|
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 |
$16.59 |
| Max. Negotiated Rate |
$22.97 |
| Rate for Payer: Aetna Commercial |
$21.69
|
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: BCBS Trust/PPO |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$23.48
|
| Rate for Payer: BCN Commercial |
$19.72
|
| Rate for Payer: BCN Commercial |
$22.23
|
| Rate for Payer: Cash Price |
$20.42
|
| Rate for Payer: Cash Price |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$21.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.42
|
| Rate for Payer: Healthscope Commercial |
$22.97
|
| Rate for Payer: Healthscope Commercial |
$25.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.45
|
| Rate for Payer: Nomi Health Commercial |
$20.93
|
| Rate for Payer: Nomi Health Commercial |
$23.59
|
| Rate for Payer: PHP Commercial |
$21.69
|
| Rate for Payer: PHP Commercial |
$24.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.59
|
| Rate for Payer: Priority Health HMO/PPO |
$25.03
|
| Rate for Payer: Priority Health HMO/PPO |
$22.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.32
|
| Rate for Payer: UHC Core |
$21.31
|
| Rate for Payer: UHC Core |
$24.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.58
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 69238148901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: BCBS Trust/PPO |
$245.05
|
| Rate for Payer: BCN Commercial |
$231.99
|
| 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: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.13
|
| 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
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 42799011901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| 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 |
$120.08
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCBS Trust/PPO |
$246.79
|
| Rate for Payer: BCN Commercial |
$233.41
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| 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 Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Medicare |
$75.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.13
|
| 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 Dual Complete DSNP |
$75.05
|
| Rate for Payer: UHC Exchange |
$75.05
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
| Rate for Payer: VA VA |
$75.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$300.20
|
|
|
Service Code
|
NDC 42799011901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.13 |
| Max. Negotiated Rate |
$270.18 |
| Rate for Payer: Aetna Commercial |
$255.17
|
| Rate for Payer: BCBS Trust/PPO |
$245.05
|
| Rate for Payer: BCN Commercial |
$231.99
|
| 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: PHP Commercial |
$255.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.13
|
| 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
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.54 |
| 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 |
$159.22
|
| Rate for Payer: BCBS MAPPO |
$99.51
|
| Rate for Payer: BCBS Trust/PPO |
$327.24
|
| Rate for Payer: BCN Commercial |
$309.48
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Nomi Health Commercial |
$326.40
|
| 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 Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Medicare |
$100.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.69
|
| 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 Dual Complete DSNP |
$99.51
|
| Rate for Payer: UHC Exchange |
$99.51
|
| Rate for Payer: UHC Medicare Advantage |
$99.51
|
| 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
|
$215.76
|
|
|
Service Code
|
NDC 50268013015
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.24 |
| Max. Negotiated Rate |
$194.18 |
| Rate for Payer: Aetna Commercial |
$183.40
|
| Rate for Payer: BCBS Trust/PPO |
$176.12
|
| Rate for Payer: BCN Commercial |
$166.74
|
| Rate for Payer: Cash Price |
$172.61
|
| Rate for Payer: Cofinity Commercial |
$185.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.61
|
| Rate for Payer: Healthscope Commercial |
$194.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.40
|
| Rate for Payer: Nomi Health Commercial |
$176.92
|
| Rate for Payer: PHP Commercial |
$183.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.24
|
| Rate for Payer: Priority Health HMO/PPO |
$187.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.87
|
| Rate for Payer: UHC Core |
$180.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.82
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$300.20
|
|
|
Service Code
|
NDC 69238148901
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.30 |
| 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 |
$120.08
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCBS Trust/PPO |
$246.79
|
| Rate for Payer: BCN Commercial |
$233.41
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.17
|
| Rate for Payer: Nomi Health Commercial |
$246.16
|
| 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 Cigna Priority Health |
$195.13
|
| Rate for Payer: Priority Health HMO/PPO |
$261.17
|
| Rate for Payer: Priority Health Medicare |
$75.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.13
|
| 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 Dual Complete DSNP |
$75.05
|
