|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$236.16
|
|
|
Service Code
|
NDC 50268012715
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.46 |
| Max. Negotiated Rate |
$236.16 |
| Rate for Payer: Aetna Commercial |
$212.54
|
| Rate for Payer: Aetna Medicare |
$118.08
|
| Rate for Payer: ASR ASR |
$229.08
|
| Rate for Payer: ASR Commercial |
$229.08
|
| Rate for Payer: BCBS Complete |
$94.46
|
| Rate for Payer: BCBS Trust/PPO |
$193.39
|
| Rate for Payer: BCN Commercial |
$183.09
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$221.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.93
|
| Rate for Payer: Healthscope Commercial |
$236.16
|
| Rate for Payer: Healthscope Whirlpool |
$229.08
|
| Rate for Payer: Mclaren Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.74
|
| Rate for Payer: Nomi Health Commercial |
$193.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.92
|
| Rate for Payer: Priority Health Narrow Network |
$165.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.82
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
OP
|
$173.95
|
|
|
Service Code
|
NDC 60687067921
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$173.95 |
| Rate for Payer: Aetna Commercial |
$156.56
|
| Rate for Payer: Aetna Medicare |
$86.97
|
| Rate for Payer: ASR ASR |
$168.73
|
| Rate for Payer: ASR Commercial |
$168.73
|
| Rate for Payer: BCBS Complete |
$69.58
|
| Rate for Payer: BCBS Trust/PPO |
$142.45
|
| Rate for Payer: BCN Commercial |
$134.86
|
| Rate for Payer: Cash Price |
$139.16
|
| Rate for Payer: Cofinity Commercial |
$163.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.16
|
| Rate for Payer: Healthscope Commercial |
$173.95
|
| Rate for Payer: Healthscope Whirlpool |
$168.73
|
| Rate for Payer: Mclaren Commercial |
$156.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.86
|
| Rate for Payer: Nomi Health Commercial |
$142.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.41
|
| Rate for Payer: Priority Health Narrow Network |
$121.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.08
|
|
|
BISOPROLOL FUMARATE 5 MG TABLET
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
NDC 29300012601
|
| Hospital Charge Code |
18288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.50 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: ASR ASR |
$455.90
|
| Rate for Payer: ASR Commercial |
$455.90
|
| Rate for Payer: BCBS Trust/PPO |
$383.00
|
| Rate for Payer: BCN Commercial |
$364.39
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$441.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$470.00
|
| Rate for Payer: Healthscope Whirlpool |
$455.90
|
| Rate for Payer: Mclaren Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$385.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.60
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$1,264.59
|
|
|
Service Code
|
NDC 00023932110
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$821.98 |
| 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: ASR Commercial |
$1,226.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.51
|
| 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 Commercial |
$1,074.90
|
| Rate for Payer: Nomi Health Commercial |
$1,036.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.84
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.60 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: ASR ASR |
$391.88
|
| Rate for Payer: ASR Commercial |
$391.88
|
| Rate for Payer: BCBS Trust/PPO |
$329.22
|
| Rate for Payer: BCN Commercial |
$313.22
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$379.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.20
|
| Rate for Payer: Healthscope Commercial |
$404.00
|
| Rate for Payer: Healthscope Whirlpool |
$391.88
|
| Rate for Payer: Mclaren Commercial |
$363.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.40
|
| Rate for Payer: Nomi Health Commercial |
$331.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.52
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
IP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$411.18 |
| Max. Negotiated Rate |
$632.59 |
| Rate for Payer: Aetna Commercial |
$569.33
|
| Rate for Payer: ASR ASR |
$613.61
|
| Rate for Payer: ASR Commercial |
$613.61
|
| Rate for Payer: BCBS Trust/PPO |
$515.50
|
| 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 Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.68
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
NDC 82182032105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Medicare |
$202.00
|
| Rate for Payer: ASR ASR |
$391.88
|
