|
BRINZOLAMIDE 1 %-BRIMONIDINE 0.2 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$708.12
|
|
|
Service Code
|
NDC 00065414727
|
| Hospital Charge Code |
166167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$492.85 |
| Max. Negotiated Rate |
$637.31 |
| Rate for Payer: Aetna Commercial |
$601.90
|
| Rate for Payer: BCBS Trust/PPO |
$584.84
|
| Rate for Payer: BCN Commercial |
$584.84
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cofinity Commercial |
$608.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.50
|
| Rate for Payer: Healthscope Commercial |
$637.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.90
|
| Rate for Payer: Nomi Health Commercial |
$580.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$531.09
|
| Rate for Payer: PHP Commercial |
$601.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$616.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.15
|
| Rate for Payer: UHC Core |
$591.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.09
|
|
|
BRINZOLAMIDE 1 %-BRIMONIDINE 0.2 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$708.12
|
|
|
Service Code
|
NDC 00065414727
|
| Hospital Charge Code |
166167
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.84 |
| Max. Negotiated Rate |
$637.31 |
| Rate for Payer: Aetna Commercial |
$601.90
|
| Rate for Payer: Aetna Medicare |
$184.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$221.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$221.29
|
| Rate for Payer: BCBS Complete |
$131.07
|
| Rate for Payer: BCBS MAPPO |
$177.03
|
| Rate for Payer: BCBS Trust/PPO |
$582.15
|
| Rate for Payer: BCN Commercial |
$582.15
|
| Rate for Payer: BCN Medicare Advantage |
$177.03
|
| Rate for Payer: Cash Price |
$566.50
|
| Rate for Payer: Cofinity Commercial |
$608.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.03
|
| Rate for Payer: Healthscope Commercial |
$637.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.09
|
| Rate for Payer: Mclaren Medicaid |
$124.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.88
|
| Rate for Payer: Meridian Medicaid |
$131.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.90
|
| Rate for Payer: Nomi Health Commercial |
$580.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$531.09
|
| Rate for Payer: PACE Senior Care Partners |
$168.18
|
| Rate for Payer: PACE SWMI |
$177.03
|
| Rate for Payer: PHP Commercial |
$601.90
|
| Rate for Payer: PHP Medicare Advantage |
$177.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$616.06
|
| Rate for Payer: Priority Health Medicare |
$178.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$492.85
|
| Rate for Payer: Railroad Medicare Medicare |
$177.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.15
|
| Rate for Payer: UHC Core |
$591.28
|
| Rate for Payer: UHC Exchange |
$177.03
|
| Rate for Payer: UHC Medicaid |
$124.84
|
| Rate for Payer: UHC Medicare Advantage |
$177.03
|
| Rate for Payer: UHCCP Medicaid |
$124.84
|
| Rate for Payer: VA VA |
$177.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.09
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$965.27
|
|
|
Service Code
|
NDC 00591212779
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.18 |
| Max. Negotiated Rate |
$868.74 |
| Rate for Payer: Aetna Commercial |
$820.48
|
| Rate for Payer: Aetna Medicare |
$250.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$301.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$301.65
|
| Rate for Payer: BCBS Complete |
$178.67
|
| Rate for Payer: BCBS MAPPO |
$241.32
|
| Rate for Payer: BCBS Trust/PPO |
$793.55
|
| Rate for Payer: BCN Commercial |
$793.55
|
| Rate for Payer: BCN Medicare Advantage |
$241.32
|
| Rate for Payer: Cash Price |
$772.22
|
| Rate for Payer: Cofinity Commercial |
$830.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.32
|
| Rate for Payer: Healthscope Commercial |
$868.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.95
|
| Rate for Payer: Mclaren Medicaid |
$170.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.38
|
| Rate for Payer: Meridian Medicaid |
$178.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$277.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.48
|
| Rate for Payer: Nomi Health Commercial |
$791.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.95
|
| Rate for Payer: PACE Senior Care Partners |
$229.25
|
| Rate for Payer: PACE SWMI |