| Rate for Payer: UHC Exchange |
$75.05
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
| Rate for Payer: VA VA |
$75.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.15
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 50268013011
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.53
|
| Rate for Payer: BCN Commercial |
$3.34
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
OP
|
$215.76
|
|
|
Service Code
|
NDC 50268013015
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.24 |
| Max. Negotiated Rate |
$194.18 |
| Rate for Payer: Aetna Commercial |
$183.40
|
| Rate for Payer: Aetna Medicare |
$56.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.42
|
| Rate for Payer: BCBS Complete |
$86.30
|
| Rate for Payer: BCBS MAPPO |
$53.94
|
| Rate for Payer: BCBS Trust/PPO |
$177.38
|
| Rate for Payer: BCN Commercial |
$167.75
|
| Rate for Payer: BCN Medicare Advantage |
$53.94
|
| Rate for Payer: Cash Price |
$172.61
|
| Rate for Payer: Cofinity Commercial |
$185.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.94
|
| Rate for Payer: Healthscope Commercial |
$194.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.40
|
| Rate for Payer: Nomi Health Commercial |
$176.92
|
| Rate for Payer: PACE Senior Care Partners |
$51.24
|
| Rate for Payer: PACE SWMI |
$53.94
|
| Rate for Payer: PHP Commercial |
$183.40
|
| Rate for Payer: PHP Medicare Advantage |
$53.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.24
|
| Rate for Payer: Priority Health HMO/PPO |
$187.71
|
| Rate for Payer: Priority Health Medicare |
$54.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.56
|
| Rate for Payer: Railroad Medicare Medicare |
$53.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.87
|
| Rate for Payer: UHC Core |
$180.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.94
|
| Rate for Payer: UHC Exchange |
$53.94
|
| Rate for Payer: UHC Medicare Advantage |
$53.94
|
| Rate for Payer: VA VA |
$53.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.82
|
|
|
BUMETANIDE 0.5 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 00185012801
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.73 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: BCBS Trust/PPO |
$324.93
|
| Rate for Payer: BCN Commercial |
$307.61
|
| 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: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| Rate for Payer: Priority Health HMO/PPO |
$346.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.69
|
| 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
|
$4.32
|
|
|
Service Code
|
NDC 50268013011
|
| Hospital Charge Code |
9309
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.35
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: BCBS MAPPO |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$3.55
|
| Rate for Payer: BCN Commercial |
$3.36
|
| Rate for Payer: BCN Medicare Advantage |
$1.08
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: Nomi Health Commercial |
$3.54
|
| Rate for Payer: PACE Senior Care Partners |
$1.03
|
| Rate for Payer: PACE SWMI |
$1.08
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: PHP Medicare Advantage |
$1.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health HMO/PPO |
$3.76
|
| Rate for Payer: Priority Health Medicare |
$1.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.80
|
| Rate for Payer: UHC Core |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.08
|
| Rate for Payer: UHC Exchange |
$1.08
|
| Rate for Payer: UHC Medicare Advantage |
$1.08
|
| Rate for Payer: VA VA |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.58 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: BCBS Trust/PPO |
$327.25
|
| Rate for Payer: BCN Commercial |
$309.82
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health HMO/PPO |
$348.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.79
|
| Rate for Payer: UHC Core |
$334.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$394.56
|
|
|
Service Code
|
NDC 00904701661
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$256.46 |
| Max. Negotiated Rate |
$355.10 |
| Rate for Payer: Aetna Commercial |
$335.38
|
| Rate for Payer: BCBS Trust/PPO |
$322.08
|
| Rate for Payer: BCN Commercial |
$304.92
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Cofinity Commercial |
$339.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.65
|
| Rate for Payer: Healthscope Commercial |
$355.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.38
|
| Rate for Payer: Nomi Health Commercial |
$323.54
|
| Rate for Payer: PHP Commercial |
$335.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.46
|
| Rate for Payer: Priority Health HMO/PPO |
$343.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.21
|
| Rate for Payer: UHC Core |
$329.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.92
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna Medicare |
$104.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$125.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$125.28
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: BCBS MAPPO |
$100.22
|
| Rate for Payer: BCBS Trust/PPO |
$329.58
|
| Rate for Payer: BCN Commercial |
$311.70
|
| Rate for Payer: BCN Medicare Advantage |
$100.22
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.22