| Rate for Payer: ASR Commercial |
$391.88
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS Trust/PPO |
$330.84
|
| Rate for Payer: BCN Commercial |
$313.22
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$379.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.20
|
| Rate for Payer: Healthscope Commercial |
$404.00
|
| Rate for Payer: Healthscope Whirlpool |
$391.88
|
| Rate for Payer: Mclaren Commercial |
$363.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.40
|
| Rate for Payer: Nomi Health Commercial |
$331.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.98
|
| Rate for Payer: Priority Health Narrow Network |
$283.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.52
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$632.59
|
|
|
Service Code
|
NDC 00023932105
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$632.59 |
| Rate for Payer: Aetna Commercial |
$569.33
|
| Rate for Payer: Aetna Medicare |
$316.30
|
| Rate for Payer: ASR ASR |
$613.61
|
| Rate for Payer: ASR Commercial |
$613.61
|
| Rate for Payer: BCBS Complete |
$253.04
|
| Rate for Payer: BCBS Trust/PPO |
$518.03
|
| 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 Commercial |
$537.70
|
| Rate for Payer: Nomi Health Commercial |
$518.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$411.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$554.28
|
| Rate for Payer: Priority Health Narrow Network |
$443.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$556.68
|
|
|
BRIMONIDINE 0.1 % EYE DROPS
|
Facility
|
OP
|
$1,264.59
|
|
|
Service Code
|
NDC 00023932110
|
| Hospital Charge Code |
70262
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$505.84 |
| Max. Negotiated Rate |
$1,264.59 |
| Rate for Payer: Aetna Commercial |
$1,138.13
|
| Rate for Payer: Aetna Medicare |
$632.29
|
| Rate for Payer: ASR ASR |
$1,226.65
|
| Rate for Payer: ASR Commercial |
$1,226.65
|
| Rate for Payer: BCBS Complete |
$505.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,035.57
|
| 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 Commercial |
$1,074.90
|
| Rate for Payer: Nomi Health Commercial |
$1,036.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$821.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,108.03
|
| Rate for Payer: Priority Health Narrow Network |
$886.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,112.84
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
IP
|
$14.80
|
|
|
Service Code
|
NDC 70069023201
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.62 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$12.06
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
BRIMONIDINE 0.2 % EYE DROPS
|
Facility
|
OP
|
$14.80
|
|
|
Service Code
|
NDC 70069023201
|
| Hospital Charge Code |
17881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$14.80 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$7.40
|
| Rate for Payer: ASR ASR |
$14.36
|
| Rate for Payer: ASR Commercial |
$14.36
|
| Rate for Payer: BCBS Complete |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.12
|
| Rate for Payer: BCN Commercial |
$11.47
|
| Rate for Payer: Cash Price |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.84
|
| Rate for Payer: Healthscope Commercial |
$14.80
|
| Rate for Payer: Healthscope Whirlpool |
$14.36
|
| Rate for Payer: Mclaren Commercial |
$13.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$12.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.97
|
| Rate for Payer: Priority Health Narrow Network |
$10.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
IP
|
$32.12
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.88 |
| Max. Negotiated Rate |
$32.12 |
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$7.09
|
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: ASR ASR |
$31.16
|
| Rate for Payer: ASR ASR |
$16.68
|
| Rate for Payer: ASR ASR |
$7.64
|
| Rate for Payer: ASR Commercial |
$31.16
|
| Rate for Payer: ASR Commercial |
$7.64
|
| Rate for Payer: ASR Commercial |
$16.68
|
| Rate for Payer: ASR Commercial |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$9.86
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCBS Trust/PPO |
$26.17
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: BCN Commercial |
$24.90
|
| Rate for Payer: BCN Commercial |
$13.34
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cash Price |
$25.69
|
| Rate for Payer: Cofinity Commercial |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$7.41
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Healthscope Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Healthscope Whirlpool |
