|
FRENULOTOMY OF PENIS
|
Facility
|
OP
|
$6,735.82
|
|
|
Service Code
|
CPT 54164
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,089.34 |
| Max. Negotiated Rate |
$6,735.82 |
| Rate for Payer: Aetna Medicare |
$2,166.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,603.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,603.59
|
| Rate for Payer: BCBS Complete |
$1,143.91
|
| Rate for Payer: BCBS MAPPO |
$2,082.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,096.19
|
| Rate for Payer: BCN Commercial |
$1,096.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,082.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,082.87
|
| Rate for Payer: Mclaren Medicaid |
$1,089.34
|
| Rate for Payer: Mclaren Medicare |
$2,082.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,187.01
|
| Rate for Payer: Meridian Medicaid |
$2,187.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,395.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,291.16
|
| Rate for Payer: Nomi Health Commercial |
$6,248.61
|
| Rate for Payer: PACE Medicare |
$1,978.73
|
| Rate for Payer: PACE SWMI |
$2,082.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,082.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,735.82
|
| Rate for Payer: Priority Health Medicare |
$2,082.87
|
| Rate for Payer: Priority Health Tiered Network |
$5,388.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,082.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,082.87
|
| Rate for Payer: UHC Medicaid |
$1,089.34
|
| Rate for Payer: UHCCP Medicaid |
$1,089.34
|
| Rate for Payer: VA VA |
$2,082.87
|
|
|
FULL TERM NEONATE WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$67,964.48
|
|
|
Service Code
|
MSDRG 793
|
| Min. Negotiated Rate |
$9,268.29 |
| Max. Negotiated Rate |
$67,964.48 |
| Rate for Payer: Aetna Medicare |
$34,114.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$41,003.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$41,003.28
|
| Rate for Payer: BCBS MAPPO |
$32,802.62
|
| Rate for Payer: BCBS Trust/PPO |
$21,511.95
|
| Rate for Payer: BCN Commercial |
$21,511.95
|
| Rate for Payer: BCN Medicare Advantage |
$32,802.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32,802.62
|
| Rate for Payer: Mclaren Medicare |
$32,802.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34,442.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37,723.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$36,082.88
|
| Rate for Payer: Nomi Health Commercial |
$53,787.84
|
| Rate for Payer: PACE Medicare |
$31,162.49
|
| Rate for Payer: PACE SWMI |
$32,802.62
|
| Rate for Payer: PHP Medicare Advantage |
$32,802.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,585.37
|
| Rate for Payer: Priority Health Medicare |
$32,802.62
|
| Rate for Payer: Priority Health Tiered Network |
$9,268.29
|
| Rate for Payer: Railroad Medicare Medicare |
$32,802.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67,964.48
|
| Rate for Payer: UHC Core |
$56,860.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32,802.62
|
| Rate for Payer: UHC Exchange |
$46,436.84
|
| Rate for Payer: VA VA |
$32,802.62
|
|
|
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY
|
Facility
|
IP
|
$36,032.78
|
|
|
Service Code
|
MSDRG 934
|
| Min. Negotiated Rate |
$16,779.88 |
| Max. Negotiated Rate |
$36,032.78 |
| Rate for Payer: Aetna Medicare |
$18,369.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,078.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,078.79
|
| Rate for Payer: BCBS MAPPO |
$17,663.03
|
| Rate for Payer: BCBS Trust/PPO |
$24,377.09
|
| Rate for Payer: BCN Commercial |
$24,377.09
|
| Rate for Payer: BCN Medicare Advantage |
$17,663.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,663.03
|
| Rate for Payer: Mclaren Medicare |
$17,663.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,546.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,312.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,429.33
|
| Rate for Payer: Nomi Health Commercial |
$28,516.74
|
| Rate for Payer: PACE Medicare |
$16,779.88
|
| Rate for Payer: PACE SWMI |
$17,663.03
|
| Rate for Payer: PHP Medicare Advantage |
$17,663.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35,639.60
|
| Rate for Payer: Priority Health Medicare |
$17,663.03
|
| Rate for Payer: Priority Health Tiered Network |
$28,511.68
|
| Rate for Payer: Railroad Medicare Medicare |
$17,663.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36,032.78
|
| Rate for Payer: UHC Core |
$30,145.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,663.03
|
| Rate for Payer: UHC Exchange |
$24,619.45
|
| Rate for Payer: VA VA |
$17,663.03
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC
|
Facility
|
IP
|
$116,915.01
|
|
|
Service Code
|
MSDRG 928
|
| Min. Negotiated Rate |
$53,210.71 |
| Max. Negotiated Rate |
$116,915.01 |
| Rate for Payer: Aetna Medicare |
$58,251.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70,014.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70,014.09
|
| Rate for Payer: BCBS MAPPO |
