|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
IP
|
$35.80
|
|
|
Service Code
|
NDC 68682-813-05
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$35.80 |
| Rate for Payer: Aetna Commercial |
$32.22
|
| Rate for Payer: ASR ASR |
$34.73
|
| Rate for Payer: BCBS Trust/PPO |
$27.76
|
| Rate for Payer: BCN Commercial |
$27.76
|
| Rate for Payer: Cash Price |
$28.64
|
| Rate for Payer: Cofinity Commercial |
$33.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.64
|
| Rate for Payer: Healthscope Commercial |
$35.80
|
| Rate for Payer: Healthscope Whirlpool |
$34.73
|
| Rate for Payer: Mclaren Commercial |
$32.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.50
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
IP
|
$22.91
|
|
|
Service Code
|
NDC 60758-801-05
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna Commercial |
$20.62
|
| Rate for Payer: ASR ASR |
$22.22
|
| Rate for Payer: BCBS Trust/PPO |
$17.76
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: Cash Price |
$18.32
|
| Rate for Payer: Cofinity Commercial |
$21.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.33
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Healthscope Whirlpool |
$22.22
|
| Rate for Payer: Mclaren Commercial |
$20.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.16
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
IP
|
$389.50
|
|
|
Service Code
|
NDC 0904-6418-61
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.65 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Aetna Commercial |
$350.55
|
| Rate for Payer: ASR ASR |
$377.82
|
| Rate for Payer: BCBS Trust/PPO |
$301.98
|
| Rate for Payer: BCN Commercial |
$301.98
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$366.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$389.50
|
| Rate for Payer: Healthscope Whirlpool |
$377.82
|
| Rate for Payer: Mclaren Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.76
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
IP
|
$171.00
|
|
|
Service Code
|
NDC 50268-760-15
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.70 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: ASR ASR |
$165.87
|
| Rate for Payer: BCBS Trust/PPO |
$132.58
|
| Rate for Payer: BCN Commercial |
$132.58
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$160.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Healthscope Whirlpool |
$165.87
|
| Rate for Payer: Mclaren Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$145.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.48
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
IP
|
$162.15
|
|
|
Service Code
|
NDC 57664-503-89
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.50 |
| Max. Negotiated Rate |
$162.15 |
| Rate for Payer: Aetna Commercial |
$145.94
|
| Rate for Payer: ASR ASR |
$157.29
|
| Rate for Payer: BCBS Trust/PPO |
$125.71
|
| Rate for Payer: BCN Commercial |
$125.71
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Commercial |
$152.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$162.15
|
| Rate for Payer: Healthscope Whirlpool |
$157.29
|
| Rate for Payer: Mclaren Commercial |
$145.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$142.69
|
|
|
TIZANIDINE 4 MG TABLET
|
Facility
IP
|
$3.42
|
|
|
Service Code
|
NDC 50268-760-11
|
| Hospital Charge Code |
14793
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: Aetna Commercial |
$3.08
|
| Rate for Payer: ASR ASR |
$3.32
|
| Rate for Payer: BCBS Trust/PPO |
$2.65
|
| Rate for Payer: BCN Commercial |
$2.65
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$3.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.42
|
| Rate for Payer: Healthscope Whirlpool |
$3.32
|
| Rate for Payer: Mclaren Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.01
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
IP
|
$272.16
|
|
|
Service Code
|
NDC 0065-0647-25
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.51 |
| Max. Negotiated Rate |
$272.16 |
| Rate for Payer: Aetna Commercial |
$244.94
|
| Rate for Payer: ASR ASR |
$264.00
|
| Rate for Payer: BCBS Trust/PPO |
$211.01
|
| Rate for Payer: BCN Commercial |
$211.01
|
| Rate for Payer: Cash Price |
$217.73
|
| Rate for Payer: Cofinity Commercial |
$255.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.73
|
| Rate for Payer: Healthscope Commercial |
$272.16
|