$7.64
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Healthscope Whirlpool |
$31.16
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$28.91
|
| Rate for Payer: Mclaren Commercial |
$7.09
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$26.34
|
| Rate for Payer: Nomi Health Commercial |
$14.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
|
|
BUDESONIDE 0.5 MG/2 ML SUSPENSION FOR NEBULIZATION
|
Facility
|
OP
|
$17.20
|
|
|
Service Code
|
HCPCS J7626
|
| Hospital Charge Code |
28775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.88 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna Commercial |
$15.48
|
| Rate for Payer: Aetna Commercial |
$7.09
|
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna Medicare |
$8.60
|
| Rate for Payer: Aetna Medicare |
$16.06
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: ASR ASR |
$31.16
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: ASR ASR |
$7.64
|
| Rate for Payer: ASR ASR |
$16.68
|
| Rate for Payer: ASR Commercial |
$16.68
|
| Rate for Payer: ASR Commercial |
$31.16
|
| Rate for Payer: ASR Commercial |
$7.64
|
| Rate for Payer: ASR Commercial |
$11.74
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$3.15
|
| Rate for Payer: BCBS Complete |
$12.85
|
| Rate for Payer: BCBS Complete |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$14.09
|
| Rate for Payer: BCBS Trust/PPO |
$6.45
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$26.30
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: BCN Commercial |
$13.34
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: BCN Commercial |
$24.90
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$25.69
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$16.17
|
| Rate for Payer: Cofinity Commercial |
$30.19
|
| Rate for Payer: Cofinity Commercial |
$7.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.76
|
| Rate for Payer: Healthscope Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$12.10
|
| Rate for Payer: Healthscope Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$7.88
|
| Rate for Payer: Healthscope Whirlpool |
$7.64
|
| Rate for Payer: Healthscope Whirlpool |
$31.16
|
| Rate for Payer: Healthscope Whirlpool |
$16.68
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Mclaren Commercial |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$28.91
|
| Rate for Payer: Mclaren Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.30
|
| Rate for Payer: Nomi Health Commercial |
$26.34
|
| Rate for Payer: Nomi Health Commercial |
$14.10
|
| Rate for Payer: Nomi Health Commercial |
$6.46
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.60
|
| Rate for Payer: Priority Health Narrow Network |
$22.52
|
| Rate for Payer: Priority Health Narrow Network |
$12.06
|
| Rate for Payer: Priority Health Narrow Network |
$5.52
|
| Rate for Payer: Priority Health Narrow Network |
$8.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.14
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
IP
|
$861.28
|
|
|
Service Code
|
NDC 00186091612
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$559.83 |
| Max. Negotiated Rate |
$861.28 |
| Rate for Payer: Aetna Commercial |
$775.15
|
| Rate for Payer: ASR ASR |
$835.44
|
| Rate for Payer: ASR Commercial |
$835.44
|
| Rate for Payer: BCBS Trust/PPO |
$701.86
|
| 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 Commercial |
$732.09
|
| Rate for Payer: Nomi Health Commercial |
$706.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.93
|
|
|
BUDESONIDE 180 MCG/ACTUATION BREATH ACTIVATED POWDER INHALER
|
Facility
|
OP
|
$861.28
|
|
|
Service Code
|
NDC 00186091612
|
| Hospital Charge Code |
96977
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.51 |
| Max. Negotiated Rate |
$861.28 |
| Rate for Payer: Aetna Commercial |
$775.15
|
| Rate for Payer: Aetna Medicare |
$430.64
|
| Rate for Payer: ASR ASR |
$835.44
|
| Rate for Payer: ASR Commercial |
$835.44
|
| Rate for Payer: BCBS Complete |
$344.51
|
| Rate for Payer: BCBS Trust/PPO |
$705.30
|
| 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 Commercial |
$732.09
|
| Rate for Payer: Nomi Health Commercial |
$706.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$559.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.65
|
| Rate for Payer: Priority Health Narrow Network |
$603.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.93
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$198.66
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: ASR Commercial |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$161.89
|