$56,011.27
|
| Rate for Payer: BCBS Trust/PPO |
$115,635.52
|
| Rate for Payer: BCN Commercial |
$115,635.52
|
| Rate for Payer: BCN Medicare Advantage |
$56,011.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56,011.27
|
| Rate for Payer: Mclaren Medicare |
$56,011.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58,811.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64,412.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$61,612.40
|
| Rate for Payer: Nomi Health Commercial |
$92,527.83
|
| Rate for Payer: PACE Medicare |
$53,210.71
|
| Rate for Payer: PACE SWMI |
$56,011.27
|
| Rate for Payer: PHP Medicare Advantage |
$56,011.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115,639.27
|
| Rate for Payer: Priority Health Medicare |
$56,011.27
|
| Rate for Payer: Priority Health Tiered Network |
$92,511.40
|
| Rate for Payer: Railroad Medicare Medicare |
$56,011.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116,915.01
|
| Rate for Payer: UHC Core |
$97,814.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56,011.27
|
| Rate for Payer: UHC Exchange |
$79,882.36
|
| Rate for Payer: VA VA |
$56,011.27
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC
|
Facility
|
IP
|
$53,733.06
|
|
|
Service Code
|
MSDRG 929
|
| Min. Negotiated Rate |
$24,196.57 |
| Max. Negotiated Rate |
$53,733.06 |
| Rate for Payer: Aetna Medicare |
$26,488.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,837.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,837.59
|
| Rate for Payer: BCBS MAPPO |
$25,470.07
|
| Rate for Payer: BCBS Trust/PPO |
$53,733.06
|
| Rate for Payer: BCN Commercial |
$53,733.06
|
| Rate for Payer: BCN Medicare Advantage |
$25,470.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25,470.07
|
| Rate for Payer: Mclaren Medicare |
$25,470.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,743.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29,290.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$28,017.08
|
| Rate for Payer: Nomi Health Commercial |
$41,548.32
|
| Rate for Payer: PACE Medicare |
$24,196.57
|
| Rate for Payer: PACE SWMI |
$25,470.07
|
| Rate for Payer: PHP Medicare Advantage |
$25,470.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51,926.19
|
| Rate for Payer: Priority Health Medicare |
$25,470.07
|
| Rate for Payer: Priority Health Tiered Network |
$41,540.94
|
| Rate for Payer: Railroad Medicare Medicare |
$25,470.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52,499.04
|
| Rate for Payer: UHC Core |
$43,922.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$25,470.07
|
| Rate for Payer: UHC Exchange |
$35,870.05
|
| Rate for Payer: VA VA |
$25,470.07
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$796.01
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
32767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$716.41 |
| Rate for Payer: Aetna Commercial |
$676.61
|
| Rate for Payer: Aetna Commercial |
$676.38
|
| Rate for Payer: Aetna Commercial |
$787.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.23
|
| Rate for Payer: Cash Price |
$636.59
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$740.86
|
| Rate for Payer: Cofinity Advantage |
$648.25
|
| Rate for Payer: Cofinity Advantage |
$557.02
|
| Rate for Payer: Cofinity Advantage |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$684.57
|
| Rate for Payer: Cofinity Commercial |
$684.34
|
| Rate for Payer: Cofinity Commercial |
$796.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.81
|
| Rate for Payer: Healthscope Commercial |
$833.46
|
| Rate for Payer: Healthscope Commercial |
$716.17
|
| Rate for Payer: Healthscope Commercial |
$716.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$597.01
|
| Rate for Payer: PHP Commercial |
$676.38
|
| Rate for Payer: PHP Commercial |
$787.16
|
| Rate for Payer: PHP Commercial |
$676.61
|
| Rate for Payer: Priority Health SBD |
$583.42
|
| Rate for Payer: Priority Health SBD |
$501.49
|
| Rate for Payer: Priority Health SBD |
$501.32
|
|
|
FULVESTRANT 250 MG/5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
OP
|
$4,244.33
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
32767
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$3,819.90 |
| Rate for Payer: Aetna Commercial |
$3,607.68
|
| Rate for Payer: Aetna Commercial |
$337.70
|
| Rate for Payer: Aetna Commercial |
$676.38
|
| Rate for Payer: Aetna Commercial |
$676.61
|
| Rate for Payer: Aetna Commercial |
$688.96
|
| Rate for Payer: Aetna Commercial |
$612.74
|
| Rate for Payer: Aetna Commercial |
$409.48
|
| Rate for Payer: Aetna Commercial |
$787.16
|
| Rate for Payer: Aetna Commercial |
$264.65
|
| Rate for Payer: Aetna Medicare |
$360.44
|
| Rate for Payer: Aetna Medicare |
$240.87
|
| Rate for Payer: Aetna Medicare |
$155.68
|
| Rate for Payer: Aetna Medicare |
$198.65
|
| Rate for Payer: Aetna Medicare |
$2,122.16
|
| Rate for Payer: Aetna Medicare |
$463.04
|
| Rate for Payer: Aetna Medicare |
$405.27
|
| Rate for Payer: Aetna Medicare |
$398.00
|
| Rate for Payer: Aetna Medicare |
