|
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
|
|
|
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 |
$194.08 |
| 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 |
$194.08
|
| 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
|
$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
|
|
|
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
|
$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
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$129.10 |
| Rate for Payer: Aetna Commercial |
$121.93
|
| Rate for Payer: BCBS Trust/PPO |
$117.10
|
| Rate for Payer: BCN Commercial |
$110.86
|
| 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: 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: PHP Commercial |
$121.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.24
|
| Rate for Payer: Priority Health HMO/PPO |
$124.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.11
|
| 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
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| 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 |
$1.15
|
| Rate for Payer: BCBS MAPPO |
$0.72
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.23
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| 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 Cigna Priority Health |
$1.87
|
| Rate for Payer: Priority Health HMO/PPO |
$2.50
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.92
|
| 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 Dual Complete DSNP |
$0.72
|
| Rate for Payer: UHC Exchange |
$0.72
|
| Rate for Payer: UHC Medicare Advantage |
$0.72
|
| Rate for Payer: VA VA |
$0.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.15
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 31722053101
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.97 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: BCBS Trust/PPO |
$381.74
|
| Rate for Payer: BCN Commercial |
$361.40
|
| 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: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.97
|
| Rate for Payer: Priority Health HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.33
|
| 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
|
$467.65
|
|
|
Service Code
|
NDC 31722053101
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.07 |
| 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 |
$187.06
|
| Rate for Payer: BCBS MAPPO |
$116.91
|
| Rate for Payer: BCBS Trust/PPO |
$384.46
|
| Rate for Payer: BCN Commercial |
$363.60
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Nomi Health Commercial |
$383.47
|
| 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 Cigna Priority Health |
$303.97
|
| Rate for Payer: Priority Health HMO/PPO |
$406.86
|
| Rate for Payer: Priority Health Medicare |
$118.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.33
|
| 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 Dual Complete DSNP |
$116.91
|
| Rate for Payer: UHC Exchange |
$116.91
|
| Rate for Payer: UHC Medicare Advantage |
$116.91
|
| Rate for Payer: VA VA |
$116.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
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
|
|
|
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
|
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
|
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 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 31722052901
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.56 |
| 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 |
$122.20
|
| Rate for Payer: BCBS MAPPO |
$76.38
|
| Rate for Payer: BCBS Trust/PPO |
$251.15
|
| Rate for Payer: BCN Commercial |
$237.53
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: Nomi Health Commercial |
$250.51
|
| 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 Cigna Priority Health |
$198.58
|
| Rate for Payer: Priority Health HMO/PPO |
$265.78
|
| Rate for Payer: Priority Health Medicare |
$77.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.68
|
| 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 Dual Complete DSNP |
$76.38
|
| Rate for Payer: UHC Exchange |
$76.38
|
| Rate for Payer: UHC Medicare Advantage |
$76.38
|
| 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 |
$198.58 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: BCBS Trust/PPO |
$249.38
|
| Rate for Payer: BCN Commercial |
$236.09
|
| 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: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.58
|
| Rate for Payer: Priority Health HMO/PPO |
$265.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.68
|
| 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
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$96.02
|
|
|
Service Code
|
NDC 00517930501
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$86.42 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Aetna Medicare |
$24.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.01
|
| Rate for Payer: BCBS Complete |
$38.41
|
| Rate for Payer: BCBS MAPPO |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.94
|
| Rate for Payer: BCN Commercial |
$74.66
|
| Rate for Payer: BCN Medicare Advantage |
$24.00
|
