|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$163.14
|
| Rate for Payer: BCN Commercial |
$163.14
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$192.70
|
| Rate for Payer: Healthscope Whirlpool |
$198.66
|
| Rate for Payer: Mclaren Commercial |
$178.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Nomi Health Commercial |
$162.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.82
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$198.66
|
|
|
Service Code
|
NDC 186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: BCBS Complete |
$79.46
|
| Rate for Payer: BCBS Trust/PPO |
$163.80
|
| Rate for Payer: BCN Commercial |
$163.80
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$192.70
|
| Rate for Payer: Healthscope Whirlpool |
$198.66
|
| Rate for Payer: Mclaren Commercial |
$178.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$158.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Nomi Health Commercial |
$162.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$174.07
|
| Rate for Payer: Priority Health Narrow Network |
$139.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.82
|
|
|
BUDESONIDE-FORMOTEROL HFA 80 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$163.14
|
| Rate for Payer: BCN Commercial |
$163.14
|
| Rate for Payer: Cash Price |
$158.93
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.93
|
| Rate for Payer: Healthscope Commercial |
$192.70
|
| Rate for Payer: Healthscope Whirlpool |
$198.66
|
| Rate for Payer: Mclaren Commercial |
$178.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.86
|
| Rate for Payer: Nomi Health Commercial |
$162.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$149.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.82
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$26.10
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Aetna Commercial |
$23.49
|
| Rate for Payer: Aetna Commercial |
$23.44
|
| Rate for Payer: Aetna Commercial |
$25.32
|
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: ASR ASR |
$27.29
|
| Rate for Payer: ASR ASR |
$25.32
|
| Rate for Payer: ASR ASR |
$25.26
|
| Rate for Payer: ASR ASR |
$21.94
|
| Rate for Payer: BCBS Trust/PPO |
$21.43
|
| Rate for Payer: BCBS Trust/PPO |
$18.58
|
| Rate for Payer: BCBS Trust/PPO |
$21.39
|
| Rate for Payer: BCBS Trust/PPO |
$23.10
|
| Rate for Payer: BCN Commercial |
$18.58
|
| Rate for Payer: BCN Commercial |
$23.10
|
| Rate for Payer: BCN Commercial |
$21.39
|
| Rate for Payer: BCN Commercial |
$21.43
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cofinity Commercial |
$24.53
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$26.44
|
| Rate for Payer: Cofinity Commercial |
$24.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| 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 |
$18.10
|
| Rate for Payer: Healthscope Commercial |
$25.32
|
| Rate for Payer: Healthscope Commercial |
$21.94
|
| Rate for Payer: Healthscope Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$27.29
|
| Rate for Payer: Healthscope Whirlpool |
$26.10
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$22.62
|
| Rate for Payer: Healthscope Whirlpool |
$26.04
|
| Rate for Payer: Mclaren Commercial |
$20.36
|
| Rate for Payer: Mclaren Commercial |
$25.32
|
| Rate for Payer: Mclaren Commercial |
$23.44
|
| Rate for Payer: Mclaren Commercial |
$23.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Nomi Health Commercial |
$21.35
|
| Rate for Payer: Nomi Health Commercial |
$23.07
|
| Rate for Payer: Nomi Health Commercial |
$21.40
|
| Rate for Payer: Nomi Health Commercial |
$18.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.75
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.13
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Aetna Commercial |
$25.32
|
| Rate for Payer: Aetna Commercial |
$23.44
|
| Rate for Payer: Aetna Commercial |
$23.49
|
| Rate for Payer: Aetna Commercial |
$20.36
|
| Rate for Payer: Aetna Medicare |
$8.37
|
| Rate for Payer: Aetna Medicare |
$10.41
|
| Rate for Payer: Aetna Medicare |
$9.66
|
| Rate for Payer: Aetna Medicare |
$9.64
|
| Rate for Payer: ASR ASR |
$25.32
|
| Rate for Payer: ASR ASR |
$25.26
|
| Rate for Payer: ASR ASR |
$21.94
|
| Rate for Payer: ASR ASR |
$27.29
|
| Rate for Payer: BCBS Complete |
$10.44
|
| Rate for Payer: BCBS Complete |
$9.05
|
| Rate for Payer: BCBS Complete |
$11.25
|
| Rate for Payer: BCBS Complete |
$10.42
|
| Rate for Payer: BCBS Trust/PPO |
$21.47
|
