|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$3.90
|
|
|
Service Code
|
NDC 50268013111
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: ASR ASR |
$3.78
|
| Rate for Payer: ASR Commercial |
$3.78
|
| Rate for Payer: BCBS Complete |
$1.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.12
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Healthscope Whirlpool |
$3.78
|
| Rate for Payer: Mclaren Commercial |
$3.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.31
|
| Rate for Payer: Nomi Health Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.42
|
| Rate for Payer: Priority Health Narrow Network |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.43
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.36 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: Aetna Medicare |
$200.45
|
| Rate for Payer: ASR ASR |
$388.87
|
| Rate for Payer: ASR Commercial |
$388.87
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: BCBS Trust/PPO |
$328.30
|
| Rate for Payer: BCN Commercial |
$310.82
|
| 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 |
$400.90
|
| Rate for Payer: Healthscope Whirlpool |
$388.87
|
| 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: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: 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
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$178.80
|
|
|
Service Code
|
NDC 00904701606
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$178.80 |
| Rate for Payer: Aetna Commercial |
$160.92
|
| Rate for Payer: Aetna Medicare |
$89.40
|
| Rate for Payer: ASR ASR |
$173.44
|
| Rate for Payer: ASR Commercial |
$173.44
|
| Rate for Payer: BCBS Complete |
$71.52
|
| Rate for Payer: BCBS Trust/PPO |
$146.42
|
| Rate for Payer: BCN Commercial |
$138.62
|
| 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 |
$178.80
|
| Rate for Payer: Healthscope Whirlpool |
$173.44
|
| 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: Priority Health Cigna Priority Health |
$116.22
|
| Rate for Payer: 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
|
IP
|
$207.50
|
|
|
Service Code
|
NDC 00904701604
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.88 |
| Max. Negotiated Rate |
$207.50 |
| Rate for Payer: Aetna Commercial |
$186.75
|
| Rate for Payer: ASR ASR |
$201.28
|
| Rate for Payer: ASR Commercial |
$201.28
|
| Rate for Payer: BCBS Trust/PPO |
$169.09
|
| 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: UHC All Payor (Choice/PPO) + Core |
$182.60
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$194.88
|
|
|
Service Code
|
NDC 50268013115
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.95 |
| Max. Negotiated Rate |
$194.88 |
| Rate for Payer: Aetna Commercial |
$175.39
|
| Rate for Payer: Aetna Medicare |
$97.44
|
| Rate for Payer: ASR ASR |
$189.03
|
| Rate for Payer: ASR Commercial |
$189.03
|
| Rate for Payer: BCBS Complete |
$77.95
|
| Rate for Payer: BCBS Trust/PPO |
$159.59
|
| 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: Priority Health HMO/PPO/Tiered Network |
$170.75
|
| Rate for Payer: Priority Health Narrow Network |
$136.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.49
|
|
|
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
|
$400.90
|
|
|
Service Code
|
NDC 00185012901
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.58 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: ASR ASR |
$388.87
|
| Rate for Payer: ASR Commercial |
$388.87
|
| Rate for Payer: BCBS Trust/PPO |
$326.69
|
| Rate for Payer: BCN Commercial |
$310.82
|
| 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 |
$400.90
|
| Rate for Payer: Healthscope Whirlpool |
$388.87
|
| 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: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.79
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$7.32
|
|
|
Service Code
|
NDC 60687038495
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Aetna Commercial |
$6.59
|
| Rate for Payer: Aetna Medicare |
$3.66
|
| Rate for Payer: ASR ASR |
$7.10
|
| Rate for Payer: ASR Commercial |
$7.10
|
| Rate for Payer: BCBS Complete |
$2.93
|
| Rate for Payer: BCBS Trust/PPO |
$5.99
|
| 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: Priority Health HMO/PPO/Tiered Network |
$6.41
|
| Rate for Payer: Priority Health Narrow Network |
$5.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.44
|
|
|
BUMETANIDE 1 MG TABLET
|
Facility
|
OP
|
$219.74
|
|
|
Service Code
|
NDC 60687038425
|
| Hospital Charge Code |
9310
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.90 |
| Max. Negotiated Rate |
$219.74 |
| Rate for Payer: Aetna Commercial |
$197.77
|
| Rate for Payer: Aetna Medicare |
$109.87
|
| Rate for Payer: ASR ASR |
$213.15
|
| Rate for Payer: ASR Commercial |
$213.15
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Trust/PPO |
$179.95
|