| Rate for Payer: Healthscope Whirlpool |
$264.00
|
| Rate for Payer: Mclaren Commercial |
$244.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.50
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
IP
|
$76.79
|
|
|
Service Code
|
NDC 0574-4031-25
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$76.79 |
| Rate for Payer: Aetna Commercial |
$69.11
|
| Rate for Payer: ASR ASR |
$74.49
|
| Rate for Payer: BCBS Trust/PPO |
$59.54
|
| Rate for Payer: BCN Commercial |
$59.54
|
| Rate for Payer: Cash Price |
$61.43
|
| Rate for Payer: Cofinity Commercial |
$72.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.43
|
| Rate for Payer: Healthscope Commercial |
$76.79
|
| Rate for Payer: Healthscope Whirlpool |
$74.49
|
| Rate for Payer: Mclaren Commercial |
$69.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.58
|
|
|
TOBRAMYCIN 0.3 %-DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
IP
|
$164.60
|
|
|
Service Code
|
NDC 24208-295-25
|
| Hospital Charge Code |
11567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.22 |
| Max. Negotiated Rate |
$164.60 |
| Rate for Payer: Aetna Commercial |
$148.14
|
| Rate for Payer: ASR ASR |
$159.66
|
| Rate for Payer: BCBS Trust/PPO |
$127.61
|
| Rate for Payer: BCN Commercial |
$127.61
|
| Rate for Payer: Cash Price |
$131.68
|
| Rate for Payer: Cofinity Commercial |
$154.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.68
|
| Rate for Payer: Healthscope Commercial |
$164.60
|
| Rate for Payer: Healthscope Whirlpool |
$159.66
|
| Rate for Payer: Mclaren Commercial |
$148.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.85
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
IP
|
$37.84
|
|
|
Service Code
|
NDC 17478-290-10
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.49 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna Commercial |
$34.06
|
| Rate for Payer: ASR ASR |
$36.70
|
| Rate for Payer: BCBS Trust/PPO |
$29.34
|
| Rate for Payer: BCN Commercial |
$29.34
|
| Rate for Payer: Cash Price |
$30.27
|
| Rate for Payer: Cofinity Commercial |
$35.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.27
|
| Rate for Payer: Healthscope Commercial |
$37.84
|
| Rate for Payer: Healthscope Whirlpool |
$36.70
|
| Rate for Payer: Mclaren Commercial |
$34.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$33.30
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
IP
|
$20.92
|
|
|
Service Code
|
NDC 70069-131-01
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: ASR ASR |
$20.29
|
| Rate for Payer: BCBS Trust/PPO |
$16.22
|
| Rate for Payer: BCN Commercial |
$16.22
|
| Rate for Payer: Cash Price |
$16.74
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.74
|
| Rate for Payer: Healthscope Commercial |
$20.92
|
| Rate for Payer: Healthscope Whirlpool |
$20.29
|
| Rate for Payer: Mclaren Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.41
|
|
|
TOBRAMYCIN 0.3 % EYE DROPS
|
Facility
IP
|
$24.18
|
|
|
Service Code
|
NDC 62332-518-05
|
| Hospital Charge Code |
7995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$24.18 |
| Rate for Payer: Aetna Commercial |
$21.76
|
| Rate for Payer: ASR ASR |
$23.45
|
| Rate for Payer: BCBS Trust/PPO |
$18.75
|
| Rate for Payer: BCN Commercial |
$18.75
|
| Rate for Payer: Cash Price |
$19.35
|
| Rate for Payer: Cofinity Commercial |
$22.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$24.18
|
| Rate for Payer: Healthscope Whirlpool |
$23.45
|
| Rate for Payer: Mclaren Commercial |
$21.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.28
|
|
|
TOBRAMYCIN 0.3 % EYE OINTMENT
|
Facility
IP
|
$696.46
|
|
|
Service Code
|
NDC 0065-0644-35
|
| Hospital Charge Code |
19769
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$487.52 |
| Max. Negotiated Rate |
$696.46 |
| Rate for Payer: Aetna Commercial |
$626.81
|
| Rate for Payer: ASR ASR |
$675.57
|
| Rate for Payer: BCBS Trust/PPO |
$539.97
|
| Rate for Payer: BCN Commercial |
$539.97
|
| Rate for Payer: Cash Price |
$557.17
|
| Rate for Payer: Cofinity Commercial |
$654.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$557.17
|
| Rate for Payer: Healthscope Commercial |
$696.46
|
| Rate for Payer: Healthscope Whirlpool |
$675.57
|
| Rate for Payer: Mclaren Commercial |
$626.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$591.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$612.88
|
|
|
TOBRAMYCIN 1.2 GRAM SOLUTION FOR INJECTION