| Rate for Payer: BCBS Trust/PPO |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$18.65
|
| Rate for Payer: BCN Commercial |
$23.19
|
| Rate for Payer: BCN Commercial |
$21.52
|
| Rate for Payer: BCN Commercial |
$18.65
|
| Rate for Payer: BCN Commercial |
$21.47
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cash Price |
$18.10
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cofinity Commercial |
$26.44
|
| Rate for Payer: Cofinity Commercial |
$21.26
|
| Rate for Payer: Cofinity Commercial |
$24.53
|
| Rate for Payer: Cofinity Commercial |
$24.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$27.29
|
| Rate for Payer: Healthscope Commercial |
$21.94
|
| Rate for Payer: Healthscope Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$25.32
|
| Rate for Payer: Healthscope Whirlpool |
$22.62
|
| Rate for Payer: Healthscope Whirlpool |
$26.10
|
| Rate for Payer: Healthscope Whirlpool |
$28.13
|
| Rate for Payer: Healthscope Whirlpool |
$26.04
|
| Rate for Payer: Mclaren Commercial |
$23.49
|
| Rate for Payer: Mclaren Commercial |
$23.44
|
| Rate for Payer: Mclaren Commercial |
$20.36
|
| Rate for Payer: Mclaren Commercial |
$25.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.91
|
| Rate for Payer: Nomi Health Commercial |
$18.55
|
| Rate for Payer: Nomi Health Commercial |
$21.40
|
| Rate for Payer: Nomi Health Commercial |
$23.07
|
| Rate for Payer: Nomi Health Commercial |
$21.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.37
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.92
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.68 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: ASR ASR |
$388.87
|
| Rate for Payer: BCBS Trust/PPO |
$329.22
|
| Rate for Payer: BCN Commercial |
$329.22
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$376.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$388.87
|
| Rate for Payer: Healthscope Whirlpool |
$400.90
|
| Rate for Payer: Mclaren Commercial |
$360.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.79
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$197.04
|
|
|
Service Code
|
NDC 50268013115
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$197.04 |
| Rate for Payer: Aetna Commercial |
$177.34
|
| Rate for Payer: ASR ASR |
$191.13
|
| Rate for Payer: BCBS Trust/PPO |
$161.81
|
| Rate for Payer: BCN Commercial |
$161.81
|
| Rate for Payer: Cash Price |
$157.63
|
| Rate for Payer: Cofinity Commercial |
$185.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.63
|
| Rate for Payer: Healthscope Commercial |
$191.13
|
| Rate for Payer: Healthscope Whirlpool |
$197.04
|
| Rate for Payer: Mclaren Commercial |
$177.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.48
|
| Rate for Payer: Nomi Health Commercial |
$161.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.40
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$7.33
|
|
|
Service Code
|
NDC 60687038495
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$7.33 |
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: Aetna Medicare |
$2.71
|
| Rate for Payer: ASR ASR |
$7.11
|
| Rate for Payer: BCBS Complete |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$6.04
|
| Rate for Payer: BCN Commercial |
$6.04
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cofinity Commercial |
$6.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.86
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Healthscope Whirlpool |
$7.33
|
| Rate for Payer: Mclaren Commercial |
$6.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.23
|
| Rate for Payer: Nomi Health Commercial |
$6.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.42
|
| Rate for Payer: Priority Health Narrow Network |
$5.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.45
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$3.94
|
|
|
Service Code
|
NDC 50268013111
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: ASR ASR |
$3.82
|
| Rate for Payer: BCBS Complete |
$1.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.25
|
| Rate for Payer: BCN Commercial |
$3.25
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Healthscope Whirlpool |
$3.94
|
| Rate for Payer: Mclaren Commercial |
$3.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Nomi Health Commercial |
$3.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.45
|
| Rate for Payer: Priority Health Narrow Network |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.47
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$178.80
|
|
|
Service Code
|
NDC 904701606