| 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: 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
|
|
|
BUPIVACAINE 0.5 %-EPINEPHRINE BITARTRATE 1:200,000 INJECTION,CARTRIDGE
|
Facility
|
OP
|
$16.24
|
|
|
Service Code
|
NDC 00362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna Commercial |
$14.62
|
| Rate for Payer: Aetna Medicare |
$8.12
|
| Rate for Payer: ASR ASR |
$15.75
|
| Rate for Payer: ASR Commercial |
$15.75
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: BCBS Trust/PPO |
$13.30
|
| Rate for Payer: BCN Commercial |
$12.59
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$16.24
|
| Rate for Payer: Healthscope Whirlpool |
$15.75
|
| Rate for Payer: Mclaren Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: 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 00362055705
|
| Hospital Charge Code |
116394
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Aetna Commercial |
$14.62
|
| Rate for Payer: ASR ASR |
$15.75
|
| Rate for Payer: ASR Commercial |
$15.75
|
| Rate for Payer: BCBS Trust/PPO |
$13.23
|
| Rate for Payer: BCN Commercial |
$12.59
|
| Rate for Payer: Cash Price |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$16.24
|
| Rate for Payer: Healthscope Whirlpool |
$15.75
|
| Rate for Payer: Mclaren Commercial |
$14.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.80
|
| Rate for Payer: Nomi Health Commercial |
$13.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.29
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$21.17
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$21.17 |
| Rate for Payer: Aetna Commercial |
$19.05
|
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: ASR ASR |
$14.57
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: ASR Commercial |
$14.57
|
| Rate for Payer: ASR Commercial |
$20.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.24
|
| Rate for Payer: BCBS Trust/PPO |
$17.25
|
| Rate for Payer: BCN Commercial |
$16.41
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cofinity Commercial |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Healthscope Whirlpool |
$20.53
|
| Rate for Payer: Healthscope Whirlpool |
$14.57
|
| Rate for Payer: Mclaren Commercial |
$13.52
|
| Rate for Payer: Mclaren Commercial |
$19.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.77
|
| Rate for Payer: Nomi Health Commercial |
$17.36
|
| Rate for Payer: Nomi Health Commercial |
$12.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.63
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$15.02
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$15.02 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Commercial |
$19.05
|
| Rate for Payer: Aetna Medicare |
$7.51
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: ASR ASR |
$14.57
|
| Rate for Payer: ASR ASR |
$20.53
|
| Rate for Payer: ASR Commercial |
$20.53
|
| Rate for Payer: ASR Commercial |
$14.57
|
| Rate for Payer: BCBS Complete |
$6.01
|
| Rate for Payer: BCBS Complete |
$8.47
|
| Rate for Payer: BCBS Trust/PPO |
$12.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.34
|
| Rate for Payer: BCN Commercial |
$16.41
|
| Rate for Payer: BCN Commercial |
$11.65
|
| Rate for Payer: Cash Price |
$12.02
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$14.12
|
| Rate for Payer: Cofinity Commercial |
$19.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Healthscope Commercial |
$21.17
|
| Rate for Payer: Healthscope Whirlpool |
$14.57
|
| Rate for Payer: Healthscope Whirlpool |
$20.53
|
| Rate for Payer: Mclaren Commercial |
$13.52
|
| Rate for Payer: Mclaren Commercial |
$19.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.77
|
| Rate for Payer: Nomi Health Commercial |
$12.32
|
| Rate for Payer: Nomi Health Commercial |
$17.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.55
|
| Rate for Payer: Priority Health Narrow Network |
$14.84
|
| Rate for Payer: Priority Health Narrow Network |
$10.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.22
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
|
OP
|
$381.78
|
|
|
Service Code
|
NDC 43598057930
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.71 |
| Max. Negotiated Rate |
$381.78 |
| Rate for Payer: Aetna Commercial |
$343.60
|
| Rate for Payer: Aetna Medicare |
$190.89
|
| Rate for Payer: ASR ASR |
$370.33
|
| Rate for Payer: ASR Commercial |
$370.33
|
| Rate for Payer: BCBS Complete |
$152.71
|
| Rate for Payer: BCBS Trust/PPO |
$312.64
|
| Rate for Payer: BCN Commercial |
$295.99
|
| Rate for Payer: Cash Price |
$305.42
|
| Rate for Payer: Cofinity Commercial |
$358.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.42
|
| Rate for Payer: Healthscope Commercial |
$381.78
|
| Rate for Payer: Healthscope Whirlpool |
$370.33
|
| Rate for Payer: Mclaren Commercial |
$343.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.51
|
| Rate for Payer: Nomi Health Commercial |