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$115.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: PACE Senior Care Partners |
$95.21
|
| Rate for Payer: PACE SWMI |
$100.22
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: PHP Medicare Advantage |
$100.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health HMO/PPO |
$348.78
|
| Rate for Payer: Priority Health Medicare |
$101.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.60
|
| Rate for Payer: Railroad Medicare Medicare |
$100.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.79
|
| Rate for Payer: UHC Core |
$334.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.22
|
| Rate for Payer: UHC Exchange |
$100.22
|
| Rate for Payer: UHC Medicare Advantage |
$100.22
|
| Rate for Payer: VA VA |
$100.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$394.56
|
|
|
Service Code
|
NDC 00904701661
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.71 |
| Max. Negotiated Rate |
$355.10 |
| Rate for Payer: Aetna Commercial |
$335.38
|
| Rate for Payer: Aetna Medicare |
$102.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.30
|
| Rate for Payer: BCBS Complete |
$157.82
|
| Rate for Payer: BCBS MAPPO |
$98.64
|
| Rate for Payer: BCBS Trust/PPO |
$324.37
|
| Rate for Payer: BCN Commercial |
$306.77
|
| Rate for Payer: BCN Medicare Advantage |
$98.64
|
| Rate for Payer: Cash Price |
$315.65
|
| Rate for Payer: Cofinity Commercial |
$339.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.64
|
| Rate for Payer: Healthscope Commercial |
$355.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.38
|
| Rate for Payer: Nomi Health Commercial |
$323.54
|
| Rate for Payer: PACE Senior Care Partners |
$93.71
|
| Rate for Payer: PACE SWMI |
$98.64
|
| Rate for Payer: PHP Commercial |
$335.38
|
| Rate for Payer: PHP Medicare Advantage |
$98.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.46
|
| Rate for Payer: Priority Health HMO/PPO |
$343.27
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.36
|
| Rate for Payer: Railroad Medicare Medicare |
$98.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.21
|
| Rate for Payer: UHC Core |
$329.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.64
|
| Rate for Payer: UHC Exchange |
$98.64
|
| Rate for Payer: UHC Medicare Advantage |
$98.64
|
| Rate for Payer: VA VA |
$98.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.92
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 00362901150
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.08
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: BCBS MAPPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCN Commercial |
$12.63
|
| Rate for Payer: BCN Medicare Advantage |
$4.06
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.06
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PACE Senior Care Partners |
$3.86
|
| Rate for Payer: PACE SWMI |
$4.06
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.06
|
| Rate for Payer: UHC Exchange |
$4.06
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: VA VA |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 00362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.08
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: BCBS MAPPO |
$4.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.35
|
| Rate for Payer: BCN Commercial |
$12.63
|
| Rate for Payer: BCN Medicare Advantage |
$4.06
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.06
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PACE Senior Care Partners |
$3.86
|
| Rate for Payer: PACE SWMI |
$4.06
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: PHP Medicare Advantage |
$4.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Medicare |
$4.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.88
|
| Rate for Payer: Railroad Medicare Medicare |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.06
|
| Rate for Payer: UHC Exchange |
$4.06
|
| Rate for Payer: UHC Medicare Advantage |
$4.06
|
| Rate for Payer: VA VA |
$4.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 00362901150
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 00362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.80
|
| Rate for Payer: BCBS Trust/PPO |
$13.26
|
| Rate for Payer: BCN Commercial |
$12.55
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: PHP Commercial |
$13.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: Priority Health HMO/PPO |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.29
|
| Rate for Payer: UHC Core |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.18
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$27.73
|
|
|
Service Code
|
NDC 63323046801
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: BCBS Trust/PPO |
$22.64
|
| Rate for Payer: BCN Commercial |
$21.43
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: Nomi Health Commercial |
$22.74
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$24.57
|
|
|
Service Code
|
NDC 00409174610
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$22.11 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$20.06
|
| Rate for Payer: BCN Commercial |
$18.99
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$21.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.66
|
| Rate for Payer: Healthscope Commercial |
$22.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.88
