|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$1,657.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$1,491.50 |
| Rate for Payer: Aetna Commercial |
$1,408.64
|
| Rate for Payer: Aetna Medicare |
$430.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$517.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$517.88
|
| Rate for Payer: BCBS Complete |
$4.34
|
| Rate for Payer: BCBS MAPPO |
$414.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,362.40
|
| Rate for Payer: BCN Commercial |
$1,288.49
|
| Rate for Payer: BCN Medicare Advantage |
$414.31
|
| Rate for Payer: Cash Price |
$1,325.78
|
| Rate for Payer: Cash Price |
$1,325.78
|
| Rate for Payer: Cofinity Commercial |
$1,425.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,325.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.31
|
| Rate for Payer: Healthscope Commercial |
$1,491.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,242.91
|
| Rate for Payer: Mclaren Medicaid |
$4.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.02
|
| Rate for Payer: Meridian Medicaid |
$4.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$476.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,408.64
|
| Rate for Payer: Nomi Health Commercial |
$1,358.92
|
| Rate for Payer: PACE Senior Care Partners |
$393.59
|
| Rate for Payer: PACE SWMI |
$414.31
|
| Rate for Payer: PHP Commercial |
$1,408.64
|
| Rate for Payer: PHP Medicare Advantage |
$414.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.19
|
| Rate for Payer: Priority Health HMO/PPO |
$1,441.78
|
| Rate for Payer: Priority Health Medicare |
$418.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.34
|
| Rate for Payer: Railroad Medicare Medicare |
$414.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,458.35
|
| Rate for Payer: UHC Core |
$1,383.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.31
|
| Rate for Payer: UHC Exchange |
$414.31
|
| Rate for Payer: UHC Medicare Advantage |
$414.31
|
| Rate for Payer: UHCCP Medicaid |
$4.13
|
| Rate for Payer: VA VA |
$414.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,242.91
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$19,247.29
|
|
|
Service Code
|
NDC 59148002050
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,571.23 |
| Max. Negotiated Rate |
$17,322.56 |
| Rate for Payer: Aetna Commercial |
$16,360.20
|
| Rate for Payer: Aetna Medicare |
$5,004.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,014.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,014.78
|
| Rate for Payer: BCBS Complete |
$7,698.92
|
| Rate for Payer: BCBS MAPPO |
$4,811.82
|
| Rate for Payer: BCBS Trust/PPO |
$15,823.20
|
| Rate for Payer: BCN Commercial |
$14,964.77
|
| Rate for Payer: BCN Medicare Advantage |
$4,811.82
|
| Rate for Payer: Cash Price |
$15,397.83
|
| Rate for Payer: Cofinity Commercial |
$16,552.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,397.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,811.82
|
| Rate for Payer: Healthscope Commercial |
$17,322.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,435.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,052.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,533.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,360.20
|
| Rate for Payer: Nomi Health Commercial |
$15,782.78
|
| Rate for Payer: PACE Senior Care Partners |
$4,571.23
|
| Rate for Payer: PACE SWMI |
$4,811.82
|
| Rate for Payer: PHP Commercial |
$16,360.20
|
| Rate for Payer: PHP Medicare Advantage |
$4,811.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,510.74
|
| Rate for Payer: Priority Health HMO/PPO |
$16,745.14
|
| Rate for Payer: Priority Health Medicare |
$4,859.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,895.68
|
| Rate for Payer: Railroad Medicare Medicare |
$4,811.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,937.62
|
| Rate for Payer: UHC Core |
$16,071.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,811.82
|
| Rate for Payer: UHC Exchange |
$4,811.82
|
| Rate for Payer: UHC Medicare Advantage |
$4,811.82
|
| Rate for Payer: VA VA |
$4,811.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,435.47
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$19,247.29
|
|
|
Service Code
|
NDC 59148002050
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12,510.74 |
| Max. Negotiated Rate |
$17,322.56 |
| Rate for Payer: Aetna Commercial |
$16,360.20
|
| Rate for Payer: BCBS Trust/PPO |
$15,711.56
|
| Rate for Payer: BCN Commercial |
$14,874.31
|
| Rate for Payer: Cash Price |
$15,397.83
|
| Rate for Payer: Cofinity Commercial |
$16,552.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,397.83
|
| Rate for Payer: Healthscope Commercial |
$17,322.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14,435.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,360.20
|
| Rate for Payer: Nomi Health Commercial |
$15,782.78
|
| Rate for Payer: PHP Commercial |
$16,360.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12,510.74
|
| Rate for Payer: Priority Health HMO/PPO |
$16,745.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12,895.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,937.62
|
| Rate for Payer: UHC Core |
$16,071.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14,435.47
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$2,012.99
|
|
|
Service Code
|
NDC 67877063533
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$478.09 |
| Max. Negotiated Rate |
$1,811.69 |
| Rate for Payer: Aetna Commercial |
$1,711.04
|
| Rate for Payer: Aetna Medicare |
$523.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$629.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$629.06
|
| Rate for Payer: BCBS Complete |
$805.20
|
| Rate for Payer: BCBS MAPPO |
$503.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,654.88
