|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
IP
|
$8.50
|
|
|
Service Code
|
NDC 8770141163
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Aetna Commercial |
$7.65
|
| Rate for Payer: ASR ASR |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$6.59
|
| Rate for Payer: BCN Commercial |
$6.59
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cofinity Commercial |
$7.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.80
|
| Rate for Payer: Healthscope Commercial |
$8.50
|
| Rate for Payer: Healthscope Whirlpool |
$8.24
|
| Rate for Payer: Mclaren Commercial |
$7.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.48
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
IP
|
$10.66
|
|
|
Service Code
|
NDC 0536-1286-36
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$10.66 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: ASR ASR |
$10.34
|
| Rate for Payer: BCBS Trust/PPO |
$8.26
|
| Rate for Payer: BCN Commercial |
$8.26
|
| Rate for Payer: Cash Price |
$8.53
|
| Rate for Payer: Cofinity Commercial |
$10.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.53
|
| Rate for Payer: Healthscope Commercial |
$10.66
|
| Rate for Payer: Healthscope Whirlpool |
$10.34
|
| Rate for Payer: Mclaren Commercial |
$9.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.38
|
|
|
BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSPENSION
|
Facility
IP
|
$9.91
|
|
|
Service Code
|
NDC 70000-0044-1
|
| Hospital Charge Code |
1090
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$9.91 |
| Rate for Payer: Aetna Commercial |
$8.92
|
| Rate for Payer: ASR ASR |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.93
|
| Rate for Payer: Cofinity Commercial |
$9.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.93
|
| Rate for Payer: Healthscope Commercial |
$9.91
|
| Rate for Payer: Healthscope Whirlpool |
$9.61
|
| Rate for Payer: Mclaren Commercial |
$8.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.72
|
|
|
BISOPROLOL FUMARATE 2.5 MG CUSTOM TAB
|
Facility
IP
|
$82.80
|
|
|
Service Code
|
NDC 9900-0000-03
|
| Hospital Charge Code |
150723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$74.52
|
| Rate for Payer: ASR ASR |
$80.32
|
| Rate for Payer: BCBS Trust/PPO |
$64.19
|
| Rate for Payer: BCN Commercial |
$64.19
|
| Rate for Payer: Cash Price |
$66.24
|
| Rate for Payer: Cofinity Commercial |
$77.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.24
|
| Rate for Payer: Healthscope Commercial |
$82.80
|
| Rate for Payer: Healthscope Whirlpool |
$80.32
|
| Rate for Payer: Mclaren Commercial |
$74.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.86
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
IP
|
$233.28
|
|
|
Service Code
|
NDC 50268-127-15
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.30 |
| Max. Negotiated Rate |
$233.28 |
| Rate for Payer: Aetna Commercial |
$209.95
|
| Rate for Payer: ASR ASR |
$226.28
|
| Rate for Payer: BCBS Trust/PPO |
$180.86
|
| Rate for Payer: BCN Commercial |
$180.86
|
| Rate for Payer: Cash Price |
$186.62
|
| Rate for Payer: Cofinity Commercial |
$219.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.62
|
| Rate for Payer: Healthscope Commercial |
$233.28
|
| Rate for Payer: Healthscope Whirlpool |
$226.28
|
| Rate for Payer: Mclaren Commercial |
$209.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$198.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.29
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
IP
|
$4.67
|
|
|
Service Code
|
NDC 50268-127-11
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna Commercial |
$4.20
|
| Rate for Payer: ASR ASR |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$3.62
|
| Rate for Payer: BCN Commercial |
$3.62
|
| Rate for Payer: Cash Price |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.67
|
| Rate for Payer: Healthscope Whirlpool |
$4.53
|
| Rate for Payer: Mclaren Commercial |
$4.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.11
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
IP
|
$256.80
|
|
|
Service Code
|
NDC 29300-126-01
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.76 |
| Max. Negotiated Rate |
$256.80 |
| Rate for Payer: Aetna Commercial |
$231.12
|
| Rate for Payer: ASR ASR |
$249.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.10
|
| Rate for Payer: BCN Commercial |
$199.10
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Commercial |
