|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$1,421.47
|
|
|
Service Code
|
NDC 50458063965
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$895.53 |
| Max. Negotiated Rate |
$1,279.32 |
| Rate for Payer: Aetna Commercial |
$1,208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.96
|
| Rate for Payer: Cash Price |
$1,137.18
|
| Rate for Payer: Cofinity Advantage |
$995.03
|
| Rate for Payer: Cofinity Commercial |
$1,222.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,137.18
|
| Rate for Payer: Healthscope Commercial |
$1,279.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,208.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,066.10
|
| Rate for Payer: PHP Commercial |
$1,208.25
|
| Rate for Payer: Priority Health SBD |
$895.53
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 68382013814
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Advantage |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health SBD |
$33.76
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.63 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 00904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Advantage |
$148.29
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
|
|
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$369.96
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
152057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$332.96 |
| Rate for Payer: Aetna Commercial |
$314.47
|
| Rate for Payer: Aetna Commercial |
$421.64
|
| Rate for Payer: Aetna Commercial |
$164.51
|
| Rate for Payer: Aetna Medicare |
$248.03
|
| Rate for Payer: Aetna Medicare |
$184.98
|
| Rate for Payer: Aetna Medicare |
$96.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.80
|
| Rate for Payer: BCBS Complete |
$198.42
|
| Rate for Payer: BCBS Complete |
$77.42
|
| Rate for Payer: BCBS Complete |
$147.98
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$295.97
|
| Rate for Payer: Cash Price |
$154.83
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cash Price |
$295.97
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cash Price |
$154.83
|
| Rate for Payer: Cofinity Advantage |
$258.97
|
| Rate for Payer: Cofinity Advantage |
$135.48
|
| Rate for Payer: Cofinity Advantage |
$347.24
|
| Rate for Payer: Cofinity Commercial |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$318.17
|
| Rate for Payer: Cofinity Commercial |
$426.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.84
|
| Rate for Payer: Healthscope Commercial |
$446.44
|
| Rate for Payer: Healthscope Commercial |
$332.96
|
| Rate for Payer: Healthscope Commercial |
$174.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.47
|
| Rate for Payer: PHP Commercial |
$314.47
|
| Rate for Payer: PHP Commercial |
$421.64
|
| Rate for Payer: PHP Commercial |
$164.51
|
| Rate for Payer: Priority Health SBD |
$312.51
|
| Rate for Payer: Priority Health SBD |
$233.07
|
| Rate for Payer: Priority Health SBD |
$121.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.06
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$2.06
|
| Rate for Payer: UHC Exchange |
$2.06
|
| Rate for Payer: UHC Exchange |
$2.06
|
|
|
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$369.96
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
152057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.07 |
| Max. Negotiated Rate |
$332.96 |
| Rate for Payer: Aetna Commercial |
$314.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.47
|
| Rate for Payer: Cash Price |
$295.97
|
| Rate for Payer: Cofinity Advantage |
$258.97
|
| Rate for Payer: Cofinity Commercial |
$318.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.97
|
| Rate for Payer: Healthscope Commercial |
$332.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.47
|
| Rate for Payer: PHP Commercial |
$314.47
|
| Rate for Payer: Priority Health SBD |
$233.07
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$112.58
|
|
|
Service Code
|
NDC 50268075515
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$101.32 |
| Rate for Payer: Aetna Commercial |
$95.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.18
|
| Rate for Payer: Cash Price |
$90.06
|
| Rate for Payer: Cofinity Advantage |
$78.81
|
| Rate for Payer: Cofinity Commercial |
$96.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.06
|
| Rate for Payer: Healthscope Commercial |
$101.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.44
|
| Rate for Payer: PHP Commercial |
$95.69
|
| Rate for Payer: Priority Health SBD |
$70.93
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 50111091601
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$293.26 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.57
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Advantage |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health SBD |
$293.26
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$112.58
|
|
|
Service Code
|
NDC 50268075515
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$101.32 |
| Rate for Payer: Aetna Commercial |
$95.69
|
| Rate for Payer: Aetna Medicare |
$56.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.18
|
| Rate for Payer: BCBS Complete |
$45.03
|
| Rate for Payer: Cash Price |
$90.06
|