| Rate for Payer: BCN Commercial |
$154.02
|
| 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 |
$198.66
|
| Rate for Payer: Healthscope Whirlpool |
$192.70
|
| 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: Priority Health Cigna Priority Health |
$129.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.82
|
|
|
BUDESONIDE-FORMOTEROL HFA 160 MCG-4.5 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$198.66
|
|
|
Service Code
|
NDC 00186037028
|
| Hospital Charge Code |
81454
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: Aetna Medicare |
$99.33
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: ASR Commercial |
$192.70
|
| Rate for Payer: BCBS Complete |
$79.46
|
| Rate for Payer: BCBS Trust/PPO |
$162.68
|
| Rate for Payer: BCN Commercial |
$154.02
|
| 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 |
$198.66
|
| Rate for Payer: Healthscope Whirlpool |
$192.70
|
| 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: Priority Health Cigna Priority Health |
$129.13
|
| Rate for Payer: 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 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.13 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: ASR Commercial |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$161.89
|
| Rate for Payer: BCN Commercial |
$154.02
|
| 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 |
$198.66
|
| Rate for Payer: Healthscope Whirlpool |
$192.70
|
| 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: Priority Health Cigna Priority Health |
$129.13
|
| 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 00186037228
|
| Hospital Charge Code |
81453
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.46 |
| Max. Negotiated Rate |
$198.66 |
| Rate for Payer: Aetna Commercial |
$178.79
|
| Rate for Payer: Aetna Medicare |
$99.33
|
| Rate for Payer: ASR ASR |
$192.70
|
| Rate for Payer: ASR Commercial |
$192.70
|
| Rate for Payer: BCBS Complete |
$79.46
|
| Rate for Payer: BCBS Trust/PPO |
$162.68
|
| Rate for Payer: BCN Commercial |
$154.02
|
| 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 |
$198.66
|
| Rate for Payer: Healthscope Whirlpool |
$192.70
|
| 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: Priority Health Cigna Priority Health |
$129.13
|
| Rate for Payer: 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
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$28.19
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$28.19 |
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: Aetna Commercial |
$23.49
|
| Rate for Payer: Aetna Commercial |
$25.32
|
| Rate for Payer: Aetna Commercial |
$23.44
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.46
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$21.54
|
| Rate for Payer: ASR ASR |
$25.32
|
| Rate for Payer: ASR ASR |
$25.26
|
| Rate for Payer: ASR ASR |
$27.29
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: ASR Commercial |
$21.54
|
| Rate for Payer: ASR Commercial |
$25.32
|
| Rate for Payer: ASR Commercial |
$27.29
|
| Rate for Payer: ASR Commercial |
$25.26
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS Complete |
$0.21
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS MAPPO |
$0.37
|
| Rate for Payer: BCBS Trust/PPO |
$18.19
|
| Rate for Payer: BCBS Trust/PPO |
$21.32
|
| Rate for Payer: BCBS Trust/PPO |
$21.37
|
| Rate for Payer: BCBS Trust/PPO |
$23.04
|
| Rate for Payer: BCBS Trust/PPO |
$23.08
|
| Rate for Payer: BCN Commercial |
$21.81
|
| Rate for Payer: BCN Commercial |
$20.19
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: BCN Commercial |
$20.24
|
| Rate for Payer: BCN Commercial |
$17.22
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: BCN Medicare Advantage |
$0.37
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| 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 |
$20.88
|
| Rate for Payer: Cofinity Commercial |
$20.88
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$24.53
|
| Rate for Payer: Cofinity Commercial |
$26.44
|
| 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 |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.37
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Healthscope Whirlpool |
$25.26
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Healthscope Whirlpool |
$21.54
|
| Rate for Payer: Healthscope Whirlpool |
$25.32
|
| Rate for Payer: Healthscope Whirlpool |
$27.29
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$0.37
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Mclaren Commercial |
$23.49
|
| Rate for Payer: Mclaren Commercial |
$19.99
|