$313.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.52
|
| Rate for Payer: Priority Health Narrow Network |
$267.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.97
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
|
OP
|
$12.73
|
|
|
Service Code
|
NDC 43598057901
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.09 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$11.46
|
| Rate for Payer: Aetna Medicare |
$6.37
|
| Rate for Payer: ASR ASR |
$12.35
|
| Rate for Payer: ASR Commercial |
$12.35
|
| Rate for Payer: BCBS Complete |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$10.42
|
| Rate for Payer: BCN Commercial |
$9.87
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Healthscope Whirlpool |
$12.35
|
| Rate for Payer: Mclaren Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Nomi Health Commercial |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.15
|
| Rate for Payer: Priority Health Narrow Network |
$8.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.20
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
|
IP
|
$381.78
|
|
|
Service Code
|
NDC 43598057930
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.16 |
| Max. Negotiated Rate |
$381.78 |
| Rate for Payer: Aetna Commercial |
$343.60
|
| Rate for Payer: ASR ASR |
$370.33
|
| Rate for Payer: ASR Commercial |
$370.33
|
| Rate for Payer: BCBS Trust/PPO |
$311.11
|
| Rate for Payer: BCN Commercial |
$295.99
|
| Rate for Payer: Cash Price |
$305.42
|
| Rate for Payer: Cofinity Commercial |
$358.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.42
|
| Rate for Payer: Healthscope Commercial |
$381.78
|
| Rate for Payer: Healthscope Whirlpool |
$370.33
|
| Rate for Payer: Mclaren Commercial |
$343.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$324.51
|
| Rate for Payer: Nomi Health Commercial |
$313.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$335.97
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
|
IP
|
$12.73
|
|
|
Service Code
|
NDC 43598057901
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$11.46
|
| Rate for Payer: ASR ASR |
$12.35
|
| Rate for Payer: ASR Commercial |
$12.35
|
| Rate for Payer: BCBS Trust/PPO |
$10.37
|
| Rate for Payer: BCN Commercial |
$9.87
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Healthscope Whirlpool |
$12.35
|
| Rate for Payer: Mclaren Commercial |
$11.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.82
|
| Rate for Payer: Nomi Health Commercial |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.20
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$263.55
|
|
|
Service Code
|
NDC 00054018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.31 |
| Max. Negotiated Rate |
$263.55 |
| Rate for Payer: Aetna Commercial |
$237.19
|
| Rate for Payer: ASR ASR |
$255.64
|
| Rate for Payer: ASR Commercial |
$255.64
|
| Rate for Payer: BCBS Trust/PPO |
$214.77
|
| Rate for Payer: BCN Commercial |
$204.33
|
| Rate for Payer: Cash Price |
$210.84
|
| Rate for Payer: Cofinity Commercial |
$247.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.84
|
| Rate for Payer: Healthscope Commercial |
$263.55
|
| Rate for Payer: Healthscope Whirlpool |
$255.64
|
| Rate for Payer: Mclaren Commercial |
$237.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.02
|
| Rate for Payer: Nomi Health Commercial |
$216.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.92
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$263.55
|
|
|
Service Code
|
NDC 00054018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.42 |
| Max. Negotiated Rate |
$263.55 |
| Rate for Payer: Aetna Commercial |
$237.19
|
| Rate for Payer: Aetna Medicare |
$131.78
|
| Rate for Payer: ASR ASR |
$255.64
|
| Rate for Payer: ASR Commercial |
$255.64
|
| Rate for Payer: BCBS Complete |
$105.42
|
| Rate for Payer: BCBS Trust/PPO |
$215.82
|
| Rate for Payer: BCN Commercial |
$204.33
|
| Rate for Payer: Cash Price |
$210.84
|
| Rate for Payer: Cofinity Commercial |
$247.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.84
|
| Rate for Payer: Healthscope Commercial |
$263.55
|
| Rate for Payer: Healthscope Whirlpool |
$255.64
|
| Rate for Payer: Mclaren Commercial |
$237.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.02
|
| Rate for Payer: Nomi Health Commercial |
$216.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.92
|
| Rate for Payer: Priority Health Narrow Network |
$184.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$231.92
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$62.78
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna Commercial |
$56.50
|
| Rate for Payer: Aetna Commercial |
$49.02
|
| Rate for Payer: ASR ASR |
$52.84
|
| Rate for Payer: ASR ASR |
$60.90
|
| Rate for Payer: ASR Commercial |
$52.84
|
| Rate for Payer: ASR Commercial |
$60.90
|
| Rate for Payer: BCBS Trust/PPO |