|
| Rate for Payer: BCN Commercial |
$1,565.10
|
| Rate for Payer: BCN Medicare Advantage |
$503.25
|
| Rate for Payer: Cash Price |
$1,610.39
|
| Rate for Payer: Cofinity Commercial |
$1,731.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,610.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$503.25
|
| Rate for Payer: Healthscope Commercial |
$1,811.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,509.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$528.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$578.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,711.04
|
| Rate for Payer: Nomi Health Commercial |
$1,650.65
|
| Rate for Payer: PACE Senior Care Partners |
$478.09
|
| Rate for Payer: PACE SWMI |
$503.25
|
| Rate for Payer: PHP Commercial |
$1,711.04
|
| Rate for Payer: PHP Medicare Advantage |
$503.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,308.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,751.30
|
| Rate for Payer: Priority Health Medicare |
$508.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,348.70
|
| Rate for Payer: Railroad Medicare Medicare |
$503.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,771.43
|
| Rate for Payer: UHC Core |
$1,680.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$503.25
|
| Rate for Payer: UHC Exchange |
$503.25
|
| Rate for Payer: UHC Medicare Advantage |
$503.25
|
| Rate for Payer: VA VA |
$503.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,509.74
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$2,012.99
|
|
|
Service Code
|
NDC 67877063533
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,308.44 |
| Max. Negotiated Rate |
$1,811.69 |
| Rate for Payer: Aetna Commercial |
$1,711.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.20
|
| Rate for Payer: BCN Commercial |
$1,555.64
|
| Rate for Payer: Cash Price |
$1,610.39
|
| Rate for Payer: Cofinity Commercial |
$1,731.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,610.39
|
| Rate for Payer: Healthscope Commercial |
$1,811.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,509.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,711.04
|
| Rate for Payer: Nomi Health Commercial |
$1,650.65
|
| Rate for Payer: PHP Commercial |
$1,711.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,308.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1,751.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,348.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,771.43
|
| Rate for Payer: UHC Core |
$1,680.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,509.74
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$99.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.64
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: BCBS MAPPO |
$95.71
|
| Rate for Payer: BCBS Trust/PPO |
$314.74
|
| Rate for Payer: BCN Commercial |
$297.67
|
| Rate for Payer: BCN Medicare Advantage |
$95.71
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.71
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PACE Senior Care Partners |
$90.93
|
| Rate for Payer: PACE SWMI |
$95.71
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: PHP Medicare Advantage |
$95.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Medicare |
$96.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: Railroad Medicare Medicare |
$95.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.71
|
| Rate for Payer: UHC Exchange |
$95.71
|
| Rate for Payer: UHC Medicare Advantage |
$95.71
|
| Rate for Payer: VA VA |
$95.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 68084034411
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.85 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: BCBS Trust/PPO |
$312.52
|
| Rate for Payer: BCN Commercial |
$295.87
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.85 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: BCBS Trust/PPO |
$312.52
|
| Rate for Payer: BCN Commercial |
$295.87
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 68084034411
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$99.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$119.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$119.64
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: BCBS MAPPO |
$95.71
|
| Rate for Payer: BCBS Trust/PPO |
$314.74
|
| Rate for Payer: BCN Commercial |
$297.67
|
| Rate for Payer: BCN Medicare Advantage |
$95.71
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.71
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: Nomi Health Commercial |
$313.94
|
| Rate for Payer: PACE Senior Care Partners |
$90.93
|
| Rate for Payer: PACE SWMI |
$95.71
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: PHP Medicare Advantage |
$95.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health HMO/PPO |
$333.08
|
| Rate for Payer: Priority Health Medicare |
$96.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.51
|
| Rate for Payer: Railroad Medicare Medicare |
$95.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.91
|
| Rate for Payer: UHC Core |
$319.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.71
|
| Rate for Payer: UHC Exchange |
$95.71
|
| Rate for Payer: UHC Medicare Advantage |
$95.71
|
| Rate for Payer: VA VA |
$95.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$101.52
|
|
|
Service Code
|
NDC 68382014014
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: Aetna Medicare |
$26.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.73
|
| Rate for Payer: BCBS Complete |
$40.61
|
| Rate for Payer: BCBS MAPPO |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$83.46
|
| Rate for Payer: BCN Commercial |
$78.93
|
| Rate for Payer: BCN Medicare Advantage |
$25.38
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.38
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Nomi Health Commercial |
