|
FRAXEL STRETCH MARKS - ENTIRE ABDOMEN
|
Professional
|
Both
|
$840.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.00
|
|
|
FRAXEL STRETCH MARKS - PERI-UMBILICAL
|
Professional
|
Both
|
$630.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$472.50
|
|
|
FULL TERM NEONATE WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$49,260.18
|
|
|
Service Code
|
MSDRG 793
|
| Min. Negotiated Rate |
$7,898.16 |
| Max. Negotiated Rate |
$49,260.18 |
| Rate for Payer: Aetna Medicare |
$31,780.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,725.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,725.95
|
| Rate for Payer: BCBS MAPPO |
$31,780.76
|
| Rate for Payer: BCN Medicare Advantage |
$31,780.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,780.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$31,780.76
|
| Rate for Payer: Mclaren Medicare |
$31,780.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,369.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,547.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$34,958.84
|
| Rate for Payer: PACE Medicare |
$30,191.72
|
| Rate for Payer: PACE SWMI |
$31,780.76
|
| Rate for Payer: PHP Commercial |
$34,958.84
|
| Rate for Payer: PHP Medicare Advantage |
$31,780.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9,872.70
|
| Rate for Payer: Priority Health Medicare |
$31,780.76
|
| Rate for Payer: Priority Health Narrow Network |
$7,898.16
|
| Rate for Payer: Railroad Medicare Medicare |
$31,780.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,780.76
|
| Rate for Payer: UHC Exchange |
$49,260.18
|
| Rate for Payer: UHCCP DNSP |
$31,780.76
|
| Rate for Payer: VA VA |
$31,780.76
|
|
|
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY
|
Facility
|
IP
|
$30,370.99
|
|
|
Service Code
|
MSDRG 934
|
| Min. Negotiated Rate |
$16,789.85 |
| Max. Negotiated Rate |
$30,370.99 |
| Rate for Payer: Aetna Medicare |
$17,673.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,091.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,091.91
|
| Rate for Payer: BCBS MAPPO |
$17,673.53
|
| Rate for Payer: BCN Medicare Advantage |
$17,673.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,673.53
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,673.53
|
| Rate for Payer: Mclaren Medicare |
$17,673.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,557.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,324.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$19,440.88
|
| Rate for Payer: PACE Medicare |
$16,789.85
|
| Rate for Payer: PACE SWMI |
$17,673.53
|
| Rate for Payer: PHP Commercial |
$19,440.88
|
| Rate for Payer: PHP Medicare Advantage |
$17,673.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$30,370.99
|
| Rate for Payer: Priority Health Medicare |
$17,673.53
|
| Rate for Payer: Priority Health Narrow Network |
$24,296.79
|
| Rate for Payer: Railroad Medicare Medicare |
$17,673.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17,673.53
|
| Rate for Payer: UHC Exchange |
$27,393.97
|
| Rate for Payer: UHCCP DNSP |
$17,673.53
|
| Rate for Payer: VA VA |
$17,673.53
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC
|
Facility
|
IP
|
$98,544.29
|
|
|
Service Code
|
MSDRG 928
|
| Min. Negotiated Rate |
$50,736.48 |
| Max. Negotiated Rate |
$98,544.29 |
| Rate for Payer: Aetna Medicare |
$53,406.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66,758.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66,758.52
|
| Rate for Payer: BCBS MAPPO |
$53,406.82
|
| Rate for Payer: BCN Medicare Advantage |
$53,406.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53,406.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$53,406.82
|
| Rate for Payer: Mclaren Medicare |
$53,406.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56,077.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61,417.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$58,747.50
|
| Rate for Payer: PACE Medicare |
$50,736.48
|
| Rate for Payer: PACE SWMI |
$53,406.82
|
| Rate for Payer: PHP Commercial |
$58,747.50
|
| Rate for Payer: PHP Medicare Advantage |
$53,406.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98,544.29
|
| Rate for Payer: Priority Health Medicare |
$53,406.82
|
| Rate for Payer: Priority Health Narrow Network |
$78,835.43
|
| Rate for Payer: Railroad Medicare Medicare |
$53,406.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53,406.82