$397.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,758.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.38
|
| Rate for Payer: BCBS Complete |
$318.30
|
| Rate for Payer: BCBS Complete |
$1,697.73
|
| Rate for Payer: BCBS Complete |
$158.92
|
| Rate for Payer: BCBS Complete |
$370.43
|
| Rate for Payer: BCBS Complete |
$324.22
|
| Rate for Payer: BCBS Complete |
$288.35
|
| Rate for Payer: BCBS Complete |
$124.54
|
| Rate for Payer: BCBS Complete |
$318.40
|
| Rate for Payer: BCBS Complete |
$192.70
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Cash Price |
$317.83
|
| Rate for Payer: Cash Price |
$249.08
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cash Price |
$317.83
|
| Rate for Payer: Cash Price |
$3,395.46
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cash Price |
$385.39
|
| Rate for Payer: Cash Price |
$576.70
|
| Rate for Payer: Cash Price |
$576.70
|
| Rate for Payer: Cash Price |
$636.59
|
| Rate for Payer: Cash Price |
$636.59
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$636.81
|
| Rate for Payer: Cash Price |
$648.43
|
| Rate for Payer: Cash Price |
$648.43
|
| Rate for Payer: Cash Price |
$740.86
|
| Rate for Payer: Cash Price |
$740.86
|
| Rate for Payer: Cofinity Advantage |
$648.25
|
| Rate for Payer: Cofinity Advantage |
$504.61
|
| Rate for Payer: Cofinity Advantage |
$2,971.03
|
| Rate for Payer: Cofinity Advantage |
$278.10
|
| Rate for Payer: Cofinity Advantage |
$557.02
|
| Rate for Payer: Cofinity Advantage |
$337.22
|
| Rate for Payer: Cofinity Advantage |
$217.94
|
| Rate for Payer: Cofinity Advantage |
$567.38
|
| Rate for Payer: Cofinity Advantage |
$557.21
|
| Rate for Payer: Cofinity Commercial |
$341.67
|
| Rate for Payer: Cofinity Commercial |
$267.76
|
| Rate for Payer: Cofinity Commercial |
$619.95
|
| Rate for Payer: Cofinity Commercial |
$3,650.12
|
| Rate for Payer: Cofinity Commercial |
$684.34
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Cofinity Commercial |
$796.42
|
| Rate for Payer: Cofinity Commercial |
$684.57
|
| Rate for Payer: Cofinity Commercial |
$697.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$636.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$648.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$576.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,395.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$740.86
|
| Rate for Payer: Healthscope Commercial |
$280.21
|
| Rate for Payer: Healthscope Commercial |
$833.46
|
| Rate for Payer: Healthscope Commercial |
$729.49
|
| Rate for Payer: Healthscope Commercial |
$648.78
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Healthscope Commercial |
$357.56
|
| Rate for Payer: Healthscope Commercial |
$3,819.90
|
| Rate for Payer: Healthscope Commercial |
$716.41
|
| Rate for Payer: Healthscope Commercial |
$716.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$740.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$249.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$317.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$576.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$648.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,395.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$636.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$636.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,607.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$676.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$787.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$688.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,183.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$607.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$597.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$540.65
|
| Rate for Payer: PHP Commercial |
$264.65
|
| Rate for Payer: PHP Commercial |
$612.74
|
| Rate for Payer: PHP Commercial |
$337.70
|
| Rate for Payer: PHP Commercial |
$409.48
|
| Rate for Payer: PHP Commercial |
$676.61
|
| Rate for Payer: PHP Commercial |
$676.38
|
| Rate for Payer: PHP Commercial |
$3,607.68
|
| Rate for Payer: PHP Commercial |
$787.16
|
| Rate for Payer: PHP Commercial |
$688.96
|
| Rate for Payer: Priority Health SBD |
$510.64
|
| Rate for Payer: Priority Health SBD |
$501.49
|
| Rate for Payer: Priority Health SBD |
$454.15
|
| Rate for Payer: Priority Health SBD |
$196.15
|
| Rate for Payer: Priority Health SBD |
$250.29
|
| Rate for Payer: Priority Health SBD |
$2,673.93
|
| Rate for Payer: Priority Health SBD |
$501.32
|
| Rate for Payer: Priority Health SBD |
$583.42
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
| Rate for Payer: UHC Exchange |
$9.44
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$17.05
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$15.35 |
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cofinity Advantage |
$13.78
|
| Rate for Payer: Cofinity Advantage |
$8.19
|
| Rate for Payer: Cofinity Advantage |
$11.94
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.64