$241.32
|
| Rate for Payer: PHP Commercial |
$820.48
|
| Rate for Payer: PHP Medicare Advantage |
$241.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$170.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$839.78
|
| Rate for Payer: Priority Health Medicare |
$243.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.83
|
| Rate for Payer: Railroad Medicare Medicare |
$241.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.44
|
| Rate for Payer: UHC Core |
$806.00
|
| Rate for Payer: UHC Exchange |
$241.32
|
| Rate for Payer: UHC Medicaid |
$170.18
|
| Rate for Payer: UHC Medicare Advantage |
$241.32
|
| Rate for Payer: UHCCP Medicaid |
$170.18
|
| Rate for Payer: VA VA |
$241.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.95
|
|
|
BRINZOLAMIDE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$965.27
|
|
|
Service Code
|
NDC 00591212779
|
| Hospital Charge Code |
22953
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$671.83 |
| Max. Negotiated Rate |
$868.74 |
| Rate for Payer: Aetna Commercial |
$820.48
|
| Rate for Payer: BCBS Trust/PPO |
$797.22
|
| Rate for Payer: BCN Commercial |
$797.22
|
| Rate for Payer: Cash Price |
$772.22
|
| Rate for Payer: Cofinity Commercial |
$830.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$772.22
|
| Rate for Payer: Healthscope Commercial |
$868.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$723.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$820.48
|
| Rate for Payer: Nomi Health Commercial |
$791.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$723.95
|
| Rate for Payer: PHP Commercial |
$820.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$839.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$671.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$849.44
|
| Rate for Payer: UHC Core |
$806.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$723.95
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$8,341.40
|
|
|
Service Code
|
APR-DRG 1384
|
| Min. Negotiated Rate |
$7,944.19 |
| Max. Negotiated Rate |
$8,341.40 |
| Rate for Payer: BCBS Complete |
$8,341.40
|
| Rate for Payer: Mclaren Medicaid |
$7,944.19
|
| Rate for Payer: Meridian Medicaid |
$8,341.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,944.19
|
| Rate for Payer: UHC Medicaid |
$7,944.19
|
| Rate for Payer: UHCCP Medicaid |
$7,944.19
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$3,758.18
|
|
|
Service Code
|
APR-DRG 1382
|
| Min. Negotiated Rate |
$3,579.22 |
| Max. Negotiated Rate |
$3,758.18 |
| Rate for Payer: BCBS Complete |
$3,758.18
|
| Rate for Payer: Mclaren Medicaid |
$3,579.22
|
| Rate for Payer: Meridian Medicaid |
$3,758.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,579.22
|
| Rate for Payer: UHC Medicaid |
$3,579.22
|
| Rate for Payer: UHCCP Medicaid |
$3,579.22
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$6,313.76
|
|
|
Service Code
|
APR-DRG 1383
|
| Min. Negotiated Rate |
$6,013.11 |
| Max. Negotiated Rate |
$6,313.76 |
| Rate for Payer: BCBS Complete |
$6,313.76
|
| Rate for Payer: Mclaren Medicaid |
$6,013.11
|
| Rate for Payer: Meridian Medicaid |
$6,313.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,013.11
|
| Rate for Payer: UHC Medicaid |
$6,013.11
|
| Rate for Payer: UHCCP Medicaid |
$6,013.11
|
|
|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$2,784.32
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$2,651.74 |
| Max. Negotiated Rate |
$2,784.32 |
| Rate for Payer: BCBS Complete |
$2,784.32
|
| Rate for Payer: Mclaren Medicaid |
$2,651.74
|
| Rate for Payer: Meridian Medicaid |
$2,784.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,651.74
|
| Rate for Payer: UHC Medicaid |
$2,651.74
|
| Rate for Payer: UHCCP Medicaid |
$2,651.74
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$25.92
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: Aetna Commercial |
$23.26
|
| Rate for Payer: Aetna Medicare |
$2.49
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: Aetna Medicare |
$7.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.99
|
| Rate for Payer: BCBS Complete |
$5.06
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Complete |
$1.77
|
| Rate for Payer: BCBS MAPPO |
$2.39
|
| Rate for Payer: BCBS MAPPO |
$6.48
|
| Rate for Payer: BCBS MAPPO |
$6.84
|
| Rate for Payer: BCBS Trust/PPO |
$21.31
|
| Rate for Payer: BCBS Trust/PPO |
$22.49
