|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UMR Bronson Commercial |
$102.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$1,421.47
|
|
|
Service Code
|
NDC 50458063965
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$525.94 |
| Max. Negotiated Rate |
$1,279.32 |
| Rate for Payer: Aetna American Axle |
$923.96
|
| Rate for Payer: Aetna Commercial |
$1,208.25
|
| Rate for Payer: Aetna Medicare |
$710.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.96
|
| Rate for Payer: BCBS Complete |
$568.59
|
| Rate for Payer: Cash Price |
$1,137.18
|
| Rate for Payer: Cofinity Advantage |
$995.03
|
| Rate for Payer: Cofinity Commercial |
$1,222.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,137.18
|
| Rate for Payer: Healthscope Commercial |
$1,279.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$995.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,066.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,137.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,208.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,066.10
|
| Rate for Payer: PHP Commercial |
$1,208.25
|
| Rate for Payer: Priority Health SBD |
$895.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$923.96
|
| Rate for Payer: UHC Core |
$740.59
|
| Rate for Payer: UHC Exchange |
$558.64
|
| Rate for Payer: UMR Bronson Commercial |
$525.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,066.10
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$53.58
|
|
|
Service Code
|
NDC 68382013814
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$48.22 |
| Rate for Payer: Aetna American Axle |
$34.83
|
| Rate for Payer: Aetna Commercial |
$45.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.83
|
| Rate for Payer: Cash Price |
$42.86
|
| Rate for Payer: Cofinity Advantage |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$46.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.86
|
| Rate for Payer: Healthscope Commercial |
$48.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.19
|
| Rate for Payer: PHP Commercial |
$45.54
|
| Rate for Payer: Priority Health SBD |
$33.76
|
| Rate for Payer: UMR Bronson Commercial |
$23.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.19
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$1,421.47
|
|
|
Service Code
|
NDC 50458063965
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$625.45 |
| Max. Negotiated Rate |
$1,279.32 |
| Rate for Payer: Aetna American Axle |
$923.96
|
| Rate for Payer: Aetna Commercial |
$1,208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.96
|
| Rate for Payer: Cash Price |
$1,137.18
|
| Rate for Payer: Cofinity Advantage |
$995.03
|
| Rate for Payer: Cofinity Commercial |
$1,222.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,137.18
|
| Rate for Payer: Healthscope Commercial |
$1,279.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$995.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,066.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,208.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,066.10
|
| Rate for Payer: PHP Commercial |
$1,208.25
|
| Rate for Payer: Priority Health SBD |
$895.53
|
| Rate for Payer: UMR Bronson Commercial |
$625.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,066.10
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$209.47 |
| Rate for Payer: Aetna American Axle |
$151.29
|
| Rate for Payer: Aetna Commercial |
$197.84
|
| Rate for Payer: Aetna Medicare |
$116.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.29
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Advantage |
$162.93
|
| Rate for Payer: Cofinity Commercial |
$200.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$209.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$162.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$174.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: PHP Commercial |
$197.84
|
| Rate for Payer: Priority Health SBD |
$146.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.29
|
| Rate for Payer: UHC Core |
$121.26
|
| Rate for Payer: UHC Exchange |
$91.47
|
| Rate for Payer: UMR Bronson Commercial |
$86.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$174.56
|
|
|
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$193.54
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
152057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$174.19 |
| Rate for Payer: Aetna American Axle |
$125.80
|
| Rate for Payer: Aetna American Axle |
$322.43
|
| Rate for Payer: Aetna Commercial |
$164.51
|
| Rate for Payer: Aetna Commercial |
$421.64
|
| Rate for Payer: Aetna Medicare |
$96.77
|
| Rate for Payer: Aetna Medicare |
$248.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.43
|
| Rate for Payer: BCBS Complete |
$198.42
|
| Rate for Payer: BCBS Complete |
$77.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.46
|
| Rate for Payer: Cash Price |
$154.83
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cash Price |
$154.83
|
| Rate for Payer: Cash Price |
$396.84
|
| Rate for Payer: Cofinity Advantage |
$135.48
|
| Rate for Payer: Cofinity Advantage |
$347.24
|
| Rate for Payer: Cofinity Commercial |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$426.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$396.84
|
| Rate for Payer: Healthscope Commercial |
$174.19
|
| Rate for Payer: Healthscope Commercial |