$241.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.44
|
| Rate for Payer: Healthscope Commercial |
$256.80
|
| Rate for Payer: Healthscope Whirlpool |
$249.10
|
| Rate for Payer: Mclaren Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$225.98
|
|
|
BONE DISEASES AND ARTHROPATHIES WITH MCC
|
Facility
IP
|
$17,353.26
|
|
|
Service Code
|
MS-DRG 553
|
| Min. Negotiated Rate |
$12,467.10 |
| Max. Negotiated Rate |
$17,353.26 |
| Rate for Payer: Aetna Medicare |
$13,123.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,404.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,404.08
|
| Rate for Payer: BCBS MAPPO |
$13,123.26
|
| Rate for Payer: BCN Medicare Advantage |
$13,123.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,123.26
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,123.26
|
| Rate for Payer: Mclaren Medicare |
$13,123.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,779.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,091.75
|
| Rate for Payer: PACE Medicare |
$12,467.10
|
| Rate for Payer: PACE SWMI |
$13,123.26
|
| Rate for Payer: PHP Commercial |
$14,435.59
|
| Rate for Payer: PHP Medicare Advantage |
$13,123.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,353.26
|
| Rate for Payer: Priority Health Medicare |
$13,123.26
|
| Rate for Payer: Priority Health Narrow Network |
$13,882.61
|
| Rate for Payer: Railroad Medicare Medicare |
$13,123.26
|
| Rate for Payer: UHC Medicare Advantage |
$13,516.96
|
| Rate for Payer: VA VA |
$13,123.26
|
|
|
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC
|
Facility
IP
|
$10,798.29
|
|
|
Service Code
|
MS-DRG 554
|
| Min. Negotiated Rate |
$8,206.70 |
| Max. Negotiated Rate |
$10,798.29 |
| Rate for Payer: PACE Medicare |
$8,206.70
|
| Rate for Payer: PACE SWMI |
$8,638.63
|
| Rate for Payer: PHP Commercial |
$9,502.49
|
| Rate for Payer: Aetna Medicare |
$8,638.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,798.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,798.29
|
| Rate for Payer: BCBS MAPPO |
$8,638.63
|
| Rate for Payer: BCN Medicare Advantage |
$8,638.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,638.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$8,638.63
|
| Rate for Payer: Mclaren Medicare |
$8,638.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,070.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,934.42
|
| Rate for Payer: PHP Medicare Advantage |
$8,638.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10,551.91
|
| Rate for Payer: Priority Health Medicare |
$8,638.63
|
| Rate for Payer: Priority Health Narrow Network |
$8,441.53
|
| Rate for Payer: Railroad Medicare Medicare |
$8,638.63
|
| Rate for Payer: UHC Medicare Advantage |
$8,897.79
|
| Rate for Payer: VA VA |
$8,638.63
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC
|
Facility
IP
|
$25,148.42
|
|
|
Service Code
|
MS-DRG 584
|
| Min. Negotiated Rate |
$17,350.07 |
| Max. Negotiated Rate |
$25,148.42 |
| Rate for Payer: Aetna Medicare |
$18,263.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,829.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,829.04
|
| Rate for Payer: BCBS MAPPO |
$18,263.23
|
| Rate for Payer: BCN Medicare Advantage |
$18,263.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18,263.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$18,263.23
|
| Rate for Payer: Mclaren Medicare |
$18,263.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19,176.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21,002.71
|
| Rate for Payer: PACE Medicare |
$17,350.07
|
| Rate for Payer: PACE SWMI |
$18,263.23
|
| Rate for Payer: PHP Commercial |
$20,089.55
|
| Rate for Payer: PHP Medicare Advantage |
$18,263.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25,148.42
|
| Rate for Payer: Priority Health Medicare |
$18,263.23
|
| Rate for Payer: Priority Health Narrow Network |
$20,118.74
|
| Rate for Payer: Railroad Medicare Medicare |
$18,263.23
|
| Rate for Payer: UHC Medicare Advantage |
$18,811.13
|
| Rate for Payer: VA VA |
$18,263.23
|
|
|
BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$21,622.56
|
|
|
Service Code
|
MS-DRG 585
|
| Min. Negotiated Rate |
$15,141.43 |
| Max. Negotiated Rate |
$21,622.56 |
| Rate for Payer: Aetna Medicare |
$15,938.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,922.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,922.94