| Rate for Payer: Cofinity Advantage |
$78.81
|
| Rate for Payer: Cofinity Commercial |
$96.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.06
|
| Rate for Payer: Healthscope Commercial |
$101.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.44
|
| Rate for Payer: PHP Commercial |
$95.69
|
| Rate for Payer: Priority Health SBD |
$70.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.18
|
| Rate for Payer: UHC Core |
$58.65
|
| Rate for Payer: UHC Exchange |
$44.24
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$2.26
|
|
|
Service Code
|
NDC 50268075511
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Aetna Medicare |
$1.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.47
|
| Rate for Payer: BCBS Complete |
$0.90
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cofinity Advantage |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.81
|
| Rate for Payer: Healthscope Commercial |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.92
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.47
|
| Rate for Payer: UHC Core |
$1.18
|
| Rate for Payer: UHC Exchange |
$0.89
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.26
|
|
|
Service Code
|
NDC 50268075511
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.47
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cofinity Advantage |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.81
|
| Rate for Payer: Healthscope Commercial |
$2.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.70
|
| Rate for Payer: PHP Commercial |
$1.92
|
| Rate for Payer: Priority Health SBD |
$1.42
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 23155087201
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.32 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.37
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Advantage |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.57
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health SBD |
$127.32
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 31722053001
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.63 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Advantage |
$241.81
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health SBD |
$217.63
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$202.10
|
|
|
Service Code
|
NDC 23155087201
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna Medicare |
$101.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.37
|
| Rate for Payer: BCBS Complete |
$80.84
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Advantage |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$161.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.57
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health SBD |
$127.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.37
|
| Rate for Payer: UHC Core |
$105.29
|
| Rate for Payer: UHC Exchange |
$79.43
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 31722053001
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.76 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna Medicare |
$172.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Advantage |
$241.81
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.54
|
| Rate for Payer: UHC Core |
$179.98
|
| Rate for Payer: UHC Exchange |
$135.76
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 50111091601
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.94 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$232.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.57
|
| Rate for Payer: BCBS Complete |
$186.20
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Advantage |
$325.85
|
| Rate for Payer: Cofinity Commercial |
$400.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$418.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: PHP Commercial |
$395.68
|
| Rate for Payer: Priority Health SBD |
$293.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.57
|
| Rate for Payer: UHC Core |
$242.53
|
| Rate for Payer: UHC Exchange |
$182.94
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$274.56
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.97 |
| Max. Negotiated Rate |
$247.10 |
| Rate for Payer: Aetna Commercial |
$233.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.46
|
| Rate for Payer: Cash Price |
$219.65
|
| Rate for Payer: Cofinity Advantage |
$192.19
|
| Rate for Payer: Cofinity Commercial |
$236.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.65
|
| Rate for Payer: Healthscope Commercial |
$247.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.92
|
| Rate for Payer: PHP Commercial |
$233.38
|
| Rate for Payer: Priority Health SBD |
$172.97
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.38 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Aetna Commercial |
$121.93
|
| Rate for Payer: Aetna Medicare |
$71.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.24
|
| Rate for Payer: BCBS Complete |
$57.38
|
| Rate for Payer: Cash Price |
$114.76
|
| Rate for Payer: Cofinity Advantage |
$100.42
|
| Rate for Payer: Cofinity Commercial |
$123.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.76
|
| Rate for Payer: Healthscope Commercial |
$129.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.59
