|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 31722053101
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$325.48 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: BCBS Trust/PPO |
$386.23
|
| Rate for Payer: BCN Commercial |
$386.23
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.53
|
| Rate for Payer: UHC Core |
$390.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.90
|
| Rate for Payer: BCBS Complete |
$0.53
|
| Rate for Payer: BCBS MAPPO |
$0.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Medicare Advantage |
$0.72
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.72
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Mclaren Medicaid |
$0.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PACE Senior Care Partners |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.72
|
| Rate for Payer: PHP Commercial |
$2.44
|
| Rate for Payer: PHP Medicare Advantage |
$0.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.50
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.00
|
| Rate for Payer: Railroad Medicare Medicare |
$0.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.53
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: UHC Exchange |
$0.72
|
| Rate for Payer: UHC Medicaid |
$0.51
|
| Rate for Payer: UHC Medicare Advantage |
$0.72
|
| Rate for Payer: UHCCP Medicaid |
$0.51
|
| Rate for Payer: VA VA |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.29 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Aetna Commercial |
$121.93
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.83
|
| Rate for Payer: BCBS Complete |
$26.55
|
| Rate for Payer: BCBS MAPPO |
$35.86
|
| Rate for Payer: BCBS Trust/PPO |
$117.93
|
| Rate for Payer: BCN Commercial |
$117.93
|
| Rate for Payer: BCN Medicare Advantage |
$35.86
|
| Rate for Payer: Cash Price |
$114.76
|
| Rate for Payer: Cofinity Commercial |
$123.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.86
|
| Rate for Payer: Healthscope Commercial |
$129.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.59
|
| Rate for Payer: Mclaren Medicaid |
$25.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.66
|
| Rate for Payer: Meridian Medicaid |
$26.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Nomi Health Commercial |
$117.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.59
|
| Rate for Payer: PACE Senior Care Partners |
$34.07
|
| Rate for Payer: PACE SWMI |
$35.86
|
| Rate for Payer: PHP Commercial |
$121.93
|
| Rate for Payer: PHP Medicare Advantage |
$35.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.80
|
| Rate for Payer: Priority Health Medicare |
$36.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.84
|
| Rate for Payer: Railroad Medicare Medicare |
$35.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.24
|
| Rate for Payer: UHC Core |
$119.78
|
| Rate for Payer: UHC Exchange |
$35.86
|
| Rate for Payer: UHC Medicaid |
$25.29
|
| Rate for Payer: UHC Medicare Advantage |
$35.86
|
| Rate for Payer: UHCCP Medicaid |
$25.29
|
| Rate for Payer: VA VA |
$35.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.59
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 31722053101
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$121.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.14
|
| Rate for Payer: BCBS Complete |
$86.56
|
| Rate for Payer: BCBS MAPPO |
$116.91
|
| Rate for Payer: BCBS Trust/PPO |
$384.46
|
| Rate for Payer: BCN Commercial |
$384.46
|
| Rate for Payer: BCN Medicare Advantage |
$116.91
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.91
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Mclaren Medicaid |
$82.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.76
|
| Rate for Payer: Meridian Medicaid |
$86.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$128.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PACE Senior Care Partners |
$111.07
|
| Rate for Payer: PACE SWMI |
$116.91
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: PHP Medicare Advantage |
$116.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Medicare |
$118.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$325.48
|
| Rate for Payer: Railroad Medicare Medicare |
$116.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.53
|
| Rate for Payer: UHC Core |
$390.49
|
| Rate for Payer: UHC Exchange |
$116.91
|
| Rate for Payer: UHC Medicaid |
$82.45
|
| Rate for Payer: UHC Medicare Advantage |
$116.91
|
| Rate for Payer: UHCCP Medicaid |
$82.45
|
| Rate for Payer: VA VA |
$116.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$274.56
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$247.10 |
| Rate for Payer: Aetna Commercial |
$233.38
|
| Rate for Payer: Aetna Medicare |
$71.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$85.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$85.80
|
| Rate for Payer: BCBS Complete |
$50.82
|
| Rate for Payer: BCBS MAPPO |
$68.64
|
| Rate for Payer: BCBS Trust/PPO |
$225.72
|
| Rate for Payer: BCN Commercial |
$225.72
|
| Rate for Payer: BCN Medicare Advantage |
$68.64
|
| Rate for Payer: Cash Price |
$219.65
|
| Rate for Payer: Cofinity Commercial |
$236.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$219.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.64