|
| Rate for Payer: BCBS MAPPO |
$15,938.35
|
| Rate for Payer: BCN Medicare Advantage |
$15,938.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,938.35
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,938.35
|
| Rate for Payer: Mclaren Medicare |
$15,938.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,735.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,329.10
|
| Rate for Payer: PACE Medicare |
$15,141.43
|
| Rate for Payer: PACE SWMI |
$15,938.35
|
| Rate for Payer: PHP Commercial |
$17,532.18
|
| Rate for Payer: PHP Medicare Advantage |
$15,938.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,622.56
|
| Rate for Payer: Priority Health Medicare |
$15,938.35
|
| Rate for Payer: Priority Health Narrow Network |
$17,298.05
|
| Rate for Payer: Railroad Medicare Medicare |
$15,938.35
|
| Rate for Payer: UHC Medicare Advantage |
$16,416.50
|
| Rate for Payer: VA VA |
$15,938.35
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
IP
|
$1,264.59
|
|
|
Service Code
|
NDC 0023-9321-10
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$885.21 |
| Max. Negotiated Rate |
$1,264.59 |
| Rate for Payer: Aetna Commercial |
$1,138.13
|
| Rate for Payer: ASR ASR |
$1,226.65
|
| Rate for Payer: BCBS Trust/PPO |
$980.44
|
| Rate for Payer: BCN Commercial |
$980.44
|
| Rate for Payer: Cash Price |
$1,011.67
|
| Rate for Payer: Cofinity Commercial |
$1,188.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,011.67
|
| Rate for Payer: Healthscope Commercial |
$1,264.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,226.65
|
| Rate for Payer: Mclaren Commercial |
$1,138.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,074.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.84
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
IP
|
$632.59
|
|
|
Service Code
|
NDC 0023-9321-05
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$442.81 |
| Max. Negotiated Rate |
$632.59 |
| Rate for Payer: Aetna Commercial |
$569.33
|
| Rate for Payer: ASR ASR |
$613.61
|
| Rate for Payer: BCBS Trust/PPO |
$490.45
|
| Rate for Payer: BCN Commercial |
$490.45
|
| Rate for Payer: Cash Price |
$506.07
|
| Rate for Payer: Cofinity Commercial |
$594.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$506.07
|
| Rate for Payer: Healthscope Commercial |
$632.59
|
| Rate for Payer: Healthscope Whirlpool |
$613.61
|
| Rate for Payer: Mclaren Commercial |
$569.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$537.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.68
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
IP
|
$12,294.30
|
|
|
Service Code
|
MS-DRG 202
|
| Min. Negotiated Rate |
$9,298.13 |
| Max. Negotiated Rate |
$12,294.30 |
| Rate for Payer: Aetna Medicare |
$9,787.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,234.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,234.39
|
| Rate for Payer: BCBS MAPPO |
$9,787.51
|
| Rate for Payer: BCN Medicare Advantage |
$9,787.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,787.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,787.51
|
| Rate for Payer: Mclaren Medicare |
$9,787.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,276.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,255.64
|
| Rate for Payer: PACE Medicare |
$9,298.13
|
| Rate for Payer: PACE SWMI |
$9,787.51
|
| Rate for Payer: PHP Commercial |
$10,766.26
|
| Rate for Payer: PHP Medicare Advantage |
$9,787.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,294.30
|
| Rate for Payer: Priority Health Medicare |
$9,787.51
|
| Rate for Payer: Priority Health Narrow Network |
$9,835.44
|
| Rate for Payer: Railroad Medicare Medicare |
$9,787.51
|
| Rate for Payer: UHC Medicare Advantage |
$10,081.14
|
| Rate for Payer: VA VA |
$9,787.51
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
IP
|
$9,455.30
|
|
|
Service Code
|
MS-DRG 203
|
| Min. Negotiated Rate |
$7,138.02 |
| Max. Negotiated Rate |
$9,455.30 |
| Rate for Payer: Aetna Medicare |
$7,564.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,455.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,455.30
|
| Rate for Payer: BCBS MAPPO |
$7,564.24
|
| Rate for Payer: BCN Medicare Advantage |
$7,564.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,564.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,564.24
|
| Rate for Payer: Mclaren Medicare |