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.79
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: PHP Commercial |
$14.49
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: Priority Health SBD |
$10.74
|
| Rate for Payer: Priority Health SBD |
$7.37
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$11.70
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$10.53 |
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna Medicare |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS Complete |
$4.68
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cofinity Advantage |
$11.94
|
| Rate for Payer: Cofinity Advantage |
$8.19
|
| Rate for Payer: Cofinity Advantage |
$13.78
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.77
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$14.49
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: Priority Health SBD |
$10.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.65
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Commercial |
$23.86
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$17.16
|
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: Aetna Commercial |
$12.49
|
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna Medicare |
$9.85
|
| Rate for Payer: Aetna Medicare |
$7.58
|
| Rate for Payer: Aetna Medicare |
$9.79
|
| Rate for Payer: Aetna Medicare |
$4.08
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: Aetna Medicare |
$8.53
|
| Rate for Payer: Aetna Medicare |
$10.52
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: Aetna Medicare |
$14.04
|
| Rate for Payer: Aetna Medicare |
$6.99
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Aetna Medicare |
$5.29
|
| Rate for Payer: Aetna Medicare |
$5.85
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Aetna Medicare |
$10.37
|
| Rate for Payer: Aetna Medicare |
$6.38
|
| Rate for Payer: Aetna Medicare |
$7.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Complete |
$8.30
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: BCBS Complete |
$6.06
|
| Rate for Payer: BCBS Complete |
$4.24
|
| Rate for Payer: BCBS Complete |
$11.23
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS Complete |
$5.59
|
| Rate for Payer: BCBS Complete |
$5.88
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS Complete |
$8.41
|
| Rate for Payer: BCBS Complete |
$4.68
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Complete |
$3.26
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$16.59
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$16.59
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cofinity Advantage |
$14.52
|
| Rate for Payer: Cofinity Advantage |
$9.79
|
| Rate for Payer: Cofinity Advantage |
$13.71
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$7.41
|
| Rate for Payer: Cofinity Advantage |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$5.71
|
| Rate for Payer: Cofinity Advantage |
$11.94
|
| Rate for Payer: Cofinity Advantage |
$10.29
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Advantage |
$14.13
|
| Rate for Payer: Cofinity Advantage |
$19.65
|
| Rate for Payer: Cofinity Advantage |
$14.72
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Advantage |
$8.19
|
| Rate for Payer: Cofinity Advantage |
$13.78
|
| Rate for Payer: Cofinity Advantage |
$8.93
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Cofinity Commercial |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$9.11
|
| Rate for Payer: Cofinity Commercial |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$12.02
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Healthscope Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$18.67
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$13.23
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Healthscope Commercial |
$9.53
|
| Rate for Payer: Healthscope Commercial |
$18.17
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.56
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.03
|
| Rate for Payer: PHP Commercial |
$11.88
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: PHP Commercial |
$9.00
|
| Rate for Payer: PHP Commercial |
$12.49
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$17.16
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$23.86
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$17.63
|
| Rate for Payer: PHP Commercial |
$6.93
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$14.49
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$13.07
|
| Rate for Payer: Priority Health SBD |
$10.74
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$5.13
|
| Rate for Payer: Priority Health SBD |
$13.25
|
| Rate for Payer: Priority Health SBD |
$9.26
|
| Rate for Payer: Priority Health SBD |
$8.81
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$8.04
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Priority Health SBD |
$6.67
|
| Rate for Payer: Priority Health SBD |
$12.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Core |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.03
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.59
