|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$65.80
|
|
|
Service Code
|
NDC 43547040110
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna American Axle |
$42.77
|
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: Priority Health SBD |
$41.45
|
| Rate for Payer: UMR Bronson Commercial |
$28.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$129.25
|
|
|
Service Code
|
NDC 00904717761
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$56.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 69315011601
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$79.90
|
|
|
Service Code
|
NDC 64980056201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna American Axle |
$51.94
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.94
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UMR Bronson Commercial |
$35.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$79.90
|
|
|
Service Code
|
NDC 64980056201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$71.91 |
| Rate for Payer: Aetna American Axle |
$51.94
|
| Rate for Payer: Aetna Commercial |
$67.92
|
| Rate for Payer: Aetna Medicare |
$39.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.94
|
| Rate for Payer: BCBS Complete |
$31.96
|
| Rate for Payer: Cash Price |
$63.92
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$68.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$71.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.92
|
| Rate for Payer: PHP Commercial |
$67.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.94
|
| Rate for Payer: Priority Health SBD |
$50.34
|
| Rate for Payer: UMR Bronson Commercial |
$29.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.92
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$136.30
|
|
|
Service Code
|
NDC 51079007220
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.43 |
| Max. Negotiated Rate |
$122.67 |
| Rate for Payer: Aetna American Axle |
$88.60
|
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.60
|
| Rate for Payer: BCBS Complete |
$54.52
|
| Rate for Payer: Cash Price |
$109.04
|
| Rate for Payer: Cofinity Commercial |
$117.22
|
| Rate for Payer: Cofinity Commercial |
$95.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.04
|
| Rate for Payer: Healthscope Commercial |
$122.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.86
|
| Rate for Payer: PHP Commercial |
$115.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.60
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UMR Bronson Commercial |
$50.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.22
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$65.80
|
|
|
Service Code
|
NDC 43547040110
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna American Axle |
$42.77
|
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna Medicare |
$32.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: BCBS Complete |
$26.32
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: Priority Health SBD |
$41.45
|
| Rate for Payer: UMR Bronson Commercial |
$24.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna American Axle |
$0.89
|
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare |
$0.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.89
|
| Rate for Payer: BCBS Complete |
$0.55
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$1.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.16
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.89
|
| Rate for Payer: Priority Health SBD |
$0.86
|
| Rate for Payer: UMR Bronson Commercial |
$0.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.03
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna American Axle |
$0.89
|
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.89
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Cofinity Commercial |
$0.96
|
| Rate for Payer: Cofinity Commercial |
$1.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$1.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.16
|
| Rate for Payer: PHP Commercial |
$1.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.89
|
| Rate for Payer: Priority Health SBD |
$0.86
|
| Rate for Payer: UMR Bronson Commercial |
$0.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.03
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$129.25
|
|
|
Service Code
|
NDC 00904717761
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.82 |
| Max. Negotiated Rate |
$116.32 |
| Rate for Payer: Aetna American Axle |
$84.01
|
| Rate for Payer: Aetna Commercial |
$109.86
|
| Rate for Payer: Aetna Medicare |
$64.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.01
|
| Rate for Payer: BCBS Complete |
$51.70
|
| Rate for Payer: Cash Price |
$103.40
|
| Rate for Payer: Cofinity Commercial |
$111.16
|
| Rate for Payer: Cofinity Commercial |
$90.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$90.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.40
|
| Rate for Payer: Healthscope Commercial |
$116.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$90.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.86
|
| Rate for Payer: PHP Commercial |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.01
|
| Rate for Payer: Priority Health SBD |
$81.43
|
| Rate for Payer: UMR Bronson Commercial |
$47.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.94
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$148.05
|
|
|
Service Code
|
NDC 51079007320
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna Medicare |
$74.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: BCBS Complete |
$59.22
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$54.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
NDC 51079007301
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: BCBS Complete |
$0.60
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 69315011701
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$169.20
|
|
|
Service Code
|
NDC 00904717861
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.45 |
| Max. Negotiated Rate |
$152.28 |
| Rate for Payer: Cofinity Commercial |
$118.44
|
| Rate for Payer: Aetna American Axle |
$109.98
|
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.98
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Commercial |
$145.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$152.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.82
|
| Rate for Payer: PHP Commercial |
$143.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.98
|
| Rate for Payer: Priority Health SBD |
$106.60
|
| Rate for Payer: UMR Bronson Commercial |
$74.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.90
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$148.05
|
|
|
Service Code
|
NDC 51079007320
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$133.24 |
| Rate for Payer: Aetna American Axle |
$96.23
|
| Rate for Payer: Aetna Commercial |
$125.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.23
|
| Rate for Payer: Cash Price |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$103.64
|
| Rate for Payer: Cofinity Commercial |
$127.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$103.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.44
|
| Rate for Payer: Healthscope Commercial |
$133.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.84
|
| Rate for Payer: PHP Commercial |
$125.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.23
|
| Rate for Payer: Priority Health SBD |
$93.27
|
| Rate for Payer: UMR Bronson Commercial |
$65.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.04
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$115.15
|
|
|
Service Code
|
NDC 64980056301
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.61 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: BCBS Complete |
$46.06
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.60
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$42.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 69315011701
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.57
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 43547040210
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.05 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$51.00
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.35
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$169.20
|
|
|
Service Code
|
NDC 00904717861
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$152.28 |
| Rate for Payer: Aetna American Axle |
$109.98
|
| Rate for Payer: Aetna Commercial |
$143.82
|
| Rate for Payer: Aetna Medicare |
$84.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.98
|
| Rate for Payer: BCBS Complete |
$67.68
|
| Rate for Payer: Cash Price |
$135.36
|
| Rate for Payer: Cofinity Commercial |
$118.44
|
| Rate for Payer: Cofinity Commercial |
$145.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$135.36
|
| Rate for Payer: Healthscope Commercial |
$152.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.82
|
| Rate for Payer: PHP Commercial |
$143.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.98
|
| Rate for Payer: Priority Health SBD |
$106.60
|
| Rate for Payer: UMR Bronson Commercial |
$62.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.90
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$115.15
|
|
|
Service Code
|
NDC 64980056301
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna American Axle |
$74.85
|
| Rate for Payer: Aetna Commercial |
$97.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.85
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$80.60
|
| Rate for Payer: Cofinity Commercial |
$99.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$103.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.88
|
| Rate for Payer: PHP Commercial |
$97.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.85
|
| Rate for Payer: Priority Health SBD |
$72.54
|
| Rate for Payer: UMR Bronson Commercial |
$50.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.36
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
NDC 51079007301
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna American Axle |
$0.97
|
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.97
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Cofinity Commercial |
$1.04
|
| Rate for Payer: Cofinity Commercial |
$1.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.19
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.27
|
| Rate for Payer: PHP Commercial |
$1.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.97
|
| Rate for Payer: Priority Health SBD |
$0.94
|
| Rate for Payer: UMR Bronson Commercial |
$0.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.12
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 43547040210
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna American Axle |
$47.35
|
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$36.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$51.00
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.35
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$26.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
G1001 CDSM - EVICORE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1001
|
| Hospital Charge Code |
99000393
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
G1001 CDSM - EVICORE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1001
|
| Hospital Charge Code |
99000393
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
|
G1002 CDSM - MEDCURRENT
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1002
|
| Hospital Charge Code |
99000394
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna American Axle |
$0.01
|
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: PHP Commercial |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.01
|
| Rate for Payer: Priority Health SBD |
$0.01
|
| Rate for Payer: UMR Bronson Commercial |
$0.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$0.01
|
|