|
| Rate for Payer: BCBS Trust/PPO |
$7.86
|
| Rate for Payer: BCN Commercial |
$22.49
|
| Rate for Payer: BCN Commercial |
$7.86
|
| Rate for Payer: BCN Commercial |
$21.31
|
| Rate for Payer: BCN Medicare Advantage |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$6.84
|
| Rate for Payer: BCN Medicare Advantage |
$6.48
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$23.53
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.52
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Mclaren Medicaid |
$1.69
|
| Rate for Payer: Mclaren Medicaid |
$4.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.51
|
| Rate for Payer: Meridian Medicaid |
$1.77
|
| Rate for Payer: Meridian Medicaid |
$4.80
|
| Rate for Payer: Meridian Medicaid |
$5.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.26
|
| Rate for Payer: Nomi Health Commercial |
$7.84
|
| Rate for Payer: Nomi Health Commercial |
$22.44
|
| Rate for Payer: Nomi Health Commercial |
$21.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.44
|
| Rate for Payer: PACE Senior Care Partners |
$6.50
|
| Rate for Payer: PACE Senior Care Partners |
$6.16
|
| Rate for Payer: PACE Senior Care Partners |
$2.27
|
| Rate for Payer: PACE SWMI |
$2.39
|
| Rate for Payer: PACE SWMI |
$6.84
|
| Rate for Payer: PACE SWMI |
$6.48
|
| Rate for Payer: PHP Commercial |
$22.03
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: PHP Commercial |
$23.26
|
| Rate for Payer: PHP Medicare Advantage |
$6.84
|
| Rate for Payer: PHP Medicare Advantage |
$6.48
|
| Rate for Payer: PHP Medicare Advantage |
$2.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.32
|
| Rate for Payer: Priority Health Medicare |
$2.41
|
| Rate for Payer: Priority Health Medicare |
$6.91
|
| Rate for Payer: Priority Health Medicare |
$6.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.04
|
| Rate for Payer: Railroad Medicare Medicare |
$6.84
|
| Rate for Payer: Railroad Medicare Medicare |
$2.39
|
| Rate for Payer: Railroad Medicare Medicare |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.81
|
| Rate for Payer: UHC Core |
$21.64
|
| Rate for Payer: UHC Core |
$7.98
|
| Rate for Payer: UHC Core |
$22.85
|
| Rate for Payer: UHC Exchange |
$2.39
|
| Rate for Payer: UHC Exchange |
$6.84
|
| Rate for Payer: UHC Exchange |
$6.48
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicaid |
$1.69
|
| Rate for Payer: UHC Medicaid |
$4.82
|
| Rate for Payer: UHC Medicare Advantage |
$6.84
|
| Rate for Payer: UHC Medicare Advantage |
$6.48
|
| Rate for Payer: UHC Medicare Advantage |
$2.39
|
| Rate for Payer: UHCCP Medicaid |
$4.82
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: UHCCP Medicaid |
$1.69
|
| Rate for Payer: VA VA |
$6.48
|
| Rate for Payer: VA VA |
$2.39
|
| Rate for Payer: VA VA |
$6.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.17
|
|
|
BUDESONIDE 0.25 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$25.92
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna Commercial |
$22.03
|
| Rate for Payer: Aetna Commercial |
$23.26
|
| Rate for Payer: Aetna Commercial |
$8.13
|
| Rate for Payer: BCBS Trust/PPO |
$22.60
|
| Rate for Payer: BCBS Trust/PPO |
$21.41
|
| Rate for Payer: BCBS Trust/PPO |
$7.90
|
| Rate for Payer: BCN Commercial |
$22.60
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: BCN Commercial |
$7.90
|
| Rate for Payer: Cash Price |
$20.74
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$23.53
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.65
|
| Rate for Payer: Healthscope Commercial |
$24.62
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$21.25
|
| Rate for Payer: Nomi Health Commercial |
$22.44
|
| Rate for Payer: Nomi Health Commercial |
$7.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.17
|
| Rate for Payer: PHP Commercial |
$22.03
|
| Rate for Payer: PHP Commercial |
$8.13
|
| Rate for Payer: PHP Commercial |
$23.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$23.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.81
|
| Rate for Payer: UHC Core |
$21.64
|
| Rate for Payer: UHC Core |
$7.98
|
| Rate for Payer: UHC Core |
$22.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.52
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$12.27
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.43
|
| Rate for Payer: Aetna Commercial |
$25.93