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.10 |
| Max. Negotiated Rate |
$178.80 |
| Rate for Payer: Aetna Commercial |
$160.92
|
| Rate for Payer: ASR ASR |
$173.44
|
| Rate for Payer: BCBS Trust/PPO |
$146.83
|
| Rate for Payer: BCN Commercial |
$146.83
|
| Rate for Payer: Cash Price |
$143.04
|
| Rate for Payer: Cofinity Commercial |
$168.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.04
|
| Rate for Payer: Healthscope Commercial |
$173.44
|
| Rate for Payer: Healthscope Whirlpool |
$178.80
|
| Rate for Payer: Mclaren Commercial |
$160.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.98
|
| Rate for Payer: Nomi Health Commercial |
$146.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.34
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$3.94
|
|
|
Service Code
|
NDC 50268013111
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: ASR ASR |
$3.82
|
| Rate for Payer: BCBS Trust/PPO |
$3.24
|
| Rate for Payer: BCN Commercial |
$3.24
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Cofinity Commercial |
$3.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.15
|
| Rate for Payer: Healthscope Commercial |
$3.82
|
| Rate for Payer: Healthscope Whirlpool |
$3.94
|
| Rate for Payer: Mclaren Commercial |
$3.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.35
|
| Rate for Payer: Nomi Health Commercial |
$3.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.47
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$240.91
|
|
|
Service Code
|
NDC 904701604
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.14 |
| Max. Negotiated Rate |
$240.91 |
| Rate for Payer: Aetna Commercial |
$216.82
|
| Rate for Payer: Aetna Medicare |
$89.14
|
| Rate for Payer: ASR ASR |
$233.68
|
| Rate for Payer: BCBS Complete |
$96.36
|
| Rate for Payer: BCBS Trust/PPO |
$198.63
|
| Rate for Payer: BCN Commercial |
$198.63
|
| Rate for Payer: Cash Price |
$192.73
|
| Rate for Payer: Cofinity Commercial |
$226.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.73
|
| Rate for Payer: Healthscope Commercial |
$233.68
|
| Rate for Payer: Healthscope Whirlpool |
$240.91
|
| Rate for Payer: Mclaren Commercial |
$216.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.78
|
| Rate for Payer: Nomi Health Commercial |
$197.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$211.09
|
| Rate for Payer: Priority Health Narrow Network |
$168.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.00
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$7.33
|
|
|
Service Code
|
NDC 60687038495
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$7.33 |
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: ASR ASR |
$7.11
|
| Rate for Payer: BCBS Trust/PPO |
$6.02
|
| Rate for Payer: BCN Commercial |
$6.02
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cofinity Commercial |
$6.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.86
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Healthscope Whirlpool |
$7.33
|
| Rate for Payer: Mclaren Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.23
|
| Rate for Payer: Nomi Health Commercial |
$6.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.45
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$197.04
|
|
|
Service Code
|
NDC 50268013115
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.90 |
| Max. Negotiated Rate |
$197.04 |
| Rate for Payer: Aetna Commercial |
$177.34
|
| Rate for Payer: Aetna Medicare |
$72.90
|
| Rate for Payer: ASR ASR |
$191.13
|
| Rate for Payer: BCBS Complete |
$78.82
|
| Rate for Payer: BCBS Trust/PPO |
$162.46
|
| Rate for Payer: BCN Commercial |
$162.46
|
| Rate for Payer: Cash Price |
$157.63
|
| Rate for Payer: Cofinity Commercial |
$185.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.63
|
| Rate for Payer: Healthscope Commercial |
$191.13
|
| Rate for Payer: Healthscope Whirlpool |
$197.04
|
| Rate for Payer: Mclaren Commercial |
$177.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.48
|
| Rate for Payer: Nomi Health Commercial |
$161.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$172.65
|
| Rate for Payer: Priority Health Narrow Network |
$138.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.40
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$240.91
|
|
|
Service Code
|
NDC 904701604
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.68 |
| Max. Negotiated Rate |
$240.91 |
| Rate for Payer: Aetna Commercial |
$216.82
|
| Rate for Payer: ASR ASR |
$233.68
|
| Rate for Payer: BCBS Trust/PPO |