|
Facility
IP
|
$184.88
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
11565
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$129.42 |
| Max. Negotiated Rate |
$184.88 |
| Rate for Payer: Aetna Commercial |
$166.39
|
| Rate for Payer: ASR ASR |
$179.33
|
| Rate for Payer: BCBS Trust/PPO |
$143.34
|
| Rate for Payer: BCN Commercial |
$143.34
|
| Rate for Payer: Cash Price |
$147.91
|
| Rate for Payer: Cofinity Commercial |
$173.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.90
|
| Rate for Payer: Healthscope Commercial |
$184.88
|
| Rate for Payer: Healthscope Whirlpool |
$179.33
|
| Rate for Payer: Mclaren Commercial |
$166.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.69
|
|
|
TOBRAMYCIN 40 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
HCPCS J3260
|
| Hospital Charge Code |
7994
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: ASR ASR |
$49.47
|
| Rate for Payer: BCBS Trust/PPO |
$39.54
|
| Rate for Payer: BCN Commercial |
$39.54
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$47.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$51.00
|
| Rate for Payer: Healthscope Whirlpool |
$49.47
|
| Rate for Payer: Mclaren Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.88
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3 %-0.1 % EYE OINTMENT
|
Facility
IP
|
$740.11
|
|
|
Service Code
|
NDC 0065-0648-35
|
| Hospital Charge Code |
11566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$518.08 |
| Max. Negotiated Rate |
$740.11 |
| Rate for Payer: Aetna Commercial |
$666.10
|
| Rate for Payer: ASR ASR |
$717.91
|
| Rate for Payer: BCBS Trust/PPO |
$573.81
|
| Rate for Payer: BCN Commercial |
$573.81
|
| Rate for Payer: Cash Price |
$592.09
|
| Rate for Payer: Cofinity Commercial |
$695.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$592.09
|
| Rate for Payer: Healthscope Commercial |
$740.11
|
| Rate for Payer: Healthscope Whirlpool |
$717.91
|
| Rate for Payer: Mclaren Commercial |
$666.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$629.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$651.30
|
|
|
TOCILIZUMAB 200 MG/10 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$3,597.06
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119445
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,517.94 |
| Max. Negotiated Rate |
$3,597.06 |
| Rate for Payer: Aetna Commercial |
$3,237.35
|
| Rate for Payer: ASR ASR |
$3,489.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,788.80
|
| Rate for Payer: BCN Commercial |
$2,788.80
|
| Rate for Payer: Cash Price |
$2,877.64
|
| Rate for Payer: Cofinity Commercial |
$3,381.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,877.65
|
| Rate for Payer: Healthscope Commercial |
$3,597.06
|
| Rate for Payer: Healthscope Whirlpool |
$3,489.15
|
| Rate for Payer: Mclaren Commercial |
$3,237.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,057.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,517.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,165.41
|
|
|
TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$5,845.22
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
119446
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,091.65 |
| Max. Negotiated Rate |
$5,845.22 |
| Rate for Payer: Aetna Commercial |
$5,260.70
|
| Rate for Payer: ASR ASR |
$5,669.86
|
| Rate for Payer: BCBS Trust/PPO |
$4,531.80
|
| Rate for Payer: BCN Commercial |
$4,531.80
|
| Rate for Payer: Cash Price |
$4,676.17
|
| Rate for Payer: Cofinity Commercial |
$5,494.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,676.18
|
| Rate for Payer: Healthscope Commercial |
$5,845.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,669.86
|
| Rate for Payer: Mclaren Commercial |
$5,260.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,968.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,091.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,143.79
|
|
|
TOCILIZUMAB 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
IP
|
$1,532.35
|
|
|
Service Code
|
HCPCS J3262
|
| Hospital Charge Code |
99452
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,072.64 |
| Max. Negotiated Rate |
$1,532.35 |
| Rate for Payer: Aetna Commercial |
$1,379.12
|
| Rate for Payer: ASR ASR |
$1,486.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.03
|
| Rate for Payer: BCN Commercial |