$7,564.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,942.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,698.88
|
| Rate for Payer: PACE Medicare |
$7,186.03
|
| Rate for Payer: PACE SWMI |
$7,564.24
|
| Rate for Payer: PHP Commercial |
$8,320.66
|
| Rate for Payer: PHP Medicare Advantage |
$7,564.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,922.52
|
| Rate for Payer: Priority Health Medicare |
$7,564.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,138.02
|
| Rate for Payer: Railroad Medicare Medicare |
$7,564.24
|
| Rate for Payer: UHC Medicare Advantage |
$7,791.17
|
| Rate for Payer: VA VA |
$7,564.24
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
IP
|
$13.65
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Aetna Commercial |
$12.28
|
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: ASR ASR |
$13.24
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$9.38
|
| Rate for Payer: BCBS Trust/PPO |
$10.58
|
| Rate for Payer: BCN Commercial |
$10.58
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$10.92
|
| Rate for Payer: Cofinity Commercial |
$12.83
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.92
|
| Rate for Payer: Healthscope Commercial |
$13.65
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Healthscope Whirlpool |
$13.24
|
| Rate for Payer: Mclaren Commercial |
$12.28
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.01
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
IP
|
$861.28
|
|
|
Service Code
|
NDC 0186-0916-12
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$602.90 |
| Max. Negotiated Rate |
$861.28 |
| Rate for Payer: Aetna Commercial |
$775.15
|
| Rate for Payer: ASR ASR |
$835.44
|
| Rate for Payer: BCBS Trust/PPO |
$667.75
|
| Rate for Payer: BCN Commercial |
$667.75
|
| Rate for Payer: Cash Price |
$689.02
|
| Rate for Payer: Cofinity Commercial |
$809.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.02
|
| Rate for Payer: Healthscope Commercial |
$861.28
|
| Rate for Payer: Healthscope Whirlpool |
$835.44
|
| Rate for Payer: Mclaren Commercial |
$775.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$732.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.93
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$517.23
|
|
|
Service Code
|
NDC 0186-0370-28
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$362.06 |
| Max. Negotiated Rate |
$517.23 |
| Rate for Payer: Aetna Commercial |
$465.51
|
| Rate for Payer: ASR ASR |
$501.71
|
| Rate for Payer: BCBS Trust/PPO |
$401.01
|
| Rate for Payer: BCN Commercial |
$401.01
|
| Rate for Payer: Cash Price |
$413.78
|
| Rate for Payer: Cofinity Commercial |
$486.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.78
|
| Rate for Payer: Healthscope Commercial |
$517.23
|
| Rate for Payer: Healthscope Whirlpool |
$501.71
|
| Rate for Payer: Mclaren Commercial |
$465.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$439.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$362.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$455.16
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
IP
|
$449.61
|
|
|
Service Code
|
NDC 0186-0372-28
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.73 |
| Max. Negotiated Rate |
$449.61 |
| Rate for Payer: Aetna Commercial |
$404.65
|
| Rate for Payer: ASR ASR |
$436.12
|
| Rate for Payer: BCBS Trust/PPO |
$348.58
|
| Rate for Payer: BCN Commercial |
$348.58
|
| Rate for Payer: Cash Price |
$359.69
|
| Rate for Payer: Cofinity Commercial |
$422.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.69
|
| Rate for Payer: Healthscope Commercial |
$449.61
|
| Rate for Payer: Healthscope Whirlpool |
$436.12
|
| Rate for Payer: Mclaren Commercial |
$404.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$395.66
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$25.75
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$25.75 |
| Rate for Payer: Aetna Commercial |
$23.18
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Commercial |
$18.65
|
| Rate for Payer: Aetna Commercial |
$25.32
|
| Rate for Payer: Aetna Commercial |
$23.44
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$25.26
|
| Rate for Payer: ASR ASR |
$24.98
|
| Rate for Payer: ASR ASR |
$27.29
|
| Rate for Payer: ASR ASR |
$20.10
|
| Rate for Payer: BCBS Trust/PPO |
$19.96
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$21.81
|
| Rate for Payer: BCBS Trust/PPO |
$21.86
|