$446.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$347.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$145.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$372.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$154.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$396.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$164.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.16
|
| Rate for Payer: PHP Commercial |
$164.51
|
| Rate for Payer: PHP Commercial |
$421.64
|
| Rate for Payer: Priority Health SBD |
$121.93
|
| Rate for Payer: Priority Health SBD |
$312.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.06
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$2.06
|
| Rate for Payer: UHC Exchange |
$2.06
|
| Rate for Payer: UMR Bronson Commercial |
$71.61
|
| Rate for Payer: UMR Bronson Commercial |
$183.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$145.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$372.04
|
|
|
TOPOTECAN 4 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,568.91
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
17285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$5,012.02 |
| Rate for Payer: Aetna American Axle |
$3,619.79
|
| Rate for Payer: Aetna American Axle |
$257.37
|
| Rate for Payer: Aetna Commercial |
$336.57
|
| Rate for Payer: Aetna Commercial |
$4,733.57
|
| Rate for Payer: Aetna Medicare |
$2,784.45
|
| Rate for Payer: Aetna Medicare |
$197.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.37
|
| Rate for Payer: BCBS Complete |
$158.38
|
| Rate for Payer: BCBS Complete |
$2,227.56
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.46
|
| Rate for Payer: BCN Commercial |
$4.46
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cash Price |
$316.77
|
| Rate for Payer: Cash Price |
$316.77
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cofinity Advantage |
$3,898.24
|
| Rate for Payer: Cofinity Advantage |
$277.17
|
| Rate for Payer: Cofinity Commercial |
$340.53
|
| Rate for Payer: Cofinity Commercial |
$4,789.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.13
|
| Rate for Payer: Healthscope Commercial |
$5,012.02
|
| Rate for Payer: Healthscope Commercial |
$356.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,455.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,176.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.97
|
| Rate for Payer: PHP Commercial |
$336.57
|
| Rate for Payer: PHP Commercial |
$4,733.57
|
| Rate for Payer: Priority Health SBD |
$3,508.41
|
| Rate for Payer: Priority Health SBD |
$249.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.06
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Core |
$2.06
|
| Rate for Payer: UHC Exchange |
$2.06
|
| Rate for Payer: UHC Exchange |
$2.06
|
| Rate for Payer: UMR Bronson Commercial |
$2,060.50
|
| Rate for Payer: UMR Bronson Commercial |
$146.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.68
|
|
|
TOPOTECAN 4 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,568.91
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
17285
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,450.32 |
| Max. Negotiated Rate |
$5,012.02 |
| Rate for Payer: Aetna American Axle |
$3,619.79
|
| Rate for Payer: Aetna Commercial |
$4,733.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,619.79
|
| Rate for Payer: Cash Price |
$4,455.13
|
| Rate for Payer: Cofinity Advantage |
$3,898.24
|
| Rate for Payer: Cofinity Commercial |
$4,789.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,455.13
|
| Rate for Payer: Healthscope Commercial |
$5,012.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,898.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,176.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,733.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,176.68
|
| Rate for Payer: PHP Commercial |
$4,733.57
|
| Rate for Payer: Priority Health SBD |
$3,508.41
|
| Rate for Payer: UMR Bronson Commercial |
$2,450.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,176.68
|
|
|
TORIPALIMAB-TPZI 240 MG/6 ML (40 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$43,810.05
|
|
|
Service Code
|
HCPCS J3263
|
| Hospital Charge Code |
205892
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.91 |
| Max. Negotiated Rate |
$39,429.04 |
| Rate for Payer: Aetna American Axle |
$28,476.53
|
| Rate for Payer: Aetna Commercial |
$37,238.54
|
| Rate for Payer: Aetna Medicare |
$41.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,476.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$49.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$49.99
|
| Rate for Payer: BCBS Complete |
$21.96
|
| Rate for Payer: BCBS MAPPO |
$39.99
|
| Rate for Payer: BCBS Trust/PPO |
$130.36
|
| Rate for Payer: BCN Commercial |
$130.36
|
| Rate for Payer: BCN Medicare Advantage |
$39.99
|
| Rate for Payer: Cash Price |
$35,048.04
|
| Rate for Payer: Cash Price |
$35,048.04
|
| Rate for Payer: Cofinity Advantage |
$30,667.03
|
| Rate for Payer: Cofinity Commercial |
$37,676.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35,048.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.99
|
| Rate for Payer: Healthscope Commercial |
$39,429.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30,667.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32,857.54
|
| Rate for Payer: Mclaren Medicaid |
$39.99
|
| Rate for Payer: Mclaren Medicare |
