42
|
| Rate for Payer: Cofinity Commercial |
$167.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.90
|
| Rate for Payer: Healthscope Commercial |
$175.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.65
|
| Rate for Payer: PHP Commercial |
$165.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.67
|
| Rate for Payer: Priority Health SBD |
$122.77
|
|
|
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 |
$1,703.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.92
|
| Rate for Payer: Cash Price |
$1,603.60
|
| Rate for Payer: Cofinity Commercial |
$1,403.15
|
| Rate for Payer: Cofinity Commercial |
$1,723.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,403.15
|
| 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 |
$1,703.82
|
| Rate for Payer: PHP Commercial |
$1,703.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,302.92
|
| Rate for Payer: Priority Health SBD |
$1,262.84
|
|
