Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

TOPIRAMATE 100 MG TABLET

Facility

$382.85

Service Code	NDC 68084034411
Hospital Charge Code	18922
Hospital Revenue Code	637
Min. Negotiated Rate	$153.14
Max. Negotiated Rate	$344.56
Rate for Payer: Aetna Commercial	$325.42
Rate for Payer: Aetna Medicare	$191.42
Rate for Payer: Aetna New Business (MI Preferred)	$248.85
Rate for Payer: BCBS Complete	$153.14
Rate for Payer: Cash Price	$306.28
Rate for Payer: Cofinity Commercial	$268.00
Rate for Payer: Cofinity Commercial	$329.25
Rate for Payer: Cofinity Medicare Advantage	$268.00
Rate for Payer: Encore Health Key Benefits Commercial	$306.28
Rate for Payer: Healthscope Commercial	$344.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$325.42
Rate for Payer: PHP Commercial	$325.42
Rate for Payer: Priority Health Cigna Priority Health	$248.85
Rate for Payer: Priority Health SBD	$241.20

TOPIRAMATE 100 MG TABLET

Facility

$382.85

Service Code	NDC 68084034411
Hospital Charge Code	18922
Hospital Revenue Code	637
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$344.56
Rate for Payer: Aetna Commercial	$325.42
Rate for Payer: Aetna New Business (MI Preferred)	$248.85
Rate for Payer: Cash Price	$306.28
Rate for Payer: Cofinity Commercial	$268.00
Rate for Payer: Cofinity Commercial	$329.25
Rate for Payer: Cofinity Medicare Advantage	$268.00
Rate for Payer: Encore Health Key Benefits Commercial	$306.28
Rate for Payer: Healthscope Commercial	$344.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$325.42
Rate for Payer: PHP Commercial	$325.42
Rate for Payer: Priority Health Cigna Priority Health	$248.85
Rate for Payer: Priority Health SBD	$241.20

TOPIRAMATE 25 MG TABLET

Facility

$215.65

Service Code	NDC 68084034211
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$135.86
Max. Negotiated Rate	$194.08
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Commercial	$150.96
Rate for Payer: Cofinity Commercial	$185.46
Rate for Payer: Cofinity Medicare Advantage	$150.96
Rate for Payer: Encore Health Key Benefits Commercial	$172.52
Rate for Payer: Healthscope Commercial	$194.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.30
Rate for Payer: PHP Commercial	$183.30
Rate for Payer: Priority Health Cigna Priority Health	$140.17
Rate for Payer: Priority Health SBD	$135.86

TOPIRAMATE 25 MG TABLET

Facility

$215.65

Service Code	NDC 68084034201
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$135.86
Max. Negotiated Rate	$194.08
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Commercial	$150.96
Rate for Payer: Cofinity Commercial	$185.46
Rate for Payer: Cofinity Medicare Advantage	$150.96
Rate for Payer: Encore Health Key Benefits Commercial	$172.52
Rate for Payer: Healthscope Commercial	$194.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.30
Rate for Payer: PHP Commercial	$183.30
Rate for Payer: Priority Health Cigna Priority Health	$140.17
Rate for Payer: Priority Health SBD	$135.86

TOPIRAMATE 25 MG TABLET

Facility

$215.65

Service Code	NDC 68084034211
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$86.26
Max. Negotiated Rate	$194.08
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna Medicare	$107.82
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
Rate for Payer: BCBS Complete	$86.26
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Commercial	$150.96
Rate for Payer: Cofinity Commercial	$185.46
Rate for Payer: Cofinity Medicare Advantage	$150.96
Rate for Payer: Encore Health Key Benefits Commercial	$172.52
Rate for Payer: Healthscope Commercial	$194.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.30
Rate for Payer: PHP Commercial	$183.30
Rate for Payer: Priority Health Cigna Priority Health	$140.17
Rate for Payer: Priority Health SBD	$135.86

TOPIRAMATE 25 MG TABLET

Facility

$1,380.18

Service Code	NDC 50458063965
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$552.07
Max. Negotiated Rate	$1,242.16
Rate for Payer: Aetna Commercial	$1,173.15
Rate for Payer: Aetna Medicare	$690.09
Rate for Payer: Aetna New Business (MI Preferred)	$897.12
Rate for Payer: BCBS Complete	$552.07
Rate for Payer: Cash Price	$1,104.14
Rate for Payer: Cofinity Commercial	$1,186.95
Rate for Payer: Cofinity Commercial	$966.13
Rate for Payer: Cofinity Medicare Advantage	$966.13
Rate for Payer: Encore Health Key Benefits Commercial	$1,104.14
Rate for Payer: Healthscope Commercial	$1,242.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,173.15
Rate for Payer: PHP Commercial	$1,173.15
Rate for Payer: Priority Health Cigna Priority Health	$897.12
Rate for Payer: Priority Health SBD	$869.51