$83.25
|
| Rate for Payer: PACE Senior Care Partners |
$24.11
|
| Rate for Payer: PACE SWMI |
$25.38
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: PHP Medicare Advantage |
$25.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health HMO/PPO |
$88.32
|
| Rate for Payer: Priority Health Medicare |
$25.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.02
|
| Rate for Payer: Railroad Medicare Medicare |
$25.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.34
|
| Rate for Payer: UHC Core |
$84.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.38
|
| Rate for Payer: UHC Exchange |
$25.38
|
| Rate for Payer: UHC Medicare Advantage |
$25.38
|
| Rate for Payer: VA VA |
$25.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$101.52
|
|
|
Service Code
|
NDC 68382014014
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.99 |
| Max. Negotiated Rate |
$91.37 |
| Rate for Payer: Aetna Commercial |
$86.29
|
| Rate for Payer: BCBS Trust/PPO |
$82.87
|
| Rate for Payer: BCN Commercial |
$78.45
|
| Rate for Payer: Cash Price |
$81.22
|
| Rate for Payer: Cofinity Commercial |
$87.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.22
|
| Rate for Payer: Healthscope Commercial |
$91.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.29
|
| Rate for Payer: Nomi Health Commercial |
$83.25
|
| Rate for Payer: PHP Commercial |
$86.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.99
|
| Rate for Payer: Priority Health HMO/PPO |
$88.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.34
|
| Rate for Payer: UHC Core |
$84.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.14
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 00904692961
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.30 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: BCBS Trust/PPO |
$279.17
|
| Rate for Payer: BCN Commercial |
$264.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Nomi Health Commercial |
$280.44
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.96
|
| Rate for Payer: UHC Core |
$285.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
NDC 00904692961
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.22 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Medicare |
$88.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$106.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$106.88
|
| Rate for Payer: BCBS Complete |
$136.80
|
| Rate for Payer: BCBS MAPPO |
$85.50
|
| Rate for Payer: BCBS Trust/PPO |
$281.16
|
| Rate for Payer: BCN Commercial |
$265.90
|
| Rate for Payer: BCN Medicare Advantage |
$85.50
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.50
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Nomi Health Commercial |
$280.44
|
| Rate for Payer: PACE Senior Care Partners |
$81.22
|
| Rate for Payer: PACE SWMI |
$85.50
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: PHP Medicare Advantage |
$85.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health HMO/PPO |
$297.54
|
| Rate for Payer: Priority Health Medicare |
$86.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.14
|
| Rate for Payer: Railroad Medicare Medicare |
$85.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.96
|
| Rate for Payer: UHC Core |
$285.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.50
|
| Rate for Payer: UHC Exchange |
$85.50
|
| Rate for Payer: UHC Medicare Advantage |
$85.50
|
| Rate for Payer: VA VA |
$85.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$56.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.39
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: BCBS MAPPO |
$53.91
|
| Rate for Payer: BCBS Trust/PPO |
$177.29
|
| Rate for Payer: BCN Commercial |
$167.67
|
| Rate for Payer: BCN Medicare Advantage |
$53.91
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.91
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: PACE Senior Care Partners |
$51.22
|
| Rate for Payer: PACE SWMI |
$53.91
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: PHP Medicare Advantage |
$53.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Medicare |
$54.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| Rate for Payer: Railroad Medicare Medicare |
$53.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.91
|
| Rate for Payer: UHC Exchange |
$53.91
|
| Rate for Payer: UHC Medicare Advantage |
$53.91
|
| Rate for Payer: VA VA |
$53.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$176.04
|
| Rate for Payer: BCN Commercial |
$166.65
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: BCBS Trust/PPO |
$159.75
|
| Rate for Payer: BCN Commercial |
$151.24
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health HMO/PPO |
$170.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.22
|
| Rate for Payer: UHC Core |
$163.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.22 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$56.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.39
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: BCBS MAPPO |
$53.91
|
| Rate for Payer: BCBS Trust/PPO |
$177.29
|
| Rate for Payer: BCN Commercial |
$167.67
|
| Rate for Payer: BCN Medicare Advantage |
$53.91
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.91
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: PACE Senior Care Partners |
$51.22
|
| Rate for Payer: PACE SWMI |
$53.91
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: PHP Medicare Advantage |
$53.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Medicare |
$54.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| Rate for Payer: Railroad Medicare Medicare |
$53.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.91
|
| Rate for Payer: UHC Exchange |
$53.91
|
| Rate for Payer: UHC Medicare Advantage |
$53.91
|
| Rate for Payer: VA VA |