|
| Rate for Payer: UHC Exchange |
$82,780.57
|
| Rate for Payer: UHCCP DNSP |
$53,406.82
|
| Rate for Payer: VA VA |
$53,406.82
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC
|
Facility
|
IP
|
$44,249.93
|
|
|
Service Code
|
MSDRG 929
|
| Min. Negotiated Rate |
$23,700.81 |
| Max. Negotiated Rate |
$44,249.93 |
| Rate for Payer: Aetna Medicare |
$24,948.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31,185.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31,185.28
|
| Rate for Payer: BCBS MAPPO |
$24,948.22
|
| Rate for Payer: BCN Medicare Advantage |
$24,948.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,948.22
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,948.22
|
| Rate for Payer: Mclaren Medicare |
$24,948.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26,195.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28,690.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$27,443.04
|
| Rate for Payer: PACE Medicare |
$23,700.81
|
| Rate for Payer: PACE SWMI |
$24,948.22
|
| Rate for Payer: PHP Commercial |
$27,443.04
|
| Rate for Payer: PHP Medicare Advantage |
$24,948.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44,249.93
|
| Rate for Payer: Priority Health Medicare |
$24,948.22
|
| Rate for Payer: Priority Health Narrow Network |
$35,399.94
|
| Rate for Payer: Railroad Medicare Medicare |
$24,948.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,948.22
|
| Rate for Payer: UHC Exchange |
$38,669.74
|
| Rate for Payer: UHCCP DNSP |
$24,948.22
|
| Rate for Payer: VA VA |
$24,948.22
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
OP
|
$23.54
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Commercial |
$17.72
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Aetna Medicare |
$6.31
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: ASR ASR |
$22.83
|
| Rate for Payer: ASR ASR |
$19.09
|
| Rate for Payer: ASR ASR |
$16.54
|
| Rate for Payer: ASR ASR |
$19.58
|
| Rate for Payer: ASR ASR |
$27.22
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$22.84
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$23.24
|
| Rate for Payer: BCBS Trust/PPO |
$23.14
|
| Rate for Payer: BCN Commercial |
$23.14
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Commercial |
$16.23
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Commercial |
$23.24
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Healthscope Commercial |
$27.22
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$22.84
|
| Rate for Payer: Healthscope Commercial |
$22.83
|
| Rate for Payer: Healthscope Whirlpool |
$28.06
|
| Rate for Payer: Healthscope Whirlpool |
$23.54
|
| Rate for Payer: Healthscope Whirlpool |
$19.68
|
| Rate for Payer: Healthscope Whirlpool |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$17.05
|
| Rate for Payer: Healthscope Whirlpool |
$23.55
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Mclaren Commercial |
$15.35
|
| Rate for Payer: Mclaren Commercial |
$18.17
|
| Rate for Payer: Mclaren Commercial |
$17.72
|
| Rate for Payer: Mclaren Commercial |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: Nomi Health Commercial |
$16.14
|
| Rate for Payer: Nomi Health Commercial |
$16.55
|
| Rate for Payer: Nomi Health Commercial |
$23.11
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Nomi Health Commercial |
$13.98
|
| Rate for Payer: Nomi Health Commercial |
$23.01
|
| Rate for Payer: Nomi Health Commercial |
$19.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.00
|
|
|
FUROSEMIDE 10 MG/ML INJECTION (CODE)
|
Facility
|
IP
|
$19.68
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
163713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.76 |
| Max. Negotiated Rate |
$19.68 |
| Rate for Payer: Aetna Commercial |
$17.72
|
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: ASR ASR |
$22.84
|
| Rate for Payer: ASR ASR |
$19.58
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$16.54
|
| Rate for Payer: ASR ASR |
$19.09
|
| Rate for Payer: ASR ASR |
$22.83
|
| Rate for Payer: ASR ASR |
$27.22
|
| Rate for Payer: BCBS Trust/PPO |
$23.15
|
| Rate for Payer: BCBS Trust/PPO |
$23.04
|
| Rate for Payer: BCBS Trust/PPO |
$19.34
|
| Rate for Payer: BCBS Trust/PPO |
$16.16
|
| Rate for Payer: BCBS Trust/PPO |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$19.33
|
| Rate for Payer: BCBS Trust/PPO |
$16.58
|
| Rate for Payer: BCN Commercial |
$23.04
|