| Rate for Payer: Cash Price |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$82.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$86.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.62
|
| Rate for Payer: Nomi Health Commercial |
$78.74
|
| Rate for Payer: PACE Senior Care Partners |
$22.80
|
| Rate for Payer: PACE SWMI |
$24.00
|
| Rate for Payer: PHP Commercial |
$81.62
|
| Rate for Payer: PHP Medicare Advantage |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.41
|
| Rate for Payer: Priority Health HMO/PPO |
$83.54
|
| Rate for Payer: Priority Health Medicare |
$24.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.33
|
| Rate for Payer: Railroad Medicare Medicare |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.50
|
| Rate for Payer: UHC Core |
$80.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.00
|
| Rate for Payer: UHC Exchange |
$24.00
|
| Rate for Payer: UHC Medicare Advantage |
$24.00
|
| Rate for Payer: VA VA |
$24.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.02
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
OP
|
$96.02
|
|
|
Service Code
|
NDC 00517930525
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$86.42 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: Aetna Medicare |
$24.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30.01
|
| Rate for Payer: BCBS Complete |
$38.41
|
| Rate for Payer: BCBS MAPPO |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.94
|
| Rate for Payer: BCN Commercial |
$74.66
|
| Rate for Payer: BCN Medicare Advantage |
$24.00
|
| Rate for Payer: Cash Price |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$82.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.00
|
| Rate for Payer: Healthscope Commercial |
$86.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.62
|
| Rate for Payer: Nomi Health Commercial |
$78.74
|
| Rate for Payer: PACE Senior Care Partners |
$22.80
|
| Rate for Payer: PACE SWMI |
$24.00
|
| Rate for Payer: PHP Commercial |
$81.62
|
| Rate for Payer: PHP Medicare Advantage |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.41
|
| Rate for Payer: Priority Health HMO/PPO |
$83.54
|
| Rate for Payer: Priority Health Medicare |
$24.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.33
|
| Rate for Payer: Railroad Medicare Medicare |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.50
|
| Rate for Payer: UHC Core |
$80.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.00
|
| Rate for Payer: UHC Exchange |
$24.00
|
| Rate for Payer: UHC Medicare Advantage |
$24.00
|
| Rate for Payer: VA VA |
$24.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.02
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$96.02
|
|
|
Service Code
|
NDC 00517930525
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$86.42 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: BCBS Trust/PPO |
$78.38
|
| Rate for Payer: BCN Commercial |
$74.20
|
| Rate for Payer: Cash Price |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$82.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.82
|
| Rate for Payer: Healthscope Commercial |
$86.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.62
|
| Rate for Payer: Nomi Health Commercial |
$78.74
|
| Rate for Payer: PHP Commercial |
$81.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.41
|
| Rate for Payer: Priority Health HMO/PPO |
$83.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.50
|
| Rate for Payer: UHC Core |
$80.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.02
|
|
|
TRACE ELEMENTS ZN 3 MG-CU 0.3 MG-MN 55 MCG-SE 60 MCG/ML IV SOLUTION
|
Facility
|
IP
|
$96.02
|
|
|
Service Code
|
NDC 00517930501
|
| Hospital Charge Code |
194947
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.41 |
| Max. Negotiated Rate |
$86.42 |
| Rate for Payer: Aetna Commercial |
$81.62
|
| Rate for Payer: BCBS Trust/PPO |
$78.38
|
| Rate for Payer: BCN Commercial |
$74.20
|
| Rate for Payer: Cash Price |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$82.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.82
|
| Rate for Payer: Healthscope Commercial |
$86.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.62
|
| Rate for Payer: Nomi Health Commercial |
$78.74
|
| Rate for Payer: PHP Commercial |
$81.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.41
|
| Rate for Payer: Priority Health HMO/PPO |
$83.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.50
|
| Rate for Payer: UHC Core |
$80.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.02
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 57664037708
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.56 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.31
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: BCBS MAPPO |
$25.85
|
| Rate for Payer: BCBS Trust/PPO |
$85.01
|
| Rate for Payer: BCN Commercial |
$80.39
|
| Rate for Payer: BCN Medicare Advantage |
$25.85
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.85
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Nomi Health Commercial |
$84.79
|
| Rate for Payer: PACE Senior Care Partners |
$24.56
|
| Rate for Payer: PACE SWMI |
$25.85
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: PHP Medicare Advantage |
$25.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.21