| Rate for Payer: BCN Commercial |
$21.81
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: BCN Commercial |
$19.96
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: BCN Commercial |
$20.19
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cofinity Commercial |
$26.44
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$24.20
|
| Rate for Payer: Cofinity Commercial |
$19.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$25.75
|
| Rate for Payer: Healthscope Commercial |
$20.72
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Commercial |
$26.04
|
| Rate for Payer: Healthscope Whirlpool |
$20.10
|
| Rate for Payer: Healthscope Whirlpool |
$27.29
|
| Rate for Payer: Healthscope Whirlpool |
$25.26
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Healthscope Whirlpool |
$24.98
|
| Rate for Payer: Mclaren Commercial |
$18.65
|
| Rate for Payer: Mclaren Commercial |
$23.18
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Mclaren Commercial |
$23.44
|
| Rate for Payer: Mclaren Commercial |
$25.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.75
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
IP
|
$201.89
|
|
|
Service Code
|
NDC 0904-7016-04
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.32 |
| Max. Negotiated Rate |
$201.89 |
| Rate for Payer: Aetna Commercial |
$181.70
|
| Rate for Payer: ASR ASR |
$195.83
|
| Rate for Payer: BCBS Trust/PPO |
$156.53
|
| Rate for Payer: BCN Commercial |
$156.53
|
| Rate for Payer: Cash Price |
$161.51
|
| Rate for Payer: Cofinity Commercial |
$189.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.51
|
| Rate for Payer: Healthscope Commercial |
$201.89
|
| Rate for Payer: Healthscope Whirlpool |
$195.83
|
| Rate for Payer: Mclaren Commercial |
$181.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$171.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.66
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
IP
|
$7.28
|
|
|
Service Code
|
NDC 60687-384-95
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: ASR ASR |
$7.06
|
| Rate for Payer: BCBS Trust/PPO |
$5.64
|
| Rate for Payer: BCN Commercial |
$5.64
|
| Rate for Payer: Cash Price |
$5.83
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$7.28
|
| Rate for Payer: Healthscope Whirlpool |
$7.06
|
| Rate for Payer: Mclaren Commercial |
$6.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.41
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
IP
|
$218.45
|
|
|
Service Code
|
NDC 60687-384-25
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.92 |
| Max. Negotiated Rate |
$218.45 |
| Rate for Payer: Aetna Commercial |
$196.60
|
| Rate for Payer: ASR ASR |
$211.90
|
| Rate for Payer: BCBS Trust/PPO |
$169.36
|
| Rate for Payer: BCN Commercial |
$169.36
|
| Rate for Payer: Cash Price |
$174.76
|
| Rate for Payer: Cofinity Commercial |
$205.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.76
|
| Rate for Payer: Healthscope Commercial |
$218.45
|
| Rate for Payer: Healthscope Whirlpool |
$211.90
|
| Rate for Payer: Mclaren Commercial |
$196.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$192.24
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
IP
|
$4.13
|
|
|
Service Code
|
NDC 50268-131-11
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$4.13 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: ASR ASR |
$4.01
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$3.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$4.13
|
| Rate for Payer: Healthscope Whirlpool |
$4.01
|
| Rate for Payer: Mclaren Commercial |
$3.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.63
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
IP
|
$206.64
|
|
|
Service Code
|
NDC 50268-131-15
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.65 |
| Max. Negotiated Rate |
$206.64 |
| Rate for Payer: Aetna Commercial |
$185.98
|
| Rate for Payer: ASR ASR |
$200.44
|
| Rate for Payer: BCBS Trust/PPO |
$160.21
|
| Rate for Payer: BCN Commercial |
$160.21
|
| Rate for Payer: Cash Price |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$194.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.31
|
| Rate for Payer: Healthscope Commercial |
$206.64
|
| Rate for Payer: Healthscope Whirlpool |
$200.44
|
| Rate for Payer: Mclaren Commercial |
$185.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$175.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$181.84
|
|