| Rate for Payer: BCN Commercial |
$16.58
|
| Rate for Payer: BCN Commercial |
$16.16
|
| Rate for Payer: BCN Commercial |
$19.33
|
| Rate for Payer: BCN Commercial |
$19.34
|
| Rate for Payer: BCN Commercial |
$14.00
|
| Rate for Payer: BCN Commercial |
$23.15
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Commercial |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Healthscope Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$22.84
|
| Rate for Payer: Healthscope Commercial |
$27.22
|
| Rate for Payer: Healthscope Commercial |
$27.34
|
| Rate for Payer: Healthscope Whirlpool |
$23.55
|
| Rate for Payer: Healthscope Whirlpool |
$17.05
|
| Rate for Payer: Healthscope Whirlpool |
$19.68
|
| Rate for Payer: Healthscope Whirlpool |
$28.06
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$23.54
|
| Rate for Payer: Mclaren Commercial |
$15.35
|
| Rate for Payer: Mclaren Commercial |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$17.72
|
| Rate for Payer: Mclaren Commercial |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$18.17
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.16
|
| Rate for Payer: Nomi Health Commercial |
$13.98
|
| Rate for Payer: Nomi Health Commercial |
$19.31
|
| Rate for Payer: Nomi Health Commercial |
$16.55
|
| Rate for Payer: Nomi Health Commercial |
$23.01
|
| Rate for Payer: Nomi Health Commercial |
$23.11
|
| Rate for Payer: Nomi Health Commercial |
$16.14
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.80
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$13.80 |
| Rate for Payer: Aetna Commercial |
$12.42
|
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna Commercial |
$9.71
|
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna Commercial |
$9.58
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Commercial |
$17.72
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: Aetna Medicare |
$6.31
|
| Rate for Payer: Aetna Medicare |
$3.09
|
| Rate for Payer: Aetna Medicare |
$7.28
|
| Rate for Payer: Aetna Medicare |
$10.43
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Aetna Medicare |
$4.57
|
| Rate for Payer: Aetna Medicare |
$5.17
|
| Rate for Payer: Aetna Medicare |
$10.38
|
| Rate for Payer: Aetna Medicare |
$7.38
|
| Rate for Payer: Aetna Medicare |
$5.11
|
| Rate for Payer: Aetna Medicare |
$3.99
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna Medicare |
$4.48
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: Aetna Medicare |
$8.71
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$19.35
|
| Rate for Payer: ASR ASR |
$16.54
|
| Rate for Payer: ASR ASR |
$13.56
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: ASR ASR |
$15.52
|
| Rate for Payer: ASR ASR |
$12.38
|
| Rate for Payer: ASR ASR |
$27.22
|
| Rate for Payer: ASR ASR |
$19.09
|
| Rate for Payer: ASR ASR |
$22.84
|
| Rate for Payer: ASR ASR |
$10.46
|
| Rate for Payer: ASR ASR |
$11.98
|
| Rate for Payer: ASR ASR |
$10.32
|
| Rate for Payer: ASR ASR |
$22.83
|
| Rate for Payer: ASR ASR |
$13.39
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: ASR ASR |
$19.58
|
| Rate for Payer: BCBS Complete |
$5.52
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Complete |
$4.32
|
| Rate for Payer: BCBS Complete |
$7.87
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Complete |
$8.08
|
| Rate for Payer: BCBS Complete |
$4.94
|
| Rate for Payer: BCBS Complete |
$4.84
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Complete |
$5.10
|
| Rate for Payer: BCBS Complete |
$7.98
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Complete |
$3.34
|
| Rate for Payer: BCBS Complete |
$5.59
|
| Rate for Payer: BCBS Complete |
$11.22
|
| Rate for Payer: BCBS Complete |
$6.82
|
| Rate for Payer: BCBS Trust/PPO |
$23.14
|
| Rate for Payer: BCBS Trust/PPO |
$11.38
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$14.06
|
| Rate for Payer: BCBS Trust/PPO |
$13.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCBS Trust/PPO |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$10.52
|
| Rate for Payer: BCBS Trust/PPO |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$8.78
|
| Rate for Payer: BCBS Trust/PPO |
$16.23
|
| Rate for Payer: BCBS Trust/PPO |
$9.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.65
|
| Rate for Payer: BCBS Trust/PPO |
$19.41
|
| Rate for Payer: BCBS Trust/PPO |
$6.88
|
| Rate for Payer: BCBS Trust/PPO |
$23.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.18