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$9.53 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Commercial |
$6.93
|
| Rate for Payer: Aetna Commercial |
$23.86
|
| Rate for Payer: Aetna Commercial |
$16.74
|
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Aetna Commercial |
$14.49
|
| Rate for Payer: Aetna Commercial |
$17.16
|
| Rate for Payer: Aetna Commercial |
$12.88
|
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$17.63
|
| Rate for Payer: Aetna Commercial |
$17.88
|
| Rate for Payer: Aetna Commercial |
$10.85
|
| Rate for Payer: Aetna Commercial |
$12.49
|
| Rate for Payer: Aetna Commercial |
$11.88
|
| Rate for Payer: Aetna Commercial |
$9.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.88
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$9.36
|
| Rate for Payer: Cash Price |
$11.76
|
| Rate for Payer: Cash Price |
$8.47
|
| Rate for Payer: Cash Price |
$6.52
|
| Rate for Payer: Cash Price |
$22.46
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$16.82
|
| Rate for Payer: Cash Price |
$16.59
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$12.12
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cofinity Advantage |
$13.71
|
| Rate for Payer: Cofinity Advantage |
$10.61
|
| Rate for Payer: Cofinity Advantage |
$14.52
|
| Rate for Payer: Cofinity Advantage |
$7.46
|
| Rate for Payer: Cofinity Advantage |
$14.49
|
| Rate for Payer: Cofinity Advantage |
$14.13
|
| Rate for Payer: Cofinity Advantage |
$11.94
|
| Rate for Payer: Cofinity Advantage |
$10.29
|
| Rate for Payer: Cofinity Advantage |
$7.41
|
| Rate for Payer: Cofinity Advantage |
$8.93
|
| Rate for Payer: Cofinity Advantage |
$19.65
|
| Rate for Payer: Cofinity Advantage |
$13.78
|
| Rate for Payer: Cofinity Advantage |
$14.72
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Advantage |
$8.19
|
| Rate for Payer: Cofinity Advantage |
$5.71
|
| Rate for Payer: Cofinity Advantage |
$9.79
|
| Rate for Payer: Cofinity Commercial |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$12.02
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Cofinity Commercial |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$12.64
|
| Rate for Payer: Cofinity Commercial |
$10.06
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$14.66
|
| Rate for Payer: Cofinity Commercial |
$9.11
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Commercial |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$17.36
|
| Rate for Payer: Cofinity Commercial |
$16.93
|
| Rate for Payer: Cofinity Commercial |
$24.14
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$16.84
|
| Rate for Payer: Cofinity Commercial |
$18.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.52
|
| Rate for Payer: Healthscope Commercial |
$18.93
|
| Rate for Payer: Healthscope Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$18.67
|
| Rate for Payer: Healthscope Commercial |
$15.35
|
| Rate for Payer: Healthscope Commercial |
$17.62
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Healthscope Commercial |
$11.48
|
| Rate for Payer: Healthscope Commercial |
$13.63
|
| Rate for Payer: Healthscope Commercial |
$9.53
|
| Rate for Payer: Healthscope Commercial |
$18.17
|
| Rate for Payer: Healthscope Commercial |
$12.58
|
| Rate for Payer: Healthscope Commercial |
$10.53
|
| Rate for Payer: Healthscope Commercial |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$13.23
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$17.72
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.79
|
| Rate for Payer: PHP Commercial |
$17.88
|
| Rate for Payer: PHP Commercial |
$16.74
|
| Rate for Payer: PHP Commercial |
$14.49
|
| Rate for Payer: PHP Commercial |
$12.49
|
| Rate for Payer: PHP Commercial |
$16.64
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$6.93
|
| Rate for Payer: PHP Commercial |
$23.86
|
| Rate for Payer: PHP Commercial |
$17.63
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$10.85
|
| Rate for Payer: PHP Commercial |
$17.16
|
| Rate for Payer: PHP Commercial |
$12.88
|
| Rate for Payer: PHP Commercial |
$11.88
|
| Rate for Payer: PHP Commercial |
$9.95
|
| Rate for Payer: PHP Commercial |
$9.00
|
| Rate for Payer: Priority Health SBD |
$13.25
|
| Rate for Payer: Priority Health SBD |
$12.40
|
| Rate for Payer: Priority Health SBD |
$9.26
|
| Rate for Payer: Priority Health SBD |
$12.72
|
| Rate for Payer: Priority Health SBD |
$10.74
|
| Rate for Payer: Priority Health SBD |
$7.37
|
| Rate for Payer: Priority Health SBD |
$9.54
|
| Rate for Payer: Priority Health SBD |
$13.04
|
| Rate for Payer: Priority Health SBD |
$17.68
|
| Rate for Payer: Priority Health SBD |
$12.34
|
| Rate for Payer: Priority Health SBD |
$13.07
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$5.13
|
| Rate for Payer: Priority Health SBD |
$8.04
|
| Rate for Payer: Priority Health SBD |
$8.81
|
| Rate for Payer: Priority Health SBD |
$6.67
|
| Rate for Payer: Priority Health SBD |
$6.71
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$129.72
|
|
|
