|
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 Commercial |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$278.63
|
| 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: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.73
|
| 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 20 MG TABLET
|
Facility
|
OP
|
$278.35
|
|
|
Service Code
|
NDC 00904728361
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.99 |
| Max. Negotiated Rate |
$250.51 |
| Rate for Payer: Aetna American Axle |
$180.93
|
| Rate for Payer: Aetna Commercial |
$236.60
|
| Rate for Payer: Aetna Medicare |
$139.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.93
|
| Rate for Payer: BCBS Complete |
$111.34
|
| Rate for Payer: Cash Price |
$222.68
|
| Rate for Payer: Cofinity Commercial |
$194.84
|
| Rate for Payer: Cofinity Commercial |
$239.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$250.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.60
|
| Rate for Payer: PHP Commercial |
$236.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.93
|
| Rate for Payer: Priority Health SBD |
$175.36
|
| Rate for Payer: UMR Bronson Commercial |
$102.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.76
|
|
|
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 Commercial |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.36
|
| 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: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.97
|
| 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
|
$278.35
|
|
|
Service Code
|
NDC 00904728361
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.47 |
| Max. Negotiated Rate |
$250.51 |
| Rate for Payer: Aetna American Axle |
$180.93
|
| Rate for Payer: Aetna Commercial |
$236.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.93
|
| Rate for Payer: Cash Price |
$222.68
|
| Rate for Payer: Cofinity Commercial |
$194.84
|
| Rate for Payer: Cofinity Commercial |
$239.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$194.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$250.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.60
|
| Rate for Payer: PHP Commercial |
$236.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.93
|
| Rate for Payer: Priority Health SBD |
$175.36
|
| Rate for Payer: UMR Bronson Commercial |
$122.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.76
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 68084053901
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.01 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UMR Bronson Commercial |
$135.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 68084053901
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna Medicare |
$153.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UMR Bronson Commercial |
$113.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$280.32
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.72 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna American Axle |
$182.21
|
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna Medicare |
$140.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: BCBS Complete |
$112.13
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.21
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UMR Bronson Commercial |
$103.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
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 Commercial |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.36
|
| 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: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.97
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 50111091701
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.34 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna American Axle |
$182.21
|
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.21
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UMR Bronson Commercial |
$123.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
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 Commercial |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.36
|
| 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: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.97
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
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 Commercial |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.36
|
| 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: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.97
|
| 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 5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 31722052901
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$428.45
|
|
|
Service Code
|
NDC 50111091501
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.52 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$188.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
NDC 50268075415
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna American Axle |
$74.10
|
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health SBD |
$71.82
|
| Rate for Payer: UMR Bronson Commercial |
$42.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.50
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
NDC 50268075415
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna American Axle |
$74.10
|
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health SBD |
$71.82
|
| Rate for Payer: UMR Bronson Commercial |
$50.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.50
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$305.50
|
|
|
Service Code
|
NDC 31722052901
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.03 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.57
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna Medicare |
$152.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.57
|
| Rate for Payer: BCBS Complete |
$122.20
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.57
|
| Rate for Payer: Priority Health SBD |
$192.47
|
| Rate for Payer: UMR Bronson Commercial |
$113.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$2.28
|
|
|
Service Code
|
NDC 50268075411
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: BCBS Complete |
$0.91
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
IP
|
$2.28
|
|
|
Service Code
|
NDC 50268075411
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.05 |
| Rate for Payer: Aetna American Axle |
$1.48
|
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.48
|
| Rate for Payer: Cash Price |
$1.82
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.82
|
| Rate for Payer: Healthscope Commercial |
$2.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.94
|
| Rate for Payer: PHP Commercial |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.48
|
| Rate for Payer: Priority Health SBD |
$1.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.71
|
|
|
TORSEMIDE 5 MG TABLET
|
Facility
|
OP
|
$428.45
|
|
|
Service Code
|
NDC 50111091501
|
| Hospital Charge Code |
18295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.53 |
| Max. Negotiated Rate |
$385.61 |
| Rate for Payer: Aetna American Axle |
$278.49
|
| Rate for Payer: Aetna Commercial |
$364.18
|
| Rate for Payer: Aetna Medicare |
$214.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.49
|
| Rate for Payer: BCBS Complete |
$171.38
|