|
| Rate for Payer: BCN Commercial |
$9.98
|
| Rate for Payer: BCN Commercial |
$13.19
|
| Rate for Payer: BCN Commercial |
$8.78
|
| Rate for Payer: BCN Commercial |
$8.89
|
| Rate for Payer: BCN Commercial |
$6.88
|
| Rate for Payer: BCN Commercial |
$23.24
|
| Rate for Payer: BCN Commercial |
$23.14
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Commercial |
$19.41
|
| Rate for Payer: BCN Commercial |
$10.18
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Commercial |
$10.52
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$11.38
|
| Rate for Payer: BCN Commercial |
$16.23
|
| Rate for Payer: BCN Commercial |
$14.06
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Cofinity Commercial |
$10.14
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$11.99
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$13.14
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$22.84
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Healthscope Commercial |
$27.22
|
| Rate for Payer: Healthscope Commercial |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$19.09
|
| Rate for Payer: Healthscope Whirlpool |
$28.06
|
| Rate for Payer: Healthscope Whirlpool |
$13.98
|
| Rate for Payer: Healthscope Whirlpool |
$17.05
|
| Rate for Payer: Healthscope Whirlpool |
$13.80
|
| Rate for Payer: Healthscope Whirlpool |
$19.68
|
| Rate for Payer: Healthscope Whirlpool |
$12.76
|
| Rate for Payer: Healthscope Whirlpool |
$8.35
|
| Rate for Payer: Healthscope Whirlpool |
$19.95
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$12.35
|
| Rate for Payer: Healthscope Whirlpool |
$23.54
|
| Rate for Payer: Healthscope Whirlpool |
$23.55
|
| Rate for Payer: Healthscope Whirlpool |
$16.00
|
| Rate for Payer: Healthscope Whirlpool |
$10.64
|
| Rate for Payer: Healthscope Whirlpool |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$10.79
|
| Rate for Payer: Healthscope Whirlpool |
$12.10
|
| Rate for Payer: Mclaren Commercial |
$17.72
|
| Rate for Payer: Mclaren Commercial |
$12.42
|
| Rate for Payer: Mclaren Commercial |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$14.40
|
| Rate for Payer: Mclaren Commercial |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$7.51
|
| Rate for Payer: Mclaren Commercial |
$9.58
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Mclaren Commercial |
$9.71
|
| Rate for Payer: Mclaren Commercial |
$11.12
|
| Rate for Payer: Mclaren Commercial |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$12.58
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Mclaren Commercial |
$11.48
|
| Rate for Payer: Mclaren Commercial |
$18.17
|
| Rate for Payer: Mclaren Commercial |
$15.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.16
|
| Rate for Payer: Nomi Health Commercial |
$10.13
|
| Rate for Payer: Nomi Health Commercial |
$16.36
|
| Rate for Payer: Nomi Health Commercial |
$23.01
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$23.11
|
| Rate for Payer: Nomi Health Commercial |
$10.46
|
| Rate for Payer: Nomi Health Commercial |
$13.98
|
| Rate for Payer: Nomi Health Commercial |
$8.85
|
| Rate for Payer: Nomi Health Commercial |
$8.73
|
| Rate for Payer: Nomi Health Commercial |
$16.14
|
| Rate for Payer: Nomi Health Commercial |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$16.55
|
| Rate for Payer: Nomi Health Commercial |
$11.46
|
| Rate for Payer: Nomi Health Commercial |
$6.85
|
| Rate for Payer: Nomi Health Commercial |
$19.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: Priority Health Narrow Network |
$0.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.23
|
|
|
FUROSEMIDE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$8.35
|
|
|
Service Code
|
HCPCS J1938
|
| Hospital Charge Code |
3291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.26 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.51
|
| Rate for Payer: Aetna Commercial |
$10.89
|
| Rate for Payer: Aetna Commercial |
$11.12
|
| Rate for Payer: Aetna Commercial |
$9.71
|
| Rate for Payer: Aetna Commercial |
$9.58
|
| Rate for Payer: Aetna Commercial |
$17.96
|
| Rate for Payer: Aetna Commercial |
$17.72
|
| Rate for Payer: Aetna Commercial |
$15.35
|
| Rate for Payer: Aetna Commercial |
$11.48
|
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Commercial |
$18.17
|
| Rate for Payer: Aetna Commercial |
$12.58
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$12.42
|