|
| Rate for Payer: Healthscope Commercial |
$247.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.92
|
| Rate for Payer: Mclaren Medicaid |
$48.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.07
|
| Rate for Payer: Meridian Medicaid |
$50.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$78.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$75.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.38
|
| Rate for Payer: Nomi Health Commercial |
$225.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.92
|
| Rate for Payer: PACE Senior Care Partners |
$65.21
|
| Rate for Payer: PACE SWMI |
$68.64
|
| Rate for Payer: PHP Commercial |
$233.38
|
| Rate for Payer: PHP Medicare Advantage |
$68.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.87
|
| Rate for Payer: Priority Health Medicare |
$69.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.09
|
| Rate for Payer: Railroad Medicare Medicare |
$68.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.61
|
| Rate for Payer: UHC Core |
$229.26
|
| Rate for Payer: UHC Exchange |
$68.64
|
| Rate for Payer: UHC Medicaid |
$48.40
|
| Rate for Payer: UHC Medicare Advantage |
$68.64
|
| Rate for Payer: UHCCP Medicaid |
$48.40
|
| Rate for Payer: VA VA |
$68.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.92
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$130.63
|
|
|
Service Code
|
NDC 00904728306
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: Aetna Medicare |
$33.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.82
|
| Rate for Payer: BCBS Complete |
$24.18
|
| Rate for Payer: BCBS MAPPO |
$32.66
|
| Rate for Payer: BCBS Trust/PPO |
$107.39
|
| Rate for Payer: BCN Commercial |
$107.39
|
| Rate for Payer: BCN Medicare Advantage |
$32.66
|
| Rate for Payer: Cash Price |
$104.50
|
| Rate for Payer: Cofinity Commercial |
$112.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.66
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.97
|
| Rate for Payer: Mclaren Medicaid |
$23.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.29
|
| Rate for Payer: Meridian Medicaid |
$24.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.04
|
| Rate for Payer: Nomi Health Commercial |
$107.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.97
|
| Rate for Payer: PACE Senior Care Partners |
$31.02
|
| Rate for Payer: PACE SWMI |
$32.66
|
| Rate for Payer: PHP Commercial |
$111.04
|
| Rate for Payer: PHP Medicare Advantage |
$32.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.65
|
| Rate for Payer: Priority Health Medicare |
$32.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.92
|
| Rate for Payer: Railroad Medicare Medicare |
$32.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.95
|
| Rate for Payer: UHC Core |
$109.08
|
| Rate for Payer: UHC Exchange |
$32.66
|
| Rate for Payer: UHC Medicaid |
$23.03
|
| Rate for Payer: UHC Medicare Advantage |
$32.66
|
| Rate for Payer: UHCCP Medicaid |
$23.03
|
| Rate for Payer: VA VA |
$32.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.97
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Aetna Commercial |
$121.93
|
| Rate for Payer: BCBS Trust/PPO |
$118.48
|
| Rate for Payer: BCN Commercial |
$118.48
|
| Rate for Payer: Cash Price |
$114.76
|
| 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: Lakeland Regional Health Systems Commercial |
$107.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Nomi Health Commercial |
$117.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.59
|
| Rate for Payer: PHP Commercial |
$121.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$124.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.24
|
| Rate for Payer: UHC Core |
$119.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.59
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$274.56
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.09 |
| Max. Negotiated Rate |
$247.10 |
| Rate for Payer: Aetna Commercial |
$233.38
|
| Rate for Payer: BCBS Trust/PPO |
$226.76
|
| Rate for Payer: BCN Commercial |
$226.76
|
| Rate for Payer: Cash Price |
$219.65
|
| 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: Lakeland Regional Health Systems Commercial |
$205.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.38
|
| Rate for Payer: Nomi Health Commercial |
$225.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.92
|
| Rate for Payer: PHP Commercial |
$233.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$238.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.61
|
| Rate for Payer: UHC Core |
$229.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.92
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.30
|
| 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: Lakeland Regional Health Systems Commercial |
$2.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: PHP Commercial |
$2.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.53
|
| Rate for Payer: UHC Core |
$2.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$130.63
|
|
|
Service Code
|
NDC 00904728306
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.92 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: BCBS Trust/PPO |
$107.89
|
| Rate for Payer: BCN Commercial |
$107.89
|
| Rate for Payer: Cash Price |