$39.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.99
|
| Rate for Payer: Meridian Medicaid |
$41.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$43.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,238.54
|
| Rate for Payer: Nomi Health Commercial |
$119.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32,857.54
|
| Rate for Payer: PACE Medicare |
$37.99
|
| Rate for Payer: PACE SWMI |
$39.99
|
| Rate for Payer: PHP Commercial |
$37,238.54
|
| Rate for Payer: PHP Medicare Advantage |
$39.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$124.29
|
| Rate for Payer: Priority Health Medicare |
$39.99
|
| Rate for Payer: Priority Health SBD |
$27,600.33
|
| Rate for Payer: Priority Health Tiered Network |
$99.43
|
| Rate for Payer: Railroad Medicare Medicare |
$39.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.35
|
| Rate for Payer: UHC Core |
$66.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$39.99
|
| Rate for Payer: UHC Exchange |
$66.35
|
| Rate for Payer: UHC Medicaid |
$20.91
|
| Rate for Payer: UHCCP Medicaid |
$20.91
|
| Rate for Payer: UMR Bronson Commercial |
$16,209.72
|
| Rate for Payer: VA VA |
$39.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32,857.54
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
IP
|
$868.32
|
|
|
Service Code
|
NDC 50111091801
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$382.06 |
| Max. Negotiated Rate |
$781.49 |
| Rate for Payer: Aetna American Axle |
$564.41
|
| Rate for Payer: Aetna Commercial |
$738.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.41
|
| Rate for Payer: Cash Price |
$694.66
|
| Rate for Payer: Cofinity Advantage |
$607.82
|
| Rate for Payer: Cofinity Commercial |
$746.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.66
|
| Rate for Payer: Healthscope Commercial |
$781.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$651.24
|
| Rate for Payer: PHP Commercial |
$738.07
|
| Rate for Payer: Priority Health SBD |
$547.04
|
| Rate for Payer: UMR Bronson Commercial |
$382.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.24
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 31722053201
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Advantage |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$175.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
OP
|
$3.26
|
|
|
Service Code
|
NDC 50268075711
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Aetna American Axle |
$2.12
|
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.12
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cofinity Advantage |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$2.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.77
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.12
|
| Rate for Payer: UHC Core |
$1.70
|
| Rate for Payer: UHC Exchange |
$1.28
|
| Rate for Payer: UMR Bronson Commercial |
$1.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 31722053201
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Advantage |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.73
|
| Rate for Payer: UHC Core |
$207.38
|
| Rate for Payer: UHC Exchange |
$156.43
|
| Rate for Payer: UMR Bronson Commercial |
$147.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
IP
|
$3.26
|
|
|
Service Code
|
NDC 50268075711
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Aetna American Axle |
$2.12
|
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.12
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cofinity Advantage |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$2.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.77
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
IP
|
$162.93
|
|
|
Service Code
|
NDC 50268075715
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.69 |
| Max. Negotiated Rate |
$146.64 |
| Rate for Payer: Aetna American Axle |
$105.90
|
| Rate for Payer: Aetna Commercial |
$138.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.90
|
| Rate for Payer: Cash Price |
$130.34
|
| Rate for Payer: Cofinity Advantage |
$114.05
|
| Rate for Payer: Cofinity Commercial |
$140.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.34
|
| Rate for Payer: Healthscope Commercial |
$146.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.20
|
| Rate for Payer: PHP Commercial |
$138.49
|
| Rate for Payer: Priority Health SBD |
$102.65
|
| Rate for Payer: UMR Bronson Commercial |
$71.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.20
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
OP
|
$162.93
|
|
|
Service Code
|
NDC 50268075715
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$146.64 |
| Rate for Payer: Aetna American Axle |
$105.90
|
| Rate for Payer: Aetna Commercial |
$138.49
|
| Rate for Payer: Aetna Medicare |
$81.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.90
|
| Rate for Payer: BCBS Complete |
$65.17
|
| Rate for Payer: Cash Price |
$130.34
|
| Rate for Payer: Cofinity Advantage |
$114.05
|
| Rate for Payer: Cofinity Commercial |
$140.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.34
|
| Rate for Payer: Healthscope Commercial |
$146.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.20
|
| Rate for Payer: PHP Commercial |
$138.49
|
| Rate for Payer: Priority Health SBD |
$102.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.90
|
| Rate for Payer: UHC Core |
$84.89
|
| Rate for Payer: UHC Exchange |
$64.03
|