| Rate for Payer: Aetna Commercial |
$21.19
|
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Commercial |
$25.37
|
| Rate for Payer: ASR ASR |
$8.10
|
| Rate for Payer: ASR ASR |
$19.58
|
| Rate for Payer: ASR ASR |
$12.38
|
| Rate for Payer: ASR ASR |
$13.56
|
| Rate for Payer: ASR ASR |
$22.84
|
| Rate for Payer: ASR ASR |
$11.74
|
| Rate for Payer: ASR ASR |
$27.34
|
| Rate for Payer: ASR ASR |
$22.83
|
| Rate for Payer: ASR ASR |
$19.09
|
| Rate for Payer: ASR ASR |
$11.98
|
| Rate for Payer: ASR ASR |
$16.54
|
| Rate for Payer: ASR ASR |
$10.32
|
| Rate for Payer: ASR ASR |
$19.35
|
| Rate for Payer: ASR ASR |
$10.46
|
| Rate for Payer: ASR ASR |
$13.39
|
| Rate for Payer: ASR ASR |
$15.52
|
| Rate for Payer: ASR ASR |
$27.22
|
| Rate for Payer: BCBS Trust/PPO |
$9.94
|
| Rate for Payer: BCBS Trust/PPO |
$16.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$8.86
|
| Rate for Payer: BCBS Trust/PPO |
$8.74
|
| Rate for Payer: BCBS Trust/PPO |
$10.14
|
| Rate for Payer: BCBS Trust/PPO |
$6.86
|
| Rate for Payer: BCBS Trust/PPO |
$23.15
|
| Rate for Payer: BCBS Trust/PPO |
$23.04
|
| Rate for Payer: BCBS Trust/PPO |
$19.34
|
| Rate for Payer: BCBS Trust/PPO |
$11.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.33
|
| Rate for Payer: BCBS Trust/PPO |
$11.48
|
| Rate for Payer: BCBS Trust/PPO |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$13.14
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCBS Trust/PPO |
$14.00
|
| Rate for Payer: BCN Commercial |
$8.74
|
| Rate for Payer: BCN Commercial |
$11.48
|
| Rate for Payer: BCN Commercial |
$19.33
|
| Rate for Payer: BCN Commercial |
$11.34
|
| Rate for Payer: BCN Commercial |
$16.16
|
| Rate for Payer: BCN Commercial |
$23.15
|
| Rate for Payer: BCN Commercial |
$23.04
|
| Rate for Payer: BCN Commercial |
$13.14
|
| Rate for Payer: BCN Commercial |
$9.94
|
| Rate for Payer: BCN Commercial |
$8.86
|
| Rate for Payer: BCN Commercial |
$10.14
|
| Rate for Payer: BCN Commercial |
$10.48
|
| Rate for Payer: BCN Commercial |
$6.86
|
| Rate for Payer: BCN Commercial |
$19.34
|
| Rate for Payer: BCN Commercial |
$16.38
|
| Rate for Payer: BCN Commercial |
$14.00
|
| Rate for Payer: BCN Commercial |
$16.58
|
| Rate for Payer: Cash Price |
$6.68
|
| Rate for Payer: Cash Price |
$22.45
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Cash Price |
$10.21
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$9.88
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cash Price |
$8.51
|
| Rate for Payer: Cash Price |
$11.18
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cofinity Commercial |
$26.50
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$10.00
|
| Rate for Payer: Cofinity Commercial |
$26.38
|
| Rate for Payer: Cofinity Commercial |
$18.50
|
| Rate for Payer: Cofinity Commercial |
$10.14
|
| Rate for Payer: Cofinity Commercial |
$11.37
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Cofinity Commercial |
$13.14
|
| Rate for Payer: Cofinity Commercial |
$11.61
|
| Rate for Payer: Cofinity Commercial |
$11.99
|
| Rate for Payer: Cofinity Commercial |
$7.85
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$22.13
|
| Rate for Payer: Cofinity Commercial |
$16.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.63
|
| Rate for Payer: Healthscope Commercial |
$16.54
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$10.46
|
| Rate for Payer: Healthscope Commercial |
$11.98
|
| Rate for Payer: Healthscope Commercial |
$10.32
|
| Rate for Payer: Healthscope Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$13.39
|
| Rate for Payer: Healthscope Commercial |
$13.56
|
| Rate for Payer: Healthscope Commercial |
$15.52
|
| Rate for Payer: Healthscope Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$22.83
|
| Rate for Payer: Healthscope Commercial |
$22.84
|
| Rate for Payer: Healthscope Commercial |
$27.22
|
| Rate for Payer: Healthscope Commercial |
$27.34
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$23.54
|
| Rate for Payer: Healthscope Whirlpool |
$13.80
|
| Rate for Payer: Healthscope Whirlpool |
$28.19
|
| Rate for Payer: Healthscope Whirlpool |
$16.00
|
| Rate for Payer: Healthscope Whirlpool |
$12.35
|
| Rate for Payer: Healthscope Whirlpool |
$12.76
|
| Rate for Payer: Healthscope Whirlpool |
$13.98
|
| Rate for Payer: Healthscope Whirlpool |
$19.95
|
| Rate for Payer: Healthscope Whirlpool |
$8.35
|
| Rate for Payer: Healthscope Whirlpool |