TOPIRAMATE 25 MG TABLET

Facility

$215.65

Service Code	NDC 68084034201
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$86.26
Max. Negotiated Rate	$194.08
Rate for Payer: Aetna Commercial	$183.30
Rate for Payer: Aetna Medicare	$107.82
Rate for Payer: Aetna New Business (MI Preferred)	$140.17
Rate for Payer: BCBS Complete	$86.26
Rate for Payer: Cash Price	$172.52
Rate for Payer: Cofinity Commercial	$150.96
Rate for Payer: Cofinity Commercial	$185.46
Rate for Payer: Cofinity Medicare Advantage	$150.96
Rate for Payer: Encore Health Key Benefits Commercial	$172.52
Rate for Payer: Healthscope Commercial	$194.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$183.30
Rate for Payer: PHP Commercial	$183.30
Rate for Payer: Priority Health Cigna Priority Health	$140.17
Rate for Payer: Priority Health SBD	$135.86

TOPIRAMATE 25 MG TABLET

Facility

$57.81

Service Code	NDC 68382013814
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$36.42
Max. Negotiated Rate	$52.03
Rate for Payer: Aetna Commercial	$49.14
Rate for Payer: Aetna New Business (MI Preferred)	$37.58
Rate for Payer: Cash Price	$46.25
Rate for Payer: Cofinity Commercial	$40.47
Rate for Payer: Cofinity Commercial	$49.72
Rate for Payer: Cofinity Medicare Advantage	$40.47
Rate for Payer: Encore Health Key Benefits Commercial	$46.25
Rate for Payer: Healthscope Commercial	$52.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.14
Rate for Payer: PHP Commercial	$49.14
Rate for Payer: Priority Health Cigna Priority Health	$37.58
Rate for Payer: Priority Health SBD	$36.42

TOPIRAMATE 25 MG TABLET

Facility

$1,380.18

Service Code	NDC 50458063965
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$869.51
Max. Negotiated Rate	$1,242.16
Rate for Payer: Aetna Commercial	$1,173.15
Rate for Payer: Aetna New Business (MI Preferred)	$897.12
Rate for Payer: Cash Price	$1,104.14
Rate for Payer: Cofinity Commercial	$1,186.95
Rate for Payer: Cofinity Commercial	$966.13
Rate for Payer: Cofinity Medicare Advantage	$966.13
Rate for Payer: Encore Health Key Benefits Commercial	$1,104.14
Rate for Payer: Healthscope Commercial	$1,242.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,173.15
Rate for Payer: PHP Commercial	$1,173.15
Rate for Payer: Priority Health Cigna Priority Health	$897.12
Rate for Payer: Priority Health SBD	$869.51

TOPIRAMATE 25 MG TABLET

Facility

$195.70

Service Code	NDC 00904692861
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$78.28
Max. Negotiated Rate	$176.13
Rate for Payer: Aetna Commercial	$166.34
Rate for Payer: Aetna Medicare	$97.85
Rate for Payer: Aetna New Business (MI Preferred)	$127.20
Rate for Payer: BCBS Complete	$78.28
Rate for Payer: Cash Price	$156.56
Rate for Payer: Cofinity Commercial	$136.99
Rate for Payer: Cofinity Commercial	$168.30
Rate for Payer: Cofinity Medicare Advantage	$136.99
Rate for Payer: Encore Health Key Benefits Commercial	$156.56
Rate for Payer: Healthscope Commercial	$176.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.34
Rate for Payer: PHP Commercial	$166.34
Rate for Payer: Priority Health Cigna Priority Health	$127.20
Rate for Payer: Priority Health SBD	$123.29

TOPIRAMATE 25 MG TABLET

Facility

$195.70

Service Code	NDC 00904692861
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$123.29
Max. Negotiated Rate	$176.13
Rate for Payer: Aetna Commercial	$166.34
Rate for Payer: Aetna New Business (MI Preferred)	$127.20
Rate for Payer: Cash Price	$156.56
Rate for Payer: Cofinity Commercial	$136.99
Rate for Payer: Cofinity Commercial	$168.30
Rate for Payer: Cofinity Medicare Advantage	$136.99
Rate for Payer: Encore Health Key Benefits Commercial	$156.56
Rate for Payer: Healthscope Commercial	$176.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.34
Rate for Payer: PHP Commercial	$166.34
Rate for Payer: Priority Health Cigna Priority Health	$127.20
Rate for Payer: Priority Health SBD	$123.29