Service Code
|
NDC 00054329446
|
| Hospital Charge Code |
3292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.72 |
| Max. Negotiated Rate |
$116.75 |
| Rate for Payer: Aetna Commercial |
$110.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.32
|
| Rate for Payer: Cash Price |
$103.78
|
| Rate for Payer: Cofinity Advantage |
$90.80
|
| Rate for Payer: Cofinity Commercial |
$111.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.78
|
| Rate for Payer: Healthscope Commercial |
$116.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.29
|
| Rate for Payer: PHP Commercial |
$110.26
|
| Rate for Payer: Priority Health SBD |
$81.72
|
|
|
FUROSEMIDE 10 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$129.72
|
|
|
Service Code
|
NDC 00054329446
|
| Hospital Charge Code |
3292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.98 |
| Max. Negotiated Rate |
$116.75 |
| Rate for Payer: Aetna Commercial |
$110.26
|
| Rate for Payer: Aetna Medicare |
$64.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.32
|
| Rate for Payer: BCBS Complete |
$51.89
|
| Rate for Payer: Cash Price |
$103.78
|
| Rate for Payer: Cofinity Advantage |
$90.80
|
| Rate for Payer: Cofinity Commercial |
$111.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.78
|
| Rate for Payer: Healthscope Commercial |
$116.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.29
|
| Rate for Payer: PHP Commercial |
$110.26
|
| Rate for Payer: Priority Health SBD |
$81.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.32
|
| Rate for Payer: UHC Core |
$67.58
|
| Rate for Payer: UHC Exchange |
$50.98
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 51079007220
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.87 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health SBD |
$85.87
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 69315011601
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.46
|
| Rate for Payer: UHC Core |
$42.85
|
| Rate for Payer: UHC Exchange |
$32.32
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare |
$0.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.89
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cofinity Advantage |
$0.96
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$1.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.03
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health SBD |
$0.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.89
|
| Rate for Payer: UHC Core |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.54
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 00904717761
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.35 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 00904717761
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.49 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna Medicare |
$69.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Advantage |
$97.06
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.12
|
| Rate for Payer: UHC Core |
$72.24
|
| Rate for Payer: UHC Exchange |
$54.49
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 00054829725
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.44 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 00054429725
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.10 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.90
|
| Rate for Payer: UHC Core |
$62.44
|
| Rate for Payer: UHC Exchange |
$47.10
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 69315011601
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.82 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Advantage |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.69
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health SBD |
$51.82
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 51079007220
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.59
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Advantage |
$95.41
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.22
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.59
|
| Rate for Payer: UHC Core |
$71.01
|
| Rate for Payer: UHC Exchange |
$53.57
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 00054829725
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$184.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.82
|
| Rate for Payer: UHC Core |
$192.22
|
| Rate for Payer: UHC Exchange |
$145.00
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.89
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cofinity Advantage |
$0.96
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$1.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.03
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health SBD |
$0.86
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 00054429725
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.51 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Advantage |
$83.89
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.89
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health SBD |
$75.51
|
|