|
| Rate for Payer: PHP Commercial |
$121.93
|
| Rate for Payer: Priority Health SBD |
$90.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.24
|
| Rate for Payer: UHC Core |
$74.74
|
| Rate for Payer: UHC Exchange |
$56.38
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.37 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Aetna Commercial |
$121.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.24
|
| Rate for Payer: Cash Price |
$114.76
|
| Rate for Payer: Cofinity Advantage |
$100.42
|
| Rate for Payer: Cofinity Commercial |
$123.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.76
|
| Rate for Payer: Healthscope Commercial |
$129.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.59
|
| Rate for Payer: PHP Commercial |
$121.93
|
| Rate for Payer: Priority Health SBD |
$90.37
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.44
|
| Rate for Payer: Priority Health SBD |
$1.81
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.87
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Advantage |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.44
|
| Rate for Payer: Priority Health SBD |
$1.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.87
|
| Rate for Payer: UHC Core |
$1.50
|
| Rate for Payer: UHC Exchange |
$1.13
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$130.63
|
|
|
Service Code
|
NDC 00904728306
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.30 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.91
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cofinity Advantage |
$91.44
|
| Rate for Payer: Cofinity Commercial |
$112.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.50
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.97
|
| Rate for Payer: PHP Commercial |
$111.04
|
| Rate for Payer: Priority Health SBD |
$82.30
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$130.63
|
|
|
Service Code
|
NDC 00904728306
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.34 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: Aetna Medicare |
$65.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.91
|
| Rate for Payer: BCBS Complete |
$52.25
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cofinity Advantage |
$91.44
|
| Rate for Payer: Cofinity Commercial |
$112.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.50
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.97
|
| Rate for Payer: PHP Commercial |
$111.04
|
| Rate for Payer: Priority Health SBD |
$82.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.91
|
| Rate for Payer: UHC Core |
$68.06
|
| Rate for Payer: UHC Exchange |
$51.34
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$274.56
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.90 |
| Max. Negotiated Rate |
$247.10 |
| Rate for Payer: Aetna Commercial |
$233.38
|
| Rate for Payer: Aetna Medicare |
$137.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.46
|
| Rate for Payer: BCBS Complete |
$109.82
|
| Rate for Payer: Cash Price |
$219.65
|
| Rate for Payer: Cofinity Advantage |
$192.19
|
| Rate for Payer: Cofinity Commercial |
$236.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.65
|
| Rate for Payer: Healthscope Commercial |
$247.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$219.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.92
|
| Rate for Payer: PHP Commercial |
$233.38
|
| Rate for Payer: Priority Health SBD |
$172.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.46
|
| Rate for Payer: UHC Core |
$143.05
|
| Rate for Payer: UHC Exchange |
$107.90
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$19,480.40
|
|
|
Service Code
|
CPT 60220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.44 |
| Max. Negotiated Rate |
$19,480.40 |
| Rate for Payer: Aetna Medicare |
$6,264.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,529.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,529.74
|
| Rate for Payer: BCBS Complete |
$3,308.27
|
| Rate for Payer: BCBS MAPPO |
$6,023.79
|
| Rate for Payer: BCBS Trust/PPO |
$4,456.46
|
| Rate for Payer: BCN Commercial |
$4,456.46
|
| Rate for Payer: BCN Medicare Advantage |
$6,023.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,023.79
|
| Rate for Payer: Mclaren Medicaid |
$3,150.44
|
| Rate for Payer: Mclaren Medicare |
$6,023.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,324.98
|
| Rate for Payer: Meridian Medicaid |
$6,324.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,927.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$6,626.17
|
| Rate for Payer: Nomi Health Commercial |
$18,071.37
|
| Rate for Payer: PACE Medicare |
$5,722.60
|
| Rate for Payer: PACE SWMI |
$6,023.79
|
| Rate for Payer: PHP Medicare Advantage |
$6,023.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,150.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,480.40
|
| Rate for Payer: Priority Health Medicare |
$6,023.79
|
| Rate for Payer: Priority Health Tiered Network |
$15,584.32
|
| Rate for Payer: Railroad Medicare Medicare |
$6,023.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,023.79
|
| Rate for Payer: UHC Medicaid |
$3,150.44
|
| Rate for Payer: UHCCP Medicaid |
$3,150.44
|
| Rate for Payer: VA VA |
$6,023.79
|
|