$197.84
|
| Rate for Payer: BCN Commercial |
$197.84
|
| Rate for Payer: Cash Price |
$192.73
|
| Rate for Payer: Cofinity Commercial |
$226.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.73
|
| Rate for Payer: Healthscope Commercial |
$233.68
|
| Rate for Payer: Healthscope Whirlpool |
$240.91
|
| Rate for Payer: Mclaren Commercial |
$216.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.78
|
| Rate for Payer: Nomi Health Commercial |
$197.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.00
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$178.80
|
|
|
Service Code
|
NDC 904701606
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.16 |
| Max. Negotiated Rate |
$178.80 |
| Rate for Payer: Aetna Commercial |
$160.92
|
| Rate for Payer: Aetna Medicare |
$66.16
|
| Rate for Payer: ASR ASR |
$173.44
|
| Rate for Payer: BCBS Complete |
$71.52
|
| Rate for Payer: BCBS Trust/PPO |
$147.42
|
| Rate for Payer: BCN Commercial |
$147.42
|
| Rate for Payer: Cash Price |
$143.04
|
| Rate for Payer: Cofinity Commercial |
$168.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.04
|
| Rate for Payer: Healthscope Commercial |
$173.44
|
| Rate for Payer: Healthscope Whirlpool |
$178.80
|
| Rate for Payer: Mclaren Commercial |
$160.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.98
|
| Rate for Payer: Nomi Health Commercial |
$146.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$156.66
|
| Rate for Payer: Priority Health Narrow Network |
$125.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.34
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$219.74
|
|
|
Service Code
|
NDC 60687038425
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$219.74 |
| Rate for Payer: Aetna Commercial |
$197.77
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: ASR ASR |
$213.15
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Trust/PPO |
$181.18
|
| Rate for Payer: BCN Commercial |
$181.18
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.80
|
| Rate for Payer: Healthscope Commercial |
$213.15
|
| Rate for Payer: Healthscope Whirlpool |
$219.74
|
| Rate for Payer: Mclaren Commercial |
$197.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.78
|
| Rate for Payer: Nomi Health Commercial |
$180.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$192.54
|
| Rate for Payer: Priority Health Narrow Network |
$154.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.37
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$219.74
|
|
|
Service Code
|
NDC 60687038425
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.81 |
| Max. Negotiated Rate |
$219.74 |
| Rate for Payer: Aetna Commercial |
$197.77
|
| Rate for Payer: ASR ASR |
$213.15
|
| Rate for Payer: BCBS Trust/PPO |
$180.45
|
| Rate for Payer: BCN Commercial |
$180.45
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.80
|
| Rate for Payer: Healthscope Commercial |
$213.15
|
| Rate for Payer: Healthscope Whirlpool |
$219.74
|
| Rate for Payer: Mclaren Commercial |
$197.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.78
|
| Rate for Payer: Nomi Health Commercial |
$180.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.37
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: Aetna Medicare |
$148.33
|
| Rate for Payer: ASR ASR |
$388.87
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: BCBS Trust/PPO |
$330.54
|
| Rate for Payer: BCN Commercial |
$330.54
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$376.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$388.87
|
| Rate for Payer: Healthscope Whirlpool |
$400.90
|
| Rate for Payer: Mclaren Commercial |
$360.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$320.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$351.27
|
| Rate for Payer: Priority Health Narrow Network |
$281.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.79
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna Commercial |
$14.61
|
| Rate for Payer: Aetna Medicare |
$6.01
|
| Rate for Payer: ASR ASR |
$15.75
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.39
|
| Rate for Payer: BCN Commercial |
$13.39
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$15.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$15.75
|
| Rate for Payer: Healthscope Whirlpool |
$16.23
|
| Rate for Payer: Mclaren Commercial |
$14.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.23
|
| Rate for Payer: Priority Health Narrow Network |
$11.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.29