$104.50
|
| 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: Lakeland Regional Health Systems Commercial |
$97.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.04
|
| Rate for Payer: Nomi Health Commercial |
$107.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$97.97
|
| Rate for Payer: PHP Commercial |
$111.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.95
|
| Rate for Payer: UHC Core |
$109.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.97
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 31722052901
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$79.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.47
|
| Rate for Payer: BCBS Complete |
$56.55
|
| Rate for Payer: BCBS MAPPO |
$76.38
|
| Rate for Payer: BCBS Trust/PPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$251.15
|
| Rate for Payer: BCN Medicare Advantage |
$76.38
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.38
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Mclaren Medicaid |
$53.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.19
|
| Rate for Payer: Meridian Medicaid |
$56.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PACE Senior Care Partners |
$72.56
|
| Rate for Payer: PACE SWMI |
$76.38
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: PHP Medicare Advantage |
$76.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.63
|
| Rate for Payer: Railroad Medicare Medicare |
$76.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Medicaid |
$53.86
|
| Rate for Payer: UHC Medicare Advantage |
$76.38
|
| Rate for Payer: UHCCP Medicaid |
$53.86
|
| Rate for Payer: VA VA |
$76.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 31722052901
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.63 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: BCBS Trust/PPO |
$252.31
|
| Rate for Payer: BCN Commercial |
$252.31
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.12
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$265.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.84
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$11,438.07
|
|
|
Service Code
|
APR-DRG 8164
|
| Min. Negotiated Rate |
$10,893.40 |
| Max. Negotiated Rate |
$11,438.07 |
| Rate for Payer: BCBS Complete |
$11,438.07
|
| Rate for Payer: Mclaren Medicaid |
$10,893.40
|
| Rate for Payer: Meridian Medicaid |
$11,438.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,893.40
|
| Rate for Payer: UHC Medicaid |
$10,893.40
|
| Rate for Payer: UHCCP Medicaid |
$10,893.40
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$1,893.02
|
|
|
Service Code
|
APR-DRG 8161
|
| Min. Negotiated Rate |
$1,802.88 |
| Max. Negotiated Rate |
$1,893.02 |
| Rate for Payer: BCBS Complete |
$1,893.02
|
| Rate for Payer: Mclaren Medicaid |
$1,802.88
|
| Rate for Payer: Meridian Medicaid |
$1,893.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,802.88
|
| Rate for Payer: UHC Medicaid |
$1,802.88
|
| Rate for Payer: UHCCP Medicaid |
$1,802.88
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$3,048.82
|
|
|
Service Code
|
APR-DRG 8162
|
| Min. Negotiated Rate |
$2,903.64 |
| Max. Negotiated Rate |
$3,048.82 |
| Rate for Payer: BCBS Complete |
$3,048.82
|
| Rate for Payer: Mclaren Medicaid |
$2,903.64
|
| Rate for Payer: Meridian Medicaid |
$3,048.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,903.64
|
| Rate for Payer: UHC Medicaid |
$2,903.64
|
| Rate for Payer: UHCCP Medicaid |
$2,903.64
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$6,697.62
|
|
|
Service Code
|
APR-DRG 8163
|
| Min. Negotiated Rate |
$6,378.69 |
| Max. Negotiated Rate |
$6,697.62 |
| Rate for Payer: BCBS Complete |
$6,697.62
|
| Rate for Payer: Mclaren Medicaid |
$6,378.69
|
| Rate for Payer: Meridian Medicaid |
$6,697.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,378.69
|
| Rate for Payer: UHC Medicaid |
$6,378.69
|
| Rate for Payer: UHCCP Medicaid |
$6,378.69
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$104.62
|
|
|
Service Code
|
NDC 00517930501
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Aetna Medicare |
$27.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.69
|
| Rate for Payer: BCBS Complete |
$19.37
|
| Rate for Payer: BCBS MAPPO |
$26.16
|
| Rate for Payer: BCBS Trust/PPO |
$86.01
|
| Rate for Payer: BCN Commercial |
$86.01
|
| Rate for Payer: BCN Medicare Advantage |
$26.16
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: Mclaren Medicaid |
$18.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.46
|
| Rate for Payer: Meridian Medicaid |
$19.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.47
|
| Rate for Payer: PACE Senior Care Partners |
$24.85
|
| Rate for Payer: PACE SWMI |
$26.16
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: PHP Medicare Advantage |
$26.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.02
|
| Rate for Payer: Priority Health Medicare |
$26.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.82
|
| Rate for Payer: Railroad Medicare Medicare |
$26.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.07
|
| Rate for Payer: UHC Core |
$87.36
|
| Rate for Payer: UHC Exchange |
$26.16
|
| Rate for Payer: UHC Medicaid |
$18.44
|
| Rate for Payer: UHC Medicare Advantage |
$26.16
|