$20.19
|
| Rate for Payer: Healthscope Whirlpool |
$10.79
|
| Rate for Payer: Healthscope Whirlpool |
$17.05
|
| Rate for Payer: Healthscope Whirlpool |
$19.68
|
| Rate for Payer: Healthscope Whirlpool |
$28.06
|
| Rate for Payer: Healthscope Whirlpool |
$10.64
|
| Rate for Payer: Healthscope Whirlpool |
$23.55
|
| Rate for Payer: Healthscope Whirlpool |
$12.10
|
| Rate for Payer: Mclaren Commercial |
$11.48
|
| Rate for Payer: Mclaren Commercial |
$12.42
|
| Rate for Payer: Mclaren Commercial |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$7.51
|
| Rate for Payer: Mclaren Commercial |
$17.72
|
| Rate for Payer: Mclaren Commercial |
$14.40
|
| Rate for Payer: Mclaren Commercial |
$17.96
|
| Rate for Payer: Mclaren Commercial |
$10.89
|
| Rate for Payer: Mclaren Commercial |
$9.58
|
| Rate for Payer: Mclaren Commercial |
$25.37
|
| Rate for Payer: Mclaren Commercial |
$9.71
|
| Rate for Payer: Mclaren Commercial |
$12.58
|
| Rate for Payer: Mclaren Commercial |
$11.12
|
| Rate for Payer: Mclaren Commercial |
$18.17
|
| Rate for Payer: Mclaren Commercial |
$25.25
|
| Rate for Payer: Mclaren Commercial |
$21.19
|
| Rate for Payer: Mclaren Commercial |
$15.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.49
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: Nomi Health Commercial |
$16.55
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: Nomi Health Commercial |
$23.01
|
| Rate for Payer: Nomi Health Commercial |
$10.46
|
| Rate for Payer: Nomi Health Commercial |
$16.36
|
| Rate for Payer: Nomi Health Commercial |
$9.92
|
| Rate for Payer: Nomi Health Commercial |
$13.98
|
| Rate for Payer: Nomi Health Commercial |
$16.14
|
| Rate for Payer: Nomi Health Commercial |
$23.11
|
| Rate for Payer: Nomi Health Commercial |
$11.46
|
| Rate for Payer: Nomi Health Commercial |
$19.31
|
| Rate for Payer: Nomi Health Commercial |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$8.73
|
| Rate for Payer: Nomi Health Commercial |
$10.13
|
| Rate for Payer: Nomi Health Commercial |
$8.85
|
| Rate for Payer: Nomi Health Commercial |
$6.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.77
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$1.41
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: ASR ASR |
$1.37
|
| Rate for Payer: BCBS Complete |
$0.56
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.13
|
| Rate for Payer: Healthscope Commercial |
$1.37
|
| Rate for Payer: Healthscope Whirlpool |
$1.41
|
| Rate for Payer: Mclaren Commercial |
$1.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.20
|
| Rate for Payer: Nomi Health Commercial |
$1.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.24
|
| Rate for Payer: Priority Health Narrow Network |
$0.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.24
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$138.65
|
|
|
Service Code
|
NDC 904717761
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.99 |
| Max. Negotiated Rate |
$138.65 |
| Rate for Payer: Aetna Commercial |
$124.78
|
| Rate for Payer: ASR ASR |
$134.49
|
| Rate for Payer: BCBS Trust/PPO |
$113.86
|
| Rate for Payer: BCN Commercial |
$113.86
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$130.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$134.49
|
| Rate for Payer: Healthscope Whirlpool |
$138.65
|
| Rate for Payer: Mclaren Commercial |
$124.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.01
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$1.41
|
|
|
Service Code
|
NDC 51079007201
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna Commercial |
$1.27
|
| Rate for Payer: ASR ASR |
$1.37
|
| Rate for Payer: BCBS Trust/PPO |
$1.16
|
| Rate for Payer: BCN Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cofinity Commercial |
$1.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.13
|
| Rate for Payer: Healthscope Commercial |
$1.37
|
| Rate for Payer: Healthscope Whirlpool |
$1.41
|
| Rate for Payer: Mclaren Commercial |
$1.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.20
|
| Rate for Payer: Nomi Health Commercial |
$1.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.24
|
|
|
FUROSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$138.65
|
|
|
Service Code
|
NDC 904717761
|
| Hospital Charge Code |
3294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.30 |
| Max. Negotiated Rate |
$138.65 |
| Rate for Payer: Aetna Commercial |
$124.78
|