| Rate for Payer: Mclaren Commercial |
$25.32
|
| Rate for Payer: Mclaren Commercial |
$23.44
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicaid |
$0.20
|
| Rate for Payer: Mclaren Medicare |
$0.37
|
| Rate for Payer: Mclaren Medicare |
$0.37
|
| Rate for Payer: Mclaren Medicare |
$0.37
|
| Rate for Payer: Mclaren Medicare |
$0.37
|
| Rate for Payer: Mclaren Medicare |
$0.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.39
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: Meridian Medicaid |
$0.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.88
|
| 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 |
$23.96
|
| Rate for Payer: Nomi Health Commercial |
$23.07
|
| Rate for Payer: Nomi Health Commercial |
$21.40
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Nomi Health Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$21.35
|
| Rate for Payer: PACE Medicare |
$0.35
|
| Rate for Payer: PACE Medicare |
$0.35
|
| Rate for Payer: PACE Medicare |
$0.35
|
| Rate for Payer: PACE Medicare |
$0.35
|
| Rate for Payer: PACE Medicare |
$0.35
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PACE SWMI |
$0.37
|
| Rate for Payer: PHP Commercial |
$0.41
|
| Rate for Payer: PHP Commercial |
$0.41
|
| Rate for Payer: PHP Commercial |
$0.41
|
| Rate for Payer: PHP Commercial |
$0.41
|
| Rate for Payer: PHP Commercial |
$0.41
|
| Rate for Payer: PHP Medicaid |
$0.20
|
| Rate for Payer: PHP Medicaid |
$0.20
|
| Rate for Payer: PHP Medicaid |
$0.20
|
| Rate for Payer: PHP Medicaid |
$0.20
|
| Rate for Payer: PHP Medicaid |
$0.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: PHP Medicare Advantage |
$0.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.46
|
| Rate for Payer: Priority Health Medicare |
$0.37
|
| Rate for Payer: Priority Health Medicare |
$0.37
|
| Rate for Payer: Priority Health Medicare |
$0.37
|
| Rate for Payer: Priority Health Medicare |
$0.37
|
| Rate for Payer: Priority Health Medicare |
$0.37
|
| Rate for Payer: Priority Health Narrow Network |
$18.25
|
| Rate for Payer: Priority Health Narrow Network |
$19.76
|
| Rate for Payer: Priority Health Narrow Network |
$19.72
|
| Rate for Payer: Priority Health Narrow Network |
$15.57
|
| Rate for Payer: Priority Health Narrow Network |
$18.30
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: Railroad Medicare Medicare |
$0.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$22.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.37
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Exchange |
$0.57
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.37
|
| Rate for Payer: UHCCP DNSP |
$0.37
|
| Rate for Payer: UHCCP DNSP |
$0.37
|
| Rate for Payer: UHCCP DNSP |
$0.37
|
| Rate for Payer: UHCCP DNSP |
$0.37
|
| Rate for Payer: UHCCP DNSP |
$0.37
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: UHCCP Medicaid |
$0.20
|
| Rate for Payer: VA VA |
$0.37
|
| Rate for Payer: VA VA |
$0.37
|
| Rate for Payer: VA VA |
$0.37
|
| Rate for Payer: VA VA |
$0.37
|
| Rate for Payer: VA VA |
$0.37
|
|
|
BUMETANIDE 0.25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$26.04
|
|
|
Service Code
|
HCPCS J1939
|
| Hospital Charge Code |
9308
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$26.04 |
| Rate for Payer: Aetna Commercial |
$23.44
|
| Rate for Payer: Aetna Commercial |
$25.32
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Commercial |
$23.49
|
| Rate for Payer: Aetna Commercial |
$19.99
|
| Rate for Payer: ASR ASR |
$27.34
|
| 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 |
$21.54
|
| Rate for Payer: ASR Commercial |
$25.32
|
| Rate for Payer: ASR Commercial |
$27.34
|
| Rate for Payer: ASR Commercial |
$27.29
|
| Rate for Payer: ASR Commercial |
$25.26
|
| Rate for Payer: ASR Commercial |
$21.54
|
| Rate for Payer: BCBS Trust/PPO |
$22.97
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCBS Trust/PPO |
$21.22
|
| Rate for Payer: BCBS Trust/PPO |
$22.92
|
| Rate for Payer: BCBS Trust/PPO |
$21.27
|
| Rate for Payer: BCN Commercial |
$20.19
|
| Rate for Payer: BCN Commercial |
$21.86
|
| Rate for Payer: BCN Commercial |
$17.22
|
| Rate for Payer: BCN Commercial |
$20.24
|
| Rate for Payer: BCN Commercial |
$21.81
|
| Rate for Payer: Cash Price |
$20.83
|
| Rate for Payer: Cash Price |
$20.88
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cofinity Commercial |
$24.48
|
| Rate for Payer: Cofinity Commercial |
$24.53
|
| Rate for Payer: Cofinity Commercial |
$20.88
|
| Rate for Payer: Cofinity Commercial |
$26.44
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.83
|
| Rate for Payer: Healthscope Commercial |