TOPIRAMATE 25 MG TABLET

Facility

$57.81

Service Code	NDC 68382013814
Hospital Charge Code	18920
Hospital Revenue Code	637
Min. Negotiated Rate	$23.12
Max. Negotiated Rate	$52.03
Rate for Payer: Aetna Commercial	$49.14
Rate for Payer: Aetna Medicare	$28.90
Rate for Payer: Aetna New Business (MI Preferred)	$37.58
Rate for Payer: BCBS Complete	$23.12
Rate for Payer: Cash Price	$46.25
Rate for Payer: Cofinity Commercial	$40.47
Rate for Payer: Cofinity Commercial	$49.72
Rate for Payer: Cofinity Medicare Advantage	$40.47
Rate for Payer: Encore Health Key Benefits Commercial	$46.25
Rate for Payer: Healthscope Commercial	$52.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$49.14
Rate for Payer: PHP Commercial	$49.14
Rate for Payer: Priority Health Cigna Priority Health	$37.58
Rate for Payer: Priority Health SBD	$36.42

TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION

Facility

$452.06

Service Code	HCPCS J9351
Hospital Charge Code	152057
Hospital Revenue Code	636
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$406.85
Rate for Payer: Aetna Commercial	$384.25
Rate for Payer: Aetna Commercial	$90.00
Rate for Payer: Aetna Commercial	$127.07
Rate for Payer: Aetna Commercial	$314.47
Rate for Payer: Aetna Medicare	$184.98
Rate for Payer: Aetna Medicare	$226.03
Rate for Payer: Aetna Medicare	$52.94
Rate for Payer: Aetna Medicare	$74.74
Rate for Payer: Aetna New Business (MI Preferred)	$240.47
Rate for Payer: Aetna New Business (MI Preferred)	$293.84
Rate for Payer: Aetna New Business (MI Preferred)	$68.82
Rate for Payer: Aetna New Business (MI Preferred)	$97.17
Rate for Payer: BCBS Complete	$59.80
Rate for Payer: BCBS Complete	$147.98
Rate for Payer: BCBS Complete	$42.35
Rate for Payer: BCBS Complete	$180.82
Rate for Payer: BCBS Trust/PPO	$4.55
Rate for Payer: BCBS Trust/PPO	$4.55
Rate for Payer: BCBS Trust/PPO	$4.55
Rate for Payer: BCBS Trust/PPO	$4.55
Rate for Payer: BCN Commercial	$4.55
Rate for Payer: BCN Commercial	$4.55
Rate for Payer: BCN Commercial	$4.55
Rate for Payer: BCN Commercial	$4.55
Rate for Payer: Cash Price	$361.65
Rate for Payer: Cash Price	$295.97
Rate for Payer: Cash Price	$119.59
Rate for Payer: Cash Price	$119.59
Rate for Payer: Cash Price	$84.70
Rate for Payer: Cash Price	$84.70
Rate for Payer: Cash Price	$295.97
Rate for Payer: Cash Price	$361.65
Rate for Payer: Cofinity Commercial	$316.44
Rate for Payer: Cofinity Commercial	$128.56
Rate for Payer: Cofinity Commercial	$74.12
Rate for Payer: Cofinity Commercial	$91.06
Rate for Payer: Cofinity Commercial	$104.64
Rate for Payer: Cofinity Commercial	$258.97
Rate for Payer: Cofinity Commercial	$318.17
Rate for Payer: Cofinity Commercial	$388.77
Rate for Payer: Cofinity Medicare Advantage	$74.12
Rate for Payer: Cofinity Medicare Advantage	$104.64
Rate for Payer: Cofinity Medicare Advantage	$258.97
Rate for Payer: Cofinity Medicare Advantage	$316.44
Rate for Payer: Encore Health Key Benefits Commercial	$119.59
Rate for Payer: Encore Health Key Benefits Commercial	$84.70
Rate for Payer: Encore Health Key Benefits Commercial	$361.65
Rate for Payer: Encore Health Key Benefits Commercial	$295.97
Rate for Payer: Healthscope Commercial	$406.85
Rate for Payer: Healthscope Commercial	$332.96
Rate for Payer: Healthscope Commercial	$134.54
Rate for Payer: Healthscope Commercial	$95.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$314.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$127.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$384.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$90.00
Rate for Payer: PHP Commercial	$127.07
Rate for Payer: PHP Commercial	$90.00
Rate for Payer: PHP Commercial	$384.25
Rate for Payer: PHP Commercial	$314.47
Rate for Payer: Priority Health Cigna Priority Health	$97.17
Rate for Payer: Priority Health Cigna Priority Health	$293.84
Rate for Payer: Priority Health Cigna Priority Health	$240.47
Rate for Payer: Priority Health Cigna Priority Health	$68.82
Rate for Payer: Priority Health SBD	$233.07
Rate for Payer: Priority Health SBD	$66.70
Rate for Payer: Priority Health SBD	$94.18
Rate for Payer: Priority Health SBD	$284.80

TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION

Facility

$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 Commercial	$258.97
Rate for Payer: Cofinity Commercial	$318.17
Rate for Payer: Cofinity Medicare Advantage	$258.97
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: PHP Commercial	$314.47
Rate for Payer: Priority Health Cigna Priority Health	$240.47
Rate for Payer: Priority Health SBD	$233.07

TORSEMIDE 10 MG TABLET

Facility

$104.50

Service Code	NDC 50268075515
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$94.05
Rate for Payer: Aetna Commercial	$88.82
Rate for Payer: Aetna Medicare	$52.25
Rate for Payer: Aetna New Business (MI Preferred)	$67.92
Rate for Payer: BCBS Complete	$41.80
Rate for Payer: Cash Price	$83.60
Rate for Payer: Cofinity Commercial	$73.15
Rate for Payer: Cofinity Commercial	$89.87
Rate for Payer: Cofinity Medicare Advantage	$73.15
Rate for Payer: Encore Health Key Benefits Commercial	$83.60
Rate for Payer: Healthscope Commercial	$94.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.82
Rate for Payer: PHP Commercial	$88.82
Rate for Payer: Priority Health Cigna Priority Health	$67.92
Rate for Payer: Priority Health SBD	$65.84

TORSEMIDE 10 MG TABLET

Facility

$2.09

Service Code	NDC 50268075511
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare	$1.04
Rate for Payer: Aetna New Business (MI Preferred)	$1.36
Rate for Payer: BCBS Complete	$0.84
Rate for Payer: Cash Price	$1.67
Rate for Payer: Cofinity Commercial	$1.46
Rate for Payer: Cofinity Commercial	$1.80
Rate for Payer: Cofinity Medicare Advantage	$1.46
Rate for Payer: Encore Health Key Benefits Commercial	$1.67
Rate for Payer: Healthscope Commercial	$1.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.78
Rate for Payer: PHP Commercial	$1.78
Rate for Payer: Priority Health Cigna Priority Health	$1.36
Rate for Payer: Priority Health SBD	$1.32

TORSEMIDE 10 MG TABLET

Facility

$199.75

Service Code	NDC 23155087201
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$125.84
Max. Negotiated Rate	$179.78
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: Aetna New Business (MI Preferred)	$129.84
Rate for Payer: Cash Price	$159.80
Rate for Payer: Cofinity Commercial	$139.82
Rate for Payer: Cofinity Commercial	$171.78
Rate for Payer: Cofinity Medicare Advantage	$139.82
Rate for Payer: Encore Health Key Benefits Commercial	$159.80
Rate for Payer: Healthscope Commercial	$179.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.79
Rate for Payer: PHP Commercial	$169.79
Rate for Payer: Priority Health Cigna Priority Health	$129.84
Rate for Payer: Priority Health SBD	$125.84

TORSEMIDE 10 MG TABLET

Facility

$475.00

Service Code	NDC 50111091601
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$299.25
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna Commercial	$403.75
Rate for Payer: Aetna New Business (MI Preferred)	$308.75
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cofinity Commercial	$332.50
Rate for Payer: Cofinity Commercial	$408.50
Rate for Payer: Cofinity Medicare Advantage	$332.50
Rate for Payer: Encore Health Key Benefits Commercial	$380.00
Rate for Payer: Healthscope Commercial	$427.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.75
Rate for Payer: PHP Commercial	$403.75
Rate for Payer: Priority Health Cigna Priority Health	$308.75
Rate for Payer: Priority Health SBD	$299.25