| Rate for Payer: UMR Bronson Commercial |
$60.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.20
|
|
|
TORSEMIDE 100 MG TABLET
|
Facility
|
OP
|
$868.32
|
|
|
Service Code
|
NDC 50111091801
|
| Hospital Charge Code |
18294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.28 |
| Max. Negotiated Rate |
$781.49 |
| Rate for Payer: Aetna American Axle |
$564.41
|
| Rate for Payer: Aetna Commercial |
$738.07
|
| Rate for Payer: Aetna Medicare |
$434.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.41
|
| Rate for Payer: BCBS Complete |
$347.33
|
| Rate for Payer: Cash Price |
$694.66
|
| Rate for Payer: Cofinity Advantage |
$607.82
|
| Rate for Payer: Cofinity Commercial |
$746.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$694.66
|
| Rate for Payer: Healthscope Commercial |
$781.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$607.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$651.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$694.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$738.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$651.24
|
| Rate for Payer: PHP Commercial |
$738.07
|
| Rate for Payer: Priority Health SBD |
$547.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.41
|
| Rate for Payer: UHC Core |
$452.39
|
| Rate for Payer: UHC Exchange |
$341.25
|
| Rate for Payer: UMR Bronson Commercial |
$321.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$651.24
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$317.30
|
|
|
Service Code
|
NDC 68084053901
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$285.57 |
| Rate for Payer: Aetna American Axle |
$206.25
|
| Rate for Payer: Aetna Commercial |
$269.70
|
| Rate for Payer: Aetna Medicare |
$158.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.25
|
| Rate for Payer: BCBS Complete |
$126.92
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cofinity Advantage |
$222.11
|
| Rate for Payer: Cofinity Commercial |
$272.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Healthscope Commercial |
$285.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.97
|
| Rate for Payer: PHP Commercial |
$269.70
|
| Rate for Payer: Priority Health SBD |
$199.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.25
|
| Rate for Payer: UHC Core |
$165.31
|
| Rate for Payer: UHC Exchange |
$124.70
|
| Rate for Payer: UMR Bronson Commercial |
$117.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.97
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 00054007725
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.77 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 31722053101
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.77 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$288.80
|
|
|
Service Code
|
NDC 00904728361
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.07 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna American Axle |
$187.72
|
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Advantage |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UMR Bronson Commercial |
$127.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.60
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 00054007725
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$233.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.97
|
| Rate for Payer: UHC Core |
$243.65
|
| Rate for Payer: UHC Exchange |
$183.79
|
| Rate for Payer: UMR Bronson Commercial |
$173.03
|
| 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 |
$173.03 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$233.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.97
|
| Rate for Payer: UHC Core |
$243.65
|
| Rate for Payer: UHC Exchange |
$183.79
|
| Rate for Payer: UMR Bronson Commercial |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$288.80
|
|
|
Service Code
|
NDC 00904728361
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.86 |
| Max. Negotiated Rate |
$259.92 |
| Rate for Payer: Aetna American Axle |
$187.72
|
| Rate for Payer: Aetna Commercial |
$245.48
|
| Rate for Payer: Aetna Medicare |
$144.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.72
|
| Rate for Payer: BCBS Complete |
$115.52
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Advantage |
$202.16
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$259.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: PHP Commercial |
$245.48
|
| Rate for Payer: Priority Health SBD |
$181.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.72
|
| Rate for Payer: UHC Core |
$150.46
|
| Rate for Payer: UHC Exchange |
$113.50
|
| Rate for Payer: UMR Bronson Commercial |
$106.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.60
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$274.56
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.81 |
| Max. Negotiated Rate |
$247.10 |
| Rate for Payer: Aetna American Axle |
$178.46
|
| Rate for Payer: Aetna Commercial |
$233.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.46
|
| Rate for Payer: Cash Price |
$219.65
|
| Rate for Payer: Cofinity Advantage |
$192.19
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$192.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.92
|
| Rate for Payer: PHP Commercial |
$233.38
|
| Rate for Payer: Priority Health SBD |
$172.97
|
| Rate for Payer: UMR Bronson Commercial |
$120.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.92
|
|