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: BCBS Trust/PPO |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$10.13
|
| Rate for Payer: BCBS Trust/PPO |
$26.40
|
| Rate for Payer: BCN Commercial |
$25.20
|
| Rate for Payer: BCN Commercial |
$10.13
|
| Rate for Payer: BCN Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$10.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$11.04
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Nomi Health Commercial |
$10.06
|
| Rate for Payer: Nomi Health Commercial |
$25.02
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.98
|
| Rate for Payer: PHP Commercial |
$10.43
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.80
|
| Rate for Payer: UHC Core |
$10.25
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: UHC Core |
$25.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.88
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$12.27
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.43
|
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Commercial |
$25.93
|
| Rate for Payer: Aetna Medicare |
$8.31
|
| Rate for Payer: Aetna Medicare |
$3.19
|
| Rate for Payer: Aetna Medicare |
$7.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.99
|
| Rate for Payer: BCBS Complete |
$5.65
|
| Rate for Payer: BCBS Complete |
$2.27
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS MAPPO |
$7.99
|
| Rate for Payer: BCBS MAPPO |
$3.07
|
| Rate for Payer: BCBS MAPPO |
$7.63
|
| Rate for Payer: BCBS Trust/PPO |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$25.08
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCN Commercial |
$25.08
|
| Rate for Payer: BCN Commercial |
$26.28
|
| Rate for Payer: BCN Commercial |
$10.09
|
| Rate for Payer: BCN Medicare Advantage |
$7.99
|
| Rate for Payer: BCN Medicare Advantage |
$7.63
|
| Rate for Payer: BCN Medicare Advantage |
$3.07
|
| Rate for Payer: Cash Price |
$25.58
|
| Rate for Payer: Cash Price |
$24.41
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$10.55
|
| Rate for Payer: Cofinity Commercial |
$26.24
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$27.46
|
| Rate for Payer: Healthscope Commercial |
$11.04
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.88
|
| Rate for Payer: Mclaren Medicaid |
$2.16
|
| Rate for Payer: Mclaren Medicaid |
$5.64
|
| Rate for Payer: Mclaren Medicaid |
$5.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.39
|
| Rate for Payer: Meridian Medicaid |
$5.92
|
| Rate for Payer: Meridian Medicaid |
$2.27
|
| Rate for Payer: Meridian Medicaid |
$5.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.93
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Nomi Health Commercial |
$25.02
|
| Rate for Payer: Nomi Health Commercial |
$10.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.20
|
| Rate for Payer: PACE Senior Care Partners |
$7.25
|
| Rate for Payer: PACE Senior Care Partners |
$2.91
|
| Rate for Payer: PACE Senior Care Partners |
$7.59
|
| Rate for Payer: PACE SWMI |
$7.99
|
| Rate for Payer: PACE SWMI |
$7.63
|
| Rate for Payer: PACE SWMI |
$3.07
|
| Rate for Payer: PHP Commercial |
$10.43
|
| Rate for Payer: PHP Commercial |
$27.17
|
| Rate for Payer: PHP Commercial |
$25.93
|
| Rate for Payer: PHP Medicare Advantage |
$7.63
|
| Rate for Payer: PHP Medicare Advantage |
$3.07
|
| Rate for Payer: PHP Medicare Advantage |
$7.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$26.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.81
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health Medicare |
$7.70
|
| Rate for Payer: Priority Health Medicare |
$3.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.54
|
| Rate for Payer: Railroad Medicare Medicare |
$7.63
|
| Rate for Payer: Railroad Medicare Medicare |
$7.99
|
| Rate for Payer: Railroad Medicare Medicare |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.80
|
| Rate for Payer: UHC Core |
$10.25
|
| Rate for Payer: UHC Core |
$26.69
|
| Rate for Payer: UHC Core |
$25.48
|
| Rate for Payer: UHC Exchange |
$7.99
|
| Rate for Payer: UHC Exchange |
$7.63
|
| Rate for Payer: UHC Exchange |
$3.07
|
| Rate for Payer: UHC Medicaid |
$2.16
|
| Rate for Payer: UHC Medicaid |
$5.64
|
| Rate for Payer: UHC Medicaid |
$5.38
|
| Rate for Payer: UHC Medicare Advantage |
$7.63
|
| Rate for Payer: UHC Medicare Advantage |
$3.07
|
| Rate for Payer: UHC Medicare Advantage |
$7.99
|
| Rate for Payer: UHCCP Medicaid |