$53.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$176.04
|
| Rate for Payer: BCN Commercial |
$166.65
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$50.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.16
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS MAPPO |
$48.92
|
| Rate for Payer: BCBS Trust/PPO |
$160.88
|
| Rate for Payer: BCN Commercial |
$152.16
|
| Rate for Payer: BCN Medicare Advantage |
$48.92
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.92
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: PACE Senior Care Partners |
$46.48
|
| Rate for Payer: PACE SWMI |
$48.92
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: PHP Medicare Advantage |
$48.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health HMO/PPO |
$170.26
|
| Rate for Payer: Priority Health Medicare |
$49.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.12
|
| Rate for Payer: Railroad Medicare Medicare |
$48.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.22
|
| Rate for Payer: UHC Core |
$163.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.92
|
| Rate for Payer: UHC Exchange |
$48.92
|
| Rate for Payer: UHC Medicare Advantage |
$48.92
|
| Rate for Payer: VA VA |
$48.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$130.63
|
|
|
Service Code
|
NDC 00904728306
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.91 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$111.04
|
| Rate for Payer: BCBS Trust/PPO |
$106.63
|
| Rate for Payer: BCN Commercial |
$100.95
|
| 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: PHP Commercial |
$111.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.91
|
| Rate for Payer: Priority Health HMO/PPO |
$113.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.52
|
| 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 20 MG TABLET
|
Facility
|
OP
|
$130.63
|
|
|
Service Code
|
NDC 00904728306
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| 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 |
$52.25
|
| Rate for Payer: BCBS MAPPO |
$32.66
|
| Rate for Payer: BCBS Trust/PPO |
$107.39
|
| Rate for Payer: BCN Commercial |
$101.56
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.04
|
| Rate for Payer: Nomi Health Commercial |
$107.12
|
| 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 Cigna Priority Health |
$84.91
|
| Rate for Payer: Priority Health HMO/PPO |
$113.65
|
| Rate for Payer: Priority Health Medicare |
$32.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.52
|
| 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 Dual Complete DSNP |
$32.66
|
| Rate for Payer: UHC Exchange |
$32.66
|
| Rate for Payer: UHC Medicare Advantage |
$32.66
|
| Rate for Payer: VA VA |
$32.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.97
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.07 |
| 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 |
$57.38
|
| Rate for Payer: BCBS MAPPO |
$35.86
|
| Rate for Payer: BCBS Trust/PPO |
$117.93
|
| Rate for Payer: BCN Commercial |
$111.53
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Nomi Health Commercial |
$117.63
|
| 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 Cigna Priority Health |
$93.24
|
| Rate for Payer: Priority Health HMO/PPO |
$124.80
|
| Rate for Payer: Priority Health Medicare |
$36.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.11
|
| 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 Dual Complete DSNP |
$35.86
|
| Rate for Payer: UHC Exchange |
$35.86
|
| Rate for Payer: UHC Medicare Advantage |
$35.86
|
| Rate for Payer: VA VA |
$35.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.59
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.21 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: BCBS Trust/PPO |
$228.83
|
| Rate for Payer: BCN Commercial |
$216.63
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Nomi Health Commercial |
$229.86
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.21
|
| Rate for Payer: Priority Health HMO/PPO |
$243.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.68
|
| Rate for Payer: UHC Core |
$234.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$280.32
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.58 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna Medicare |
$72.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.60
|
| Rate for Payer: BCBS Complete |
$112.13
|
| Rate for Payer: BCBS MAPPO |
$70.08
|
| Rate for Payer: BCBS Trust/PPO |
$230.45
|
| Rate for Payer: BCN Commercial |
$217.95
|
| Rate for Payer: BCN Medicare Advantage |
$70.08
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.08
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Nomi Health Commercial |
$229.86
|
| Rate for Payer: PACE Senior Care Partners |
$66.58
|
| Rate for Payer: PACE SWMI |
$70.08
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: PHP Medicare Advantage |
$70.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.21
|
| Rate for Payer: Priority Health HMO/PPO |
$243.88
|
| Rate for Payer: Priority Health Medicare |
$70.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.81
|
| Rate for Payer: Railroad Medicare Medicare |
$70.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.68
|
| Rate for Payer: UHC Core |
$234.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.08
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicare Advantage |
$70.08
|
| Rate for Payer: VA VA |
$70.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna Commercial |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.22
|
| 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: PHP Commercial |
$2.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health HMO/PPO |
$2.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.92
|
| 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
|
|