$44.39
|
| Rate for Payer: BCBS Trust/PPO |
$51.16
|
| Rate for Payer: BCN Commercial |
$48.67
|
| Rate for Payer: BCN Commercial |
$42.23
|
| Rate for Payer: Cash Price |
$50.22
|
| Rate for Payer: Cash Price |
$43.57
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$59.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.22
|
| Rate for Payer: Healthscope Commercial |
$54.47
|
| Rate for Payer: Healthscope Commercial |
$62.78
|
| Rate for Payer: Healthscope Whirlpool |
$60.90
|
| Rate for Payer: Healthscope Whirlpool |
$52.84
|
| Rate for Payer: Mclaren Commercial |
$49.02
|
| Rate for Payer: Mclaren Commercial |
$56.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.30
|
| Rate for Payer: Nomi Health Commercial |
$51.48
|
| Rate for Payer: Nomi Health Commercial |
$44.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.25
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$54.47
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$54.47 |
| Rate for Payer: Aetna Commercial |
$49.02
|
| Rate for Payer: Aetna Commercial |
$56.50
|
| Rate for Payer: Aetna Medicare |
$27.23
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: ASR ASR |
$52.84
|
| Rate for Payer: ASR ASR |
$60.90
|
| Rate for Payer: ASR Commercial |
$60.90
|
| Rate for Payer: ASR Commercial |
$52.84
|
| Rate for Payer: BCBS Complete |
$21.79
|
| Rate for Payer: BCBS Complete |
$25.11
|
| Rate for Payer: BCBS Trust/PPO |
$44.61
|
| Rate for Payer: BCBS Trust/PPO |
$51.41
|
| Rate for Payer: BCN Commercial |
$48.67
|
| Rate for Payer: BCN Commercial |
$42.23
|
| Rate for Payer: Cash Price |
$43.57
|
| Rate for Payer: Cash Price |
$50.22
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$59.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.22
|
| Rate for Payer: Healthscope Commercial |
$54.47
|
| Rate for Payer: Healthscope Commercial |
$62.78
|
| Rate for Payer: Healthscope Whirlpool |
$52.84
|
| Rate for Payer: Healthscope Whirlpool |
$60.90
|
| Rate for Payer: Mclaren Commercial |
$49.02
|
| Rate for Payer: Mclaren Commercial |
$56.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.30
|
| Rate for Payer: Nomi Health Commercial |
$44.67
|
| Rate for Payer: Nomi Health Commercial |
$51.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.01
|
| Rate for Payer: Priority Health Narrow Network |
$44.01
|
| Rate for Payer: Priority Health Narrow Network |
$38.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.93
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$195.30
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.12 |
| Max. Negotiated Rate |
$195.30 |
| Rate for Payer: Aetna Commercial |
$175.77
|
| Rate for Payer: Aetna Medicare |
$97.65
|
| Rate for Payer: ASR ASR |
$189.44
|
| Rate for Payer: ASR Commercial |
$189.44
|
| Rate for Payer: BCBS Complete |
$78.12
|
| Rate for Payer: BCBS Trust/PPO |
$159.93
|
| Rate for Payer: BCN Commercial |
$151.42
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$183.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.24
|
| Rate for Payer: Healthscope Commercial |
$195.30
|
| Rate for Payer: Healthscope Whirlpool |
$189.44
|
| Rate for Payer: Mclaren Commercial |
$175.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.00
|
| Rate for Payer: Nomi Health Commercial |
$160.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.12
|
| Rate for Payer: Priority Health Narrow Network |
$136.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.86
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$386.40
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$347.76
|
| Rate for Payer: Aetna Medicare |
$193.20
|
| Rate for Payer: ASR ASR |
$374.81
|
| Rate for Payer: ASR Commercial |
$374.81
|
| Rate for Payer: BCBS Complete |
$154.56
|
| Rate for Payer: BCBS Trust/PPO |
$316.42
|
| Rate for Payer: BCN Commercial |
$299.58
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$363.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$386.40
|
| Rate for Payer: Healthscope Whirlpool |
$374.81
|
| Rate for Payer: Mclaren Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$316.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.56
|
| Rate for Payer: Priority Health Narrow Network |
$270.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.03
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$386.40
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$347.76
|
| Rate for Payer: ASR ASR |
$374.81
|
| Rate for Payer: ASR Commercial |
$374.81
|
| Rate for Payer: BCBS Trust/PPO |
$314.88
|
| Rate for Payer: BCN Commercial |
$299.58
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$363.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$386.40
|
| Rate for Payer: Healthscope Whirlpool |
$374.81
|
| Rate for Payer: Mclaren Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$316.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.03
|
|