| Rate for Payer: Cash Price |
$342.76
|
| Rate for Payer: Cofinity Commercial |
$299.92
|
| Rate for Payer: Cofinity Commercial |
$368.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$299.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.76
|
| Rate for Payer: Healthscope Commercial |
$385.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$299.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.18
|
| Rate for Payer: PHP Commercial |
$364.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.49
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$158.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.34
|
|
|
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SINGLE INTERSPACE, CERVICAL
|
Facility
|
OP
|
$50,486.50
|
|
|
Service Code
|
CPT 22856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,613.40 |
| Max. Negotiated Rate |
$50,486.50 |
| Rate for Payer: Aetna Medicare |
$18,652.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,419.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,419.31
|
| Rate for Payer: BCBS Complete |
$10,094.07
|
| Rate for Payer: BCBS MAPPO |
$17,935.45
|
| Rate for Payer: BCN Medicare Advantage |
$17,935.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,935.45
|
| Rate for Payer: Mclaren Medicaid |
$9,613.40
|
| Rate for Payer: Mclaren Medicare |
$17,935.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,832.22
|
| Rate for Payer: Meridian Medicaid |
$10,094.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,625.77
|
| Rate for Payer: PACE Medicare |
$17,038.68
|
| Rate for Payer: PACE SWMI |
$17,935.45
|
| Rate for Payer: PHP Medicare Advantage |
$17,935.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,613.40
|
| Rate for Payer: Priority Health Medicare |
$17,935.45
|
| Rate for Payer: Railroad Medicare Medicare |
$17,935.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50,486.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,935.45
|
| Rate for Payer: UHC Exchange |
$34,276.44
|
| Rate for Payer: UHC Medicare Advantage |
$17,935.45
|
| Rate for Payer: UHCCP Medicaid |
$9,613.40
|
| Rate for Payer: VA VA |
$17,935.45
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERAL SUBTOTAL LOBECTOMY, INCLUDING ISTHMUSECTOMY
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 60225
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUT ISTHMUSECTOMY
|
Facility
|
OP
|
$16,017.15
|
|
|
Service Code
|
CPT 60220
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,049.91 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$15,481.44
|
|
|
Service Code
|
HCPCS J9352
|
| Hospital Charge Code |
175966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$209.61 |
| Max. Negotiated Rate |
$13,933.30 |
| Rate for Payer: Aetna American Axle |
$10,062.94
|
| Rate for Payer: Aetna Commercial |
$13,159.22
|
| Rate for Payer: Aetna Medicare |
$406.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,062.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.84
|
| Rate for Payer: BCBS Complete |
$220.09
|
| Rate for Payer: BCBS MAPPO |
$391.07
|
| Rate for Payer: BCN Medicare Advantage |
$391.07
|
| Rate for Payer: Cash Price |
$12,385.15
|
| Rate for Payer: Cash Price |
$12,385.15
|
| Rate for Payer: Cofinity Commercial |
$13,314.04
|
| Rate for Payer: Cofinity Commercial |
$10,837.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,837.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,385.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.07
|
| Rate for Payer: Healthscope Commercial |
$13,933.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,837.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,611.08
|
| Rate for Payer: Mclaren Medicaid |
$209.61
|
| Rate for Payer: Mclaren Medicare |
$391.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.62
|
| Rate for Payer: Meridian Medicaid |
$220.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,159.22
|
| Rate for Payer: PACE Medicare |
$371.52
|
| Rate for Payer: PACE SWMI |
$391.07
|
| Rate for Payer: PHP Commercial |
$13,159.22
|
| Rate for Payer: PHP Medicare Advantage |
$391.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,062.94
|
| Rate for Payer: Priority Health Medicare |
$391.07
|
| Rate for Payer: Priority Health SBD |
$9,753.31
|
| Rate for Payer: Railroad Medicare Medicare |
$391.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,100.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.07
|
| Rate for Payer: UHC Exchange |
$747.37
|
| Rate for Payer: UHC Medicare Advantage |
$391.07
|
| Rate for Payer: UHCCP Medicaid |
$209.61
|
| Rate for Payer: UMR Bronson Commercial |
$5,728.13
|
| Rate for Payer: VA VA |
$391.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,611.08
|
|
|
TRABECTEDIN 1 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$15,481.44
|
|
|
Service Code
|
HCPCS J9352
|
| Hospital Charge Code |
175966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,811.83 |
| Max. Negotiated Rate |
$13,933.30 |
| Rate for Payer: Aetna American Axle |
$10,062.94
|
| Rate for Payer: Aetna Commercial |
$13,159.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10,062.94
|
| Rate for Payer: Cash Price |
$12,385.15
|
| Rate for Payer: Cofinity Commercial |
$10,837.01
|
| Rate for Payer: Cofinity Commercial |
$13,314.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,837.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12,385.15
|
| Rate for Payer: Healthscope Commercial |
$13,933.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,837.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11,611.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,159.22
|
| Rate for Payer: PHP Commercial |
$13,159.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10,062.94
|
| Rate for Payer: Priority Health SBD |
$9,753.31
|
| Rate for Payer: UMR Bronson Commercial |
$6,811.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11,611.08
|
|
|
TRABECULOTOMY AB EXTERNO
|
Facility
|
OP
|
$6,261.32
|
|
|
Service Code
|
CPT 65850
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,192.25 |
| Max. Negotiated Rate |
$6,261.32 |
| Rate for Payer: Aetna Medicare |
$2,313.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,780.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,780.44
|
| Rate for Payer: BCBS Complete |
$1,251.86
|
| Rate for Payer: BCBS MAPPO |
$2,224.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,224.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,224.35
|
| Rate for Payer: Mclaren Medicaid |
$1,192.25
|
| Rate for Payer: Mclaren Medicare |
$2,224.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,335.57
|
| Rate for Payer: Meridian Medicaid |
$1,251.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,558.00
|
| Rate for Payer: PACE Medicare |
$2,113.13
|
| Rate for Payer: PACE SWMI |
$2,224.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,224.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,192.25
|
| Rate for Payer: Priority Health Medicare |
$2,224.35
|
| Rate for Payer: Railroad Medicare Medicare |
$2,224.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,261.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,224.35
|
| Rate for Payer: UHC Exchange |
$4,250.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,224.35
|
| Rate for Payer: UHCCP Medicaid |
$1,192.25
|
| Rate for Payer: VA VA |
$2,224.35
|
|