|
| Rate for Payer: Priority Health HMO/PPO |
$89.96
|
| Rate for Payer: Priority Health Medicare |
$26.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.28
|
| Rate for Payer: Railroad Medicare Medicare |
$25.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.99
|
| Rate for Payer: UHC Core |
$86.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.85
|
| Rate for Payer: UHC Exchange |
$25.85
|
| Rate for Payer: UHC Medicare Advantage |
$25.85
|
| Rate for Payer: VA VA |
$25.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$101.05
|
|
|
Service Code
|
NDC 51079099120
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: Aetna Medicare |
$26.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.58
|
| Rate for Payer: BCBS Complete |
$40.42
|
| Rate for Payer: BCBS MAPPO |
$25.26
|
| Rate for Payer: BCBS Trust/PPO |
$83.07
|
| Rate for Payer: BCN Commercial |
$78.57
|
| Rate for Payer: BCN Medicare Advantage |
$25.26
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.26
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$82.86
|
| Rate for Payer: PACE Senior Care Partners |
$24.00
|
| Rate for Payer: PACE SWMI |
$25.26
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: PHP Medicare Advantage |
$25.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.68
|
| Rate for Payer: Priority Health HMO/PPO |
$87.91
|
| Rate for Payer: Priority Health Medicare |
$25.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.70
|
| Rate for Payer: Railroad Medicare Medicare |
$25.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.92
|
| Rate for Payer: UHC Core |
$84.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.26
|
| Rate for Payer: UHC Exchange |
$25.26
|
| Rate for Payer: UHC Medicare Advantage |
$25.26
|
| Rate for Payer: VA VA |
$25.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 00904717961
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.86 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$86.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$86.66
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: BCBS MAPPO |
$69.32
|
| Rate for Payer: BCBS Trust/PPO |
$227.97
|
| Rate for Payer: BCN Commercial |
$215.60
|
| Rate for Payer: BCN Medicare Advantage |
$69.32
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.32
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.70
|
| Rate for Payer: Nomi Health Commercial |
$227.39
|
| Rate for Payer: PACE Senior Care Partners |
$65.86
|
| Rate for Payer: PACE SWMI |
$69.32
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: PHP Medicare Advantage |
$69.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.24
|
| Rate for Payer: Priority Health HMO/PPO |
$241.25
|
| Rate for Payer: Priority Health Medicare |
$70.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.79
|
| Rate for Payer: Railroad Medicare Medicare |
$69.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.32
|
| Rate for Payer: UHC Exchange |
$69.32
|
| Rate for Payer: UHC Medicare Advantage |
$69.32
|
| Rate for Payer: VA VA |
$69.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.98
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$101.05
|
|
|
Service Code
|
NDC 51079099120
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.68 |
| Max. Negotiated Rate |
$90.94 |
| Rate for Payer: Aetna Commercial |
$85.89
|
| Rate for Payer: BCBS Trust/PPO |
$82.49
|
| Rate for Payer: BCN Commercial |
$78.09
|
| Rate for Payer: Cash Price |
$80.84
|
| Rate for Payer: Cofinity Commercial |
$86.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.84
|
| Rate for Payer: Healthscope Commercial |
$90.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.89
|
| Rate for Payer: Nomi Health Commercial |
$82.86
|
| Rate for Payer: PHP Commercial |
$85.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.68
|
| Rate for Payer: Priority Health HMO/PPO |
$87.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.92
|
| Rate for Payer: UHC Core |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.79
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 68084080811
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.89
|
| Rate for Payer: BCBS Complete |
$1.14
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.22
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: PACE Senior Care Partners |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.85
|
| Rate for Payer: Priority Health HMO/PPO |
$2.48
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.91
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.71
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$136.30
|
|
|
Service Code
|
NDC 55154254104
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.60 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: BCBS Trust/PPO |
$111.26
|
| Rate for Payer: BCN Commercial |
$105.33
|
| Rate for Payer: Cash Price |
$109.04
|
| 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: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: Nomi Health Commercial |
$111.77
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health HMO/PPO |
$118.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.94
|
| Rate for Payer: UHC Core |
$113.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