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
IP
|
$16.24
|
|
|
Service Code
|
NDC 362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.18 |
| Max. Negotiated Rate |
$16.23 |
| Rate for Payer: Aetna Commercial |
$14.61
|
| Rate for Payer: ASR ASR |
$15.75
|
| Rate for Payer: BCBS Trust/PPO |
$13.33
|
| Rate for Payer: BCN Commercial |
$13.33
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$15.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$15.75
|
| Rate for Payer: Healthscope Whirlpool |
$16.23
|
| Rate for Payer: Mclaren Commercial |
$14.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.29
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$21.17
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna Commercial |
$19.05
|
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Aetna Medicare |
$6.13
|
| Rate for Payer: Aetna Medicare |
$7.83
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: ASR ASR |
$16.08
|
| Rate for Payer: BCBS Complete |
$6.63
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS Trust/PPO |
$17.45
|
| Rate for Payer: BCBS Trust/PPO |
$13.67
|
| Rate for Payer: BCN Commercial |
$13.67
|
| Rate for Payer: BCN Commercial |
$17.45
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.26
|
| Rate for Payer: Healthscope Commercial |
$20.53
|
| Rate for Payer: Healthscope Commercial |
$16.08
|
| Rate for Payer: Healthscope Whirlpool |
$21.17
|
| Rate for Payer: Healthscope Whirlpool |
$16.58
|
| Rate for Payer: Mclaren Commercial |
$19.05
|
| Rate for Payer: Mclaren Commercial |
$14.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Nomi Health Commercial |
$13.59
|
| Rate for Payer: Nomi Health Commercial |
$17.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.63
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$16.58
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.43 |
| Max. Negotiated Rate |
$16.58 |
| Rate for Payer: Aetna Commercial |
$14.92
|
| Rate for Payer: Aetna Commercial |
$19.05
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: ASR ASR |
$16.08
|
| Rate for Payer: BCBS Trust/PPO |
$17.38
|
| Rate for Payer: BCBS Trust/PPO |
$13.61
|
| Rate for Payer: BCN Commercial |
$17.38
|
| Rate for Payer: BCN Commercial |
$13.61
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.26
|
| Rate for Payer: Healthscope Commercial |
$16.08
|
| Rate for Payer: Healthscope Commercial |
$20.53
|
| Rate for Payer: Healthscope Whirlpool |
$21.17
|
| Rate for Payer: Healthscope Whirlpool |
$16.58
|
| Rate for Payer: Mclaren Commercial |
$19.05
|
| Rate for Payer: Mclaren Commercial |
$14.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.09
|
| Rate for Payer: Nomi Health Commercial |
$17.36
|
| Rate for Payer: Nomi Health Commercial |
$13.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.63
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
|
OP
|
$12.97
|
|
|
Service Code
|
NDC 43598057901
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.97 |
| Rate for Payer: Aetna Commercial |
$11.67
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: ASR ASR |
$12.58
|
| Rate for Payer: BCBS Complete |
$5.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.69
|
| Rate for Payer: BCN Commercial |
$10.69
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Healthscope Commercial |
$12.58
|
| Rate for Payer: Healthscope Whirlpool |
$12.97
|
| Rate for Payer: Mclaren Commercial |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.03
|
| Rate for Payer: Nomi Health Commercial |
$10.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.37
|
| Rate for Payer: Priority Health Narrow Network |
$9.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.41
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
|
IP
|
$389.13
|
|
|
Service Code
|
NDC 43598057930
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.85 |
| Max. Negotiated Rate |
$389.13 |
| Rate for Payer: Aetna Commercial |
$350.22
|
| Rate for Payer: ASR ASR |
$377.46
|
| Rate for Payer: BCBS Trust/PPO |
$319.55
|
| Rate for Payer: BCN Commercial |
$319.55
|
| Rate for Payer: Cash Price |
$311.30
|
| Rate for Payer: Cofinity Commercial |
$365.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.30
|
| Rate for Payer: Healthscope Commercial |
$377.46
|
| Rate for Payer: Healthscope Whirlpool |
$389.13
|
| Rate for Payer: Mclaren Commercial |
$350.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.76
|
| Rate for Payer: Nomi Health Commercial |
$319.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.43
|
|