$26.10
|
| Rate for Payer: Healthscope Commercial |
$28.13
|
| Rate for Payer: Healthscope Commercial |
$26.04
|
| Rate for Payer: Healthscope Commercial |
$22.21
|
| Rate for Payer: Healthscope Commercial |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$27.34
|
| Rate for Payer: Healthscope Whirlpool |
$21.54
|
| Rate for Payer: Healthscope Whirlpool |
$25.32
|
| Rate for Payer: Healthscope Whirlpool |
$25.26
|
| Rate for Payer: Healthscope Whirlpool |
$27.29
|
| Rate for Payer: Mclaren Commercial |
$23.44
|
| Rate for Payer: Mclaren Commercial |
$23.49
|
| Rate for Payer: Mclaren Commercial |
$19.99
|
| Rate for Payer: Mclaren Commercial |
$25.32
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.18
|
| Rate for Payer: Nomi Health Commercial |
$21.40
|
| Rate for Payer: Nomi Health Commercial |
$18.21
|
| Rate for Payer: Nomi Health Commercial |
$21.35
|
| Rate for Payer: Nomi Health Commercial |
$23.12
|
| Rate for Payer: Nomi Health Commercial |
$23.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
| 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 |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.75
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$7.32
|
|
|
Service Code
|
NDC 60687038495
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: ASR ASR |
$7.10
|
| Rate for Payer: ASR Commercial |
$7.10
|
| Rate for Payer: BCBS Trust/PPO |
$5.97
|
| Rate for Payer: BCN Commercial |
$5.68
|
| Rate for Payer: Cash Price |
$5.86
|
| Rate for Payer: Cofinity Commercial |
$6.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.86
|
| Rate for Payer: Healthscope Commercial |
$7.32
|
| Rate for Payer: Healthscope Whirlpool |
$7.10
|
| Rate for Payer: Mclaren Commercial |
$6.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.22
|
| Rate for Payer: Nomi Health Commercial |
$6.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.44
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$207.50
|
|
|
Service Code
|
NDC 00904701604
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$207.50 |
| Rate for Payer: Aetna Commercial |
$186.75
|
| Rate for Payer: Aetna Medicare |
$103.75
|
| Rate for Payer: ASR ASR |
$201.28
|
| Rate for Payer: ASR Commercial |
$201.28
|
| Rate for Payer: BCBS Complete |
$83.00
|
| Rate for Payer: BCBS Trust/PPO |
$169.92
|
| Rate for Payer: BCN Commercial |
$160.87
|
| Rate for Payer: Cash Price |
$166.00
|
| Rate for Payer: Cofinity Commercial |
$195.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.00
|
| Rate for Payer: Healthscope Commercial |
$207.50
|
| Rate for Payer: Healthscope Whirlpool |
$201.28
|
| Rate for Payer: Mclaren Commercial |
$186.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.38
|
| Rate for Payer: Nomi Health Commercial |
$170.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.81
|
| Rate for Payer: Priority Health Narrow Network |
$145.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$182.60
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$194.88
|
|
|
Service Code
|
NDC 50268013115
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.67 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$175.39
|
| Rate for Payer: ASR ASR |
$189.03
|
| Rate for Payer: ASR Commercial |
$189.03
|
| Rate for Payer: BCBS Trust/PPO |
$158.81
|
| Rate for Payer: BCN Commercial |
$151.09
|
| Rate for Payer: Cash Price |
$155.90
|
| Rate for Payer: Cofinity Commercial |
$183.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$155.90
|
| Rate for Payer: Healthscope Commercial |
$194.88
|
| Rate for Payer: Healthscope Whirlpool |
$189.03
|
| Rate for Payer: Mclaren Commercial |
$175.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.65
|
| Rate for Payer: Nomi Health Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.49
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
IP
|
$219.74
|
|
|
Service Code
|
NDC 60687038425
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.83 |
| Max. Negotiated Rate |
$219.74 |
| Rate for Payer: Aetna Commercial |
$197.77
|
| Rate for Payer: ASR ASR |
$213.15
|
| Rate for Payer: ASR Commercial |
$213.15
|
| Rate for Payer: BCBS Trust/PPO |
$179.07
|
| Rate for Payer: BCN Commercial |
$170.36
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cofinity Commercial |
$206.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.79
|
| Rate for Payer: Healthscope Commercial |
$219.74
|
| Rate for Payer: Healthscope Whirlpool |
$213.15
|
| 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: Priority Health Cigna Priority Health |
$142.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$193.37
|
|