| Rate for Payer: Aetna Medicare |
$51.30
|
| Rate for Payer: ASR ASR |
$134.49
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS Trust/PPO |
$114.32
|
| Rate for Payer: BCN Commercial |
$114.32
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$130.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$134.49
|
| Rate for Payer: Healthscope Whirlpool |
$138.65
|
| Rate for Payer: Mclaren Commercial |
$124.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$113.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$103.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.49
|
| Rate for Payer: Priority Health Narrow Network |
$97.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.01
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
NDC 51079007301
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Healthscope Whirlpool |
$1.48
|
| Rate for Payer: Mclaren Commercial |
$1.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.30
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
NDC 51079007301
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Aetna Commercial |
$1.33
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: ASR ASR |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$1.44
|
| Rate for Payer: Healthscope Whirlpool |
$1.48
|
| Rate for Payer: Mclaren Commercial |
$1.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.26
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.30
|
| Rate for Payer: Priority Health Narrow Network |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.30
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 43547040210
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: ASR ASR |
$82.06
|
| Rate for Payer: BCBS Trust/PPO |
$69.47
|
| Rate for Payer: BCN Commercial |
$69.47
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$79.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Healthscope Whirlpool |
$84.60
|
| Rate for Payer: Mclaren Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.45
|
|
|
FUROSEMIDE 40 MG TABLET
|
Facility
|
OP
|
$84.60
|
|
|
Service Code
|
NDC 43547040210
|
| Hospital Charge Code |
3295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$76.14
|
| Rate for Payer: Aetna Medicare |
$31.30
|
| Rate for Payer: ASR ASR |
$82.06
|
| Rate for Payer: BCBS Complete |
$33.84
|
| Rate for Payer: BCBS Trust/PPO |
$69.75
|
| Rate for Payer: BCN Commercial |
$69.75
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$79.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$82.06
|
| Rate for Payer: Healthscope Whirlpool |
$84.60
|
| Rate for Payer: Mclaren Commercial |
$76.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.91
|
| Rate for Payer: Nomi Health Commercial |
$69.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$74.13
|
| Rate for Payer: Priority Health Narrow Network |
$59.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.45
|
|
|
G1001 CDSM - EVICORE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1001
|
| Hospital Charge Code |
99000393
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$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 Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$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 Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
|
|
G1002 CDSM - MEDCURRENT
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1002
|
| Hospital Charge Code |
99000394
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
|
|
G1003 CDSM - MEDICALIS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G1003
|
| Hospital Charge Code |
99000395
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
|
|
G1003 CDSM - MEDICALIS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1003
|
| Hospital Charge Code |
99000395
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
|
|
G1004 CDSM - NATIONAL DECISION SUPPORT COMPANY
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G1004
|
| Hospital Charge Code |
99000396
|
|
Hospital Revenue Code
|
990
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: ASR ASR |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.01
|
| Rate for Payer: Healthscope Commercial |
$0.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.01
|
| Rate for Payer: Mclaren Commercial |
$0.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Nomi Health Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.01
|
| Rate for Payer: Priority Health Narrow Network |
$0.01
|
|