TORSEMIDE 10 MG TABLET

Facility

$199.75

Service Code	NDC 23155087201
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$79.90
Max. Negotiated Rate	$179.78
Rate for Payer: Aetna Commercial	$169.79
Rate for Payer: Aetna Medicare	$99.88
Rate for Payer: Aetna New Business (MI Preferred)	$129.84
Rate for Payer: BCBS Complete	$79.90
Rate for Payer: Cash Price	$159.80
Rate for Payer: Cofinity Commercial	$139.82
Rate for Payer: Cofinity Commercial	$171.78
Rate for Payer: Cofinity Medicare Advantage	$139.82
Rate for Payer: Encore Health Key Benefits Commercial	$159.80
Rate for Payer: Healthscope Commercial	$179.78
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.79
Rate for Payer: PHP Commercial	$169.79
Rate for Payer: Priority Health Cigna Priority Health	$129.84
Rate for Payer: Priority Health SBD	$125.84

TORSEMIDE 10 MG TABLET

Facility

$345.45

Service Code	NDC 31722053001
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$138.18
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 Commercial	$241.82
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.82
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: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

TORSEMIDE 10 MG TABLET

Facility

$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 Commercial	$241.82
Rate for Payer: Cofinity Commercial	$297.09
Rate for Payer: Cofinity Medicare Advantage	$241.82
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: PHP Commercial	$293.63
Rate for Payer: Priority Health Cigna Priority Health	$224.54
Rate for Payer: Priority Health SBD	$217.63

TORSEMIDE 10 MG TABLET

Facility

$2.09

Service Code	NDC 50268075511
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$1.32
Max. Negotiated Rate	$1.88
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna New Business (MI Preferred)	$1.36
Rate for Payer: Cash Price	$1.67
Rate for Payer: Cofinity Commercial	$1.46
Rate for Payer: Cofinity Commercial	$1.80
Rate for Payer: Cofinity Medicare Advantage	$1.46
Rate for Payer: Encore Health Key Benefits Commercial	$1.67
Rate for Payer: Healthscope Commercial	$1.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.78
Rate for Payer: PHP Commercial	$1.78
Rate for Payer: Priority Health Cigna Priority Health	$1.36
Rate for Payer: Priority Health SBD	$1.32

TORSEMIDE 10 MG TABLET

Facility

$104.50

Service Code	NDC 50268075515
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$65.84
Max. Negotiated Rate	$94.05
Rate for Payer: Aetna Commercial	$88.82
Rate for Payer: Aetna New Business (MI Preferred)	$67.92
Rate for Payer: Cash Price	$83.60
Rate for Payer: Cofinity Commercial	$73.15
Rate for Payer: Cofinity Commercial	$89.87
Rate for Payer: Cofinity Medicare Advantage	$73.15
Rate for Payer: Encore Health Key Benefits Commercial	$83.60
Rate for Payer: Healthscope Commercial	$94.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$88.82
Rate for Payer: PHP Commercial	$88.82
Rate for Payer: Priority Health Cigna Priority Health	$67.92
Rate for Payer: Priority Health SBD	$65.84

TORSEMIDE 10 MG TABLET

Facility

$475.00

Service Code	NDC 50111091601
Hospital Charge Code	18292
Hospital Revenue Code	637
Min. Negotiated Rate	$190.00
Max. Negotiated Rate	$427.50
Rate for Payer: Aetna Commercial	$403.75
Rate for Payer: Aetna Medicare	$237.50
Rate for Payer: Aetna New Business (MI Preferred)	$308.75
Rate for Payer: BCBS Complete	$190.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cofinity Commercial	$332.50
Rate for Payer: Cofinity Commercial	$408.50
Rate for Payer: Cofinity Medicare Advantage	$332.50
Rate for Payer: Encore Health Key Benefits Commercial	$380.00
Rate for Payer: Healthscope Commercial	$427.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.75
Rate for Payer: PHP Commercial	$403.75
Rate for Payer: Priority Health Cigna Priority Health	$308.75
Rate for Payer: Priority Health SBD	$299.25

TORSEMIDE 20 MG TABLET

Facility

$280.32

Service Code	NDC 50111091701
Hospital Charge Code	18293
Hospital Revenue Code	637
Min. Negotiated Rate	$176.60
Max. Negotiated Rate	$252.29
Rate for Payer: Aetna Commercial	$238.27
Rate for Payer: Aetna New Business (MI Preferred)	$182.21
Rate for Payer: Cash Price	$224.26
Rate for Payer: Cofinity Commercial	$196.22
Rate for Payer: Cofinity Commercial	$241.08
Rate for Payer: Cofinity Medicare Advantage	$196.22
Rate for Payer: Encore Health Key Benefits Commercial	$224.26
Rate for Payer: Healthscope Commercial	$252.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$238.27
Rate for Payer: PHP Commercial	$238.27
Rate for Payer: Priority Health Cigna Priority Health	$182.21
Rate for Payer: Priority Health SBD	$176.60

Know your out-of-pocket cost for care.

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