|
| Rate for Payer: Nomi Health Commercial |
$20.15
|
| Rate for Payer: PHP Commercial |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.97
|
| Rate for Payer: Priority Health HMO/PPO |
$21.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.62
|
| Rate for Payer: UHC Core |
$20.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.43
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$25.76
|
|
|
Service Code
|
NDC 00409904211
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: Aetna Medicare |
$6.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.05
|
| Rate for Payer: BCBS Complete |
$10.30
|
| Rate for Payer: BCBS MAPPO |
$6.44
|
| Rate for Payer: BCBS Trust/PPO |
$21.18
|
| Rate for Payer: BCN Commercial |
$20.03
|
| Rate for Payer: BCN Medicare Advantage |
$6.44
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.44
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: Nomi Health Commercial |
$21.12
|
| Rate for Payer: PACE Senior Care Partners |
$6.12
|
| Rate for Payer: PACE SWMI |
$6.44
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: PHP Medicare Advantage |
$6.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO |
$22.41
|
| Rate for Payer: Priority Health Medicare |
$6.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.44
|
| Rate for Payer: UHC Exchange |
$6.44
|
| Rate for Payer: UHC Medicare Advantage |
$6.44
|
| Rate for Payer: VA VA |
$6.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$27.73
|
|
|
Service Code
|
NDC 63323046801
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Aetna Commercial |
$23.57
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.67
|
| Rate for Payer: BCBS Complete |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$6.93
|
| Rate for Payer: BCBS Trust/PPO |
$22.80
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: BCN Medicare Advantage |
$6.93
|
| Rate for Payer: Cash Price |
$22.18
|
| Rate for Payer: Cofinity Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.93
|
| Rate for Payer: Healthscope Commercial |
$24.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.57
|
| Rate for Payer: Nomi Health Commercial |
$22.74
|
| Rate for Payer: PACE Senior Care Partners |
$6.59
|
| Rate for Payer: PACE SWMI |
$6.93
|
| Rate for Payer: PHP Commercial |
$23.57
|
| Rate for Payer: PHP Medicare Advantage |
$6.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health HMO/PPO |
$24.13
|
| Rate for Payer: Priority Health Medicare |
$7.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.58
|
| Rate for Payer: Railroad Medicare Medicare |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.40
|
| Rate for Payer: UHC Core |
$23.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.93
|
| Rate for Payer: UHC Exchange |
$6.93
|
| Rate for Payer: UHC Medicare Advantage |
$6.93
|
| Rate for Payer: VA VA |
$6.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
IP
|
$25.76
|
|
|
Service Code
|
NDC 00409904211
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$23.18 |
| Rate for Payer: Aetna Commercial |
$21.90
|
| Rate for Payer: BCBS Trust/PPO |
$21.03
|
| Rate for Payer: BCN Commercial |
$19.91
|
| Rate for Payer: Cash Price |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$23.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.90
|
| Rate for Payer: Nomi Health Commercial |
$21.12
|
| Rate for Payer: PHP Commercial |
$21.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.74
|
| Rate for Payer: Priority Health HMO/PPO |
$22.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.67
|
| Rate for Payer: UHC Core |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.32
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJECTION SOLUTION
|
Facility
|
OP
|
$43.93
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
105633
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$39.54 |
| Rate for Payer: Aetna Commercial |
$37.34
|
| Rate for Payer: Aetna Medicare |
$11.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.73
|
| Rate for Payer: BCBS Complete |
$17.57
|
| Rate for Payer: BCBS MAPPO |
$10.98
|
| Rate for Payer: BCBS Trust/PPO |
$36.11
|
| Rate for Payer: BCN Commercial |
$34.16
|
| Rate for Payer: BCN Medicare Advantage |
$10.98
|
| Rate for Payer: Cash Price |
$35.14
|
| Rate for Payer: Cofinity Commercial |
$37.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.98
|
| Rate for Payer: Healthscope Commercial |
$39.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.34
|
| Rate for Payer: Nomi Health Commercial |
$36.02
|
| Rate for Payer: PACE Senior Care Partners |
$10.43
|
| Rate for Payer: PACE SWMI |
$10.98
|
| Rate for Payer: PHP Commercial |
$37.34
|
| Rate for Payer: PHP Medicare Advantage |
$10.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.55
|
| Rate for Payer: Priority Health HMO/PPO |
$38.22
|
| Rate for Payer: Priority Health Medicare |
$11.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.43
|
| Rate for Payer: Railroad Medicare Medicare |
$10.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.66
|
| Rate for Payer: UHC Core |
$36.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.98
|
| Rate for Payer: UHC Exchange |
$10.98
|
| Rate for Payer: UHC Medicare Advantage |
$10.98
|
| Rate for Payer: VA VA |
$10.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.95
|
|