$1,188.03
|
| Rate for Payer: Cash Price |
$1,225.88
|
| Rate for Payer: Cofinity Commercial |
$1,440.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,225.88
|
| Rate for Payer: Healthscope Commercial |
$1,532.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,486.38
|
| Rate for Payer: Mclaren Commercial |
$1,379.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,302.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,348.47
|
|
|
TOLVAPTAN 30 MG TABLET
|
Facility
IP
|
$16,534.86
|
|
|
Service Code
|
NDC 67877-636-02
|
| Hospital Charge Code |
97894
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11,574.40 |
| Max. Negotiated Rate |
$16,534.86 |
| Rate for Payer: Aetna Commercial |
$14,881.37
|
| Rate for Payer: ASR ASR |
$16,038.81
|
| Rate for Payer: BCBS Trust/PPO |
$12,819.48
|
| Rate for Payer: BCN Commercial |
$12,819.48
|
| Rate for Payer: Cash Price |
$13,227.88
|
| Rate for Payer: Cofinity Commercial |
$15,542.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,227.89
|
| Rate for Payer: Healthscope Commercial |
$16,534.86
|
| Rate for Payer: Healthscope Whirlpool |
$16,038.81
|
| Rate for Payer: Mclaren Commercial |
$14,881.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14,054.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,574.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14,550.68
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
IP
|
$470.00
|
|
|
Service Code
|
NDC 0904-6928-61
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$329.00 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: ASR ASR |
$455.90
|
| Rate for Payer: BCBS Trust/PPO |
$364.39
|
| Rate for Payer: BCN Commercial |
$364.39
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$441.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$470.00
|
| Rate for Payer: Healthscope Whirlpool |
$455.90
|
| Rate for Payer: Mclaren Commercial |
$423.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$399.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$413.60
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084-342-11
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Cofinity Commercial |
$202.71
|
| Rate for Payer: Aetna Commercial |
$194.08
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: BCBS Trust/PPO |
$167.19
|
| Rate for Payer: BCN Commercial |
$167.19
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$215.65
|
| Rate for Payer: Healthscope Whirlpool |
$209.18
|
| Rate for Payer: Mclaren Commercial |
$194.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
IP
|
$475.00
|
|
|
Service Code
|
NDC 50111-916-01
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.50 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: ASR ASR |
$460.75
|
| Rate for Payer: BCBS Trust/PPO |
$368.27
|
| Rate for Payer: BCN Commercial |
$368.27
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$446.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$475.00
|
| Rate for Payer: Healthscope Whirlpool |
$460.75
|
| Rate for Payer: Mclaren Commercial |
$427.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$418.00
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
IP
|
$2.06
|
|
|
Service Code
|
NDC 50268-755-11
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.85
|
| Rate for Payer: ASR ASR |
$2.00
|
| Rate for Payer: BCBS Trust/PPO |
$1.60
|
| Rate for Payer: BCN Commercial |
$1.60
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.65
|
| Rate for Payer: Healthscope Commercial |
$2.06
|
| Rate for Payer: Healthscope Whirlpool |
$2.00
|
| Rate for Payer: Mclaren Commercial |
$1.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.81
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
IP
|
$103.08
|
|
|
Service Code
|
NDC 50268-755-15
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.16 |
| Max. Negotiated Rate |
$103.08 |
| Rate for Payer: Aetna Commercial |
$92.77
|
| Rate for Payer: ASR ASR |
$99.99
|
| Rate for Payer: BCBS Trust/PPO |
$79.92
|
| Rate for Payer: BCN Commercial |
$79.92
|
| Rate for Payer: Cash Price |
$82.46
|
| Rate for Payer: Cofinity Commercial |
$96.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.46
|
| Rate for Payer: Healthscope Commercial |
$103.08
|
| Rate for Payer: Healthscope Whirlpool |
$99.99
|
| Rate for Payer: Mclaren Commercial |
$92.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.71
|
|