$5.38
|
| Rate for Payer: UHCCP Medicaid |
$2.16
|
| Rate for Payer: UHCCP Medicaid |
$5.64
|
| Rate for Payer: VA VA |
$3.07
|
| Rate for Payer: VA VA |
$7.99
|
| Rate for Payer: VA VA |
$7.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.98
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$10.28
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$62.88
|
| Rate for Payer: Aetna Commercial |
$27.31
|
| Rate for Payer: Aetna Medicare |
$19.23
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Aetna Medicare |
$8.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.12
|
| Rate for Payer: BCBS Complete |
$5.95
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Complete |
$13.69
|
| Rate for Payer: BCBS MAPPO |
$18.50
|
| Rate for Payer: BCBS MAPPO |
$2.57
|
| Rate for Payer: BCBS MAPPO |
$8.03
|
| Rate for Payer: BCBS Trust/PPO |
$8.45
|
| Rate for Payer: BCBS Trust/PPO |
$26.41
|
| Rate for Payer: BCBS Trust/PPO |
$60.82
|
| Rate for Payer: BCN Commercial |
$26.41
|
| Rate for Payer: BCN Commercial |
$60.82
|
| Rate for Payer: BCN Commercial |
$8.45
|
| Rate for Payer: BCN Medicare Advantage |
$18.50
|
| Rate for Payer: BCN Medicare Advantage |
$8.03
|
| Rate for Payer: BCN Medicare Advantage |
$2.57
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| Rate for Payer: Cofinity Commercial |
$27.63
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.57
|
| Rate for Payer: Healthscope Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$66.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.10
|
| Rate for Payer: Mclaren Medicaid |
$1.81
|
| Rate for Payer: Mclaren Medicaid |
$13.04
|
| Rate for Payer: Mclaren Medicaid |
$5.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.42
|
| Rate for Payer: Meridian Medicaid |
$13.69
|
| Rate for Payer: Meridian Medicaid |
$1.90
|
| Rate for Payer: Meridian Medicaid |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: Nomi Health Commercial |
$26.35
|
| Rate for Payer: Nomi Health Commercial |
$8.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.71
|
| Rate for Payer: PACE Senior Care Partners |
$7.63
|
| Rate for Payer: PACE Senior Care Partners |
$2.44
|
| Rate for Payer: PACE Senior Care Partners |
$17.57
|
| Rate for Payer: PACE SWMI |
$18.50
|
| Rate for Payer: PACE SWMI |
$8.03
|
| Rate for Payer: PACE SWMI |
$2.57
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Commercial |
$62.88
|
| Rate for Payer: PHP Commercial |
$27.31
|
| Rate for Payer: PHP Medicare Advantage |
$8.03
|
| Rate for Payer: PHP Medicare Advantage |
$2.57
|
| Rate for Payer: PHP Medicare Advantage |
$18.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.36
|
| Rate for Payer: Priority Health Medicare |
$18.68
|
| Rate for Payer: Priority Health Medicare |
$8.11
|
| Rate for Payer: Priority Health Medicare |
$2.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.15
|
| Rate for Payer: Railroad Medicare Medicare |
$8.03
|
| Rate for Payer: Railroad Medicare Medicare |
$18.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.05
|
| Rate for Payer: UHC Core |
$8.58
|
| Rate for Payer: UHC Core |
$61.77
|
| Rate for Payer: UHC Core |
$26.83
|
| Rate for Payer: UHC Exchange |
$18.50
|
| Rate for Payer: UHC Exchange |
$8.03
|
| Rate for Payer: UHC Exchange |
$2.57
|
| Rate for Payer: UHC Medicaid |
$1.81
|
| Rate for Payer: UHC Medicaid |
$13.04
|
| Rate for Payer: UHC Medicaid |
$5.66
|
| Rate for Payer: UHC Medicare Advantage |
$8.03
|
| Rate for Payer: UHC Medicare Advantage |
$2.57
|
| Rate for Payer: UHC Medicare Advantage |
$18.50
|
| Rate for Payer: UHCCP Medicaid |
$5.66
|
| Rate for Payer: UHCCP Medicaid |
$1.81
|
| Rate for Payer: UHCCP Medicaid |
$13.04
|
| Rate for Payer: VA VA |
$2.57
|
| Rate for Payer: VA VA |
$18.50
|
| Rate for Payer: VA VA |
$8.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.48
|
|
|
BUDESONIDE 1 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$10.28
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
88223
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$9.25 |
| Rate for Payer: Aetna Commercial |
$8.74
|
| Rate for Payer: Aetna Commercial |
$27.31
|
| Rate for Payer: Aetna Commercial |
$62.88
|
| Rate for Payer: BCBS Trust/PPO |
$26.54
|
| Rate for Payer: BCBS Trust/PPO |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$61.10
|
| Rate for Payer: BCN Commercial |
$26.54
|
| Rate for Payer: BCN Commercial |