| Rate for Payer: UHCCP Medicaid |
$18.44
|
| Rate for Payer: VA VA |
$26.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$104.62
|
|
|
Service Code
|
NDC 00517930501
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.82 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: BCBS Trust/PPO |
$86.41
|
| Rate for Payer: BCN Commercial |
$86.41
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.47
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.07
|
| Rate for Payer: UHC Core |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$104.62
|
|
|
Service Code
|
NDC 00517930525
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: Aetna Medicare |
$27.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.69
|
| Rate for Payer: BCBS Complete |
$19.37
|
| Rate for Payer: BCBS MAPPO |
$26.16
|
| Rate for Payer: BCBS Trust/PPO |
$86.01
|
| Rate for Payer: BCN Commercial |
$86.01
|
| Rate for Payer: BCN Medicare Advantage |
$26.16
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.16
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: Mclaren Medicaid |
$18.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.46
|
| Rate for Payer: Meridian Medicaid |
$19.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.47
|
| Rate for Payer: PACE Senior Care Partners |
$24.85
|
| Rate for Payer: PACE SWMI |
$26.16
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: PHP Medicare Advantage |
$26.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.02
|
| Rate for Payer: Priority Health Medicare |
$26.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.82
|
| Rate for Payer: Railroad Medicare Medicare |
$26.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.07
|
| Rate for Payer: UHC Core |
$87.36
|
| Rate for Payer: UHC Exchange |
$26.16
|
| Rate for Payer: UHC Medicaid |
$18.44
|
| Rate for Payer: UHC Medicare Advantage |
$26.16
|
| Rate for Payer: UHCCP Medicaid |
$18.44
|
| Rate for Payer: VA VA |
$26.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$104.62
|
|
|
Service Code
|
NDC 00517930525
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.82 |
| Max. Negotiated Rate |
$94.16 |
| Rate for Payer: Aetna Commercial |
$88.93
|
| Rate for Payer: BCBS Trust/PPO |
$86.41
|
| Rate for Payer: BCN Commercial |
$86.41
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cofinity Commercial |
$89.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.70
|
| Rate for Payer: Healthscope Commercial |
$94.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$78.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.93
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.47
|
| Rate for Payer: PHP Commercial |
$88.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$91.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.07
|
| Rate for Payer: UHC Core |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$78.47
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$37,999.83
|
|
|
Service Code
|
APR-DRG 0042
|
| Min. Negotiated Rate |
$36,190.31 |
| Max. Negotiated Rate |
$37,999.83 |
| Rate for Payer: BCBS Complete |
$37,999.83
|
| Rate for Payer: Mclaren Medicaid |
$36,190.31
|
| Rate for Payer: Meridian Medicaid |
$37,999.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$36,190.31
|
| Rate for Payer: UHC Medicaid |
$36,190.31
|
| Rate for Payer: UHCCP Medicaid |
$36,190.31
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$60,568.35
|
|
|
Service Code
|
APR-DRG 0043
|
| Min. Negotiated Rate |
$57,684.15 |
| Max. Negotiated Rate |
$60,568.35 |
| Rate for Payer: BCBS Complete |
$60,568.35
|
| Rate for Payer: Mclaren Medicaid |
$57,684.15
|
| Rate for Payer: Meridian Medicaid |
$60,568.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$57,684.15
|
| Rate for Payer: UHC Medicaid |
$57,684.15
|
| Rate for Payer: UHCCP Medicaid |
$57,684.15
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$97,814.13
|
|
|
Service Code
|
APR-DRG 0044
|
| Min. Negotiated Rate |
$93,156.31 |
| Max. Negotiated Rate |
$97,814.13 |
| Rate for Payer: BCBS Complete |
$97,814.13
|
| Rate for Payer: Mclaren Medicaid |
$93,156.31
|
| Rate for Payer: Meridian Medicaid |
$97,814.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$93,156.31
|
| Rate for Payer: UHC Medicaid |
$93,156.31
|
| Rate for Payer: UHCCP Medicaid |
$93,156.31
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$25,475.37
|
|
|
Service Code
|
APR-DRG 0041
|
| Min. Negotiated Rate |
$24,262.26 |
| Max. Negotiated Rate |
$25,475.37 |
| Rate for Payer: BCBS Complete |
$25,475.37
|
| Rate for Payer: Mclaren Medicaid |
$24,262.26
|
| Rate for Payer: Meridian Medicaid |
$25,475.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,262.26
|
| Rate for Payer: UHC Medicaid |
$24,262.26
|
| Rate for Payer: UHCCP Medicaid |
$24,262.26
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$22,323.49
|
|
|
Service Code
|
APR-DRG 0052
|
| Min. Negotiated Rate |
$21,260.46 |
| Max. Negotiated Rate |
$22,323.49 |
| Rate for Payer: BCBS Complete |
$22,323.49
|
| Rate for Payer: Mclaren Medicaid |
$21,260.46
|
| Rate for Payer: Meridian Medicaid |
$22,323.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$21,260.46
|
| Rate for Payer: UHC Medicaid |
$21,260.46
|
| Rate for Payer: UHCCP Medicaid |
$21,260.46
|
|