$8.49
|
| Rate for Payer: BCN Commercial |
$61.10
|
| Rate for Payer: Cash Price |
$8.22
|
| Rate for Payer: Cash Price |
$59.18
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$63.62
|
| Rate for Payer: Cofinity Commercial |
$27.63
|
| Rate for Payer: Cofinity Commercial |
$8.84
|
| 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 |
$59.18
|
| Rate for Payer: Healthscope Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$9.25
|
| Rate for Payer: Healthscope Commercial |
$66.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.88
|
| Rate for Payer: Nomi Health Commercial |
$8.43
|
| Rate for Payer: Nomi Health Commercial |
$26.35
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.48
|
| Rate for Payer: PHP Commercial |
$8.74
|
| Rate for Payer: PHP Commercial |
$62.88
|
| Rate for Payer: PHP Commercial |
$27.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.05
|
| Rate for Payer: UHC Core |
$8.58
|
| Rate for Payer: UHC Core |
$61.77
|
| Rate for Payer: UHC Core |
$26.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.10
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: BCBS Trust/PPO |
$153.32
|
| Rate for Payer: BCN Commercial |
$153.32
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.23
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.01
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.61
|
| Rate for Payer: BCN Commercial |
$152.61
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Mclaren Medicaid |
$32.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Meridian Medicaid |
$34.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.23
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Medicare |
$46.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$32.73
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: UHCCP Medicaid |
$32.73
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$185.64
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.01
|
| Rate for Payer: BCBS Complete |
$34.36
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.61
|
| Rate for Payer: BCN Commercial |
$152.61
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Mclaren Medicaid |
$32.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Meridian Medicaid |
$34.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.23
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Medicare |
$46.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$32.73
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: UHCCP Medicaid |
$32.73
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$185.64
|
|
|
Service Code
|
NDC 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.21 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.79
|
| Rate for Payer: BCBS Trust/PPO |
$153.32
|
| Rate for Payer: BCN Commercial |
$153.32
|
| Rate for Payer: Cash Price |
$148.51
|
| Rate for Payer: Cofinity Commercial |
$159.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.51
|
| Rate for Payer: Healthscope Commercial |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.79
|
| Rate for Payer: Nomi Health Commercial |
$152.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.23
|
| Rate for Payer: PHP Commercial |
$157.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.36
|
| Rate for Payer: UHC Core |
$155.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.23
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$25.52
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$21.08
|
| Rate for Payer: BCN Commercial |
$21.08
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.14
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC Core |
$21.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$25.52
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Medicare |
$6.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.97
|
| Rate for Payer: BCBS Complete |
$4.72
|
| Rate for Payer: BCBS MAPPO |
$6.38
|
| Rate for Payer: BCBS Trust/PPO |
$20.98
|
| Rate for Payer: BCN Commercial |
$20.98
|
| Rate for Payer: BCN Medicare Advantage |
$6.38
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Mclaren Medicaid |
$4.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.70
|
| Rate for Payer: Meridian Medicaid |
$4.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.14
|
| Rate for Payer: PACE Senior Care Partners |
$6.06
|
| Rate for Payer: PACE SWMI |
$6.38
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Medicare Advantage |
$6.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.20
|
| Rate for Payer: Priority Health Medicare |
$6.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.76
|
| Rate for Payer: Railroad Medicare Medicare |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC Core |
$21.31
|
| Rate for Payer: UHC Exchange |
$6.38
|
| Rate for Payer: UHC Medicaid |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.38
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: VA VA |
$6.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 69238148901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.94 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.29
|
| Rate for Payer: BCN Commercial |
$199.29
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.18 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$103.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.39
|
| Rate for Payer: BCBS Complete |
$73.68
|
| Rate for Payer: BCBS MAPPO |
$99.51
|
| Rate for Payer: BCBS Trust/PPO |
$327.24
|
| Rate for Payer: BCN Commercial |
$327.24
|
| Rate for Payer: BCN Medicare Advantage |
$99.51
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.51
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Mclaren Medicaid |
$70.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.49
|
| Rate for Payer: Meridian Medicaid |
$73.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PACE Senior Care Partners |
$94.54
|
| Rate for Payer: PACE SWMI |
$99.51
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: PHP Medicare Advantage |
$99.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Medicare |
$100.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.04
|
| Rate for Payer: Railroad Medicare Medicare |
$99.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.28
|
| Rate for Payer: UHC Core |
$332.37
|
| Rate for Payer: UHC Exchange |
$99.51
|
| Rate for Payer: UHC Medicaid |
$70.18
|
| Rate for Payer: UHC Medicare Advantage |
$99.51
|
| Rate for Payer: UHCCP Medicaid |
$70.18
|
| Rate for Payer: VA VA |
$99.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 42799011901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.94 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: BCBS Trust/PPO |
$247.94
|
| Rate for Payer: BCN Commercial |
$247.94
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.15
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.18
|
| Rate for Payer: UHC Core |
$250.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.04 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: BCBS Trust/PPO |
$328.75
|
| Rate for Payer: BCN Commercial |
$328.75
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.28
|
| Rate for Payer: UHC Core |
$332.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 42799011901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.93 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: Aetna Medicare |
$78.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.81
|
| Rate for Payer: BCBS Complete |
$55.57
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCBS Trust/PPO |
$246.79
|
| Rate for Payer: BCN Commercial |
$246.79
|
| Rate for Payer: BCN Medicare Advantage |
$75.05
|
| Rate for Payer: Cash Price |
$240.16
|
| Rate for Payer: Cofinity Commercial |
$258.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.05
|
| Rate for Payer: Healthscope Commercial |
$270.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.15
|
| Rate for Payer: Mclaren Medicaid |
$52.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: Meridian Medicaid |
$55.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.15
|
| Rate for Payer: PACE Senior Care Partners |
$71.30
|
| Rate for Payer: PACE SWMI |
$75.05
|
| Rate for Payer: PHP Commercial |
$255.17
|
| Rate for Payer: PHP Medicare Advantage |
$75.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Medicare |
$75.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.94
|
| Rate for Payer: Railroad Medicare Medicare |
$75.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.18
|
| Rate for Payer: UHC Core |
$250.67
|
| Rate for Payer: UHC Exchange |
$75.05
|
| Rate for Payer: UHC Medicaid |
$52.93
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
| Rate for Payer: UHCCP Medicaid |
$52.93
|
| Rate for Payer: VA VA |
$75.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
