|
TOLVAPTAN 15 MG TABLET
|
Facility
|
IP
|
$2,108.52
|
|
|
Service Code
|
NDC 67877063533
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,581.39 |
| Max. Negotiated Rate |
$2,108.52 |
| Rate for Payer: Aetna Commercial |
$1,897.67
|
| Rate for Payer: ASR ASR |
$2,045.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,731.52
|
| Rate for Payer: BCN Commercial |
$1,731.52
|
| Rate for Payer: Cash Price |
$1,686.82
|
| Rate for Payer: Cofinity Commercial |
$1,982.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.82
|
| Rate for Payer: Healthscope Commercial |
$2,045.26
|
| Rate for Payer: Healthscope Whirlpool |
$2,108.52
|
| Rate for Payer: Mclaren Commercial |
$1,897.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,792.24
|
| Rate for Payer: Nomi Health Commercial |
$1,728.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,581.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,855.50
|
|
|
TOLVAPTAN 15 MG TABLET
|
Facility
|
OP
|
$2,108.52
|
|
|
Service Code
|
NDC 67877063533
|
| Hospital Charge Code |
97893
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$780.15 |
| Max. Negotiated Rate |
$2,108.52 |
| Rate for Payer: Aetna Commercial |
$1,897.67
|
| Rate for Payer: Aetna Medicare |
$780.15
|
| Rate for Payer: ASR ASR |
$2,045.26
|
| Rate for Payer: BCBS Complete |
$843.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.47
|
| Rate for Payer: BCN Commercial |
$1,738.47
|
| Rate for Payer: Cash Price |
$1,686.82
|
| Rate for Payer: Cofinity Commercial |
$1,982.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,686.82
|
| Rate for Payer: Healthscope Commercial |
$2,045.26
|
| Rate for Payer: Healthscope Whirlpool |
$2,108.52
|
| Rate for Payer: Mclaren Commercial |
$1,897.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,686.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,792.24
|
| Rate for Payer: Nomi Health Commercial |
$1,728.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,581.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,847.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,478.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,855.50
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$7,438.02
|
|
|
Service Code
|
APR-DRG 0972
|
| Min. Negotiated Rate |
$6,724.86 |
| Max. Negotiated Rate |
$7,438.02 |
| Rate for Payer: BCBS Complete |
$7,438.02
|
| Rate for Payer: Mclaren Medicaid |
$7,083.83
|
| Rate for Payer: Meridian Medicaid |
$7,438.02
|
| Rate for Payer: PHP Medicaid |
$6,724.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,083.83
|
| Rate for Payer: UHC Medicaid |
$7,083.83
|
| Rate for Payer: UHCCP Medicaid |
$7,083.83
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$11,134.96
|
|
|
Service Code
|
APR-DRG 0973
|
| Min. Negotiated Rate |
$10,067.34 |
| Max. Negotiated Rate |
$11,134.96 |
| Rate for Payer: BCBS Complete |
$11,134.96
|
| Rate for Payer: Mclaren Medicaid |
$10,604.73
|
| Rate for Payer: Meridian Medicaid |
$11,134.96
|
| Rate for Payer: PHP Medicaid |
$10,067.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,604.73
|
| Rate for Payer: UHC Medicaid |
$10,604.73
|
| Rate for Payer: UHCCP Medicaid |
$10,604.73
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$19,813.84
|
|
|
Service Code
|
APR-DRG 0974
|
| Min. Negotiated Rate |
$17,914.08 |
| Max. Negotiated Rate |
$19,813.84 |
| Rate for Payer: BCBS Complete |
$19,813.84
|
| Rate for Payer: Mclaren Medicaid |
$18,870.32
|
| Rate for Payer: Meridian Medicaid |
$19,813.84
|
| Rate for Payer: PHP Medicaid |
$17,914.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,870.32
|
| Rate for Payer: UHC Medicaid |
$18,870.32
|
| Rate for Payer: UHCCP Medicaid |
$18,870.32
|
|
|
TONSIL AND ADENOID PROCEDURES
|
Facility
|
IP
|
$4,882.21
|
|
|
Service Code
|
APR-DRG 0971
|
| Min. Negotiated Rate |
$4,414.10 |
| Max. Negotiated Rate |
$4,882.21 |
| Rate for Payer: BCBS Complete |
$4,882.21
|
| Rate for Payer: Mclaren Medicaid |
$4,649.72
|
| Rate for Payer: Meridian Medicaid |
$4,882.21
|
| Rate for Payer: PHP Medicaid |
$4,414.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,649.72
|
| Rate for Payer: UHC Medicaid |
$4,649.72
|
| Rate for Payer: UHCCP Medicaid |
$4,649.72
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$232.75
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.56 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Trust/PPO |
$191.13
|
| Rate for Payer: BCN Commercial |
$191.13
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.89 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$190.66
|
| Rate for Payer: ASR ASR |
$205.49
|
| Rate for Payer: BCBS Trust/PPO |
$173.97
|
| Rate for Payer: BCN Commercial |
$173.97
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$199.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$205.49
|
| Rate for Payer: Healthscope Whirlpool |
$211.85
|
| Rate for Payer: Mclaren Commercial |
$190.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.43
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$190.66
|
| Rate for Payer: Aetna Medicare |
$78.38
|
| Rate for Payer: ASR ASR |
$205.49
|
| Rate for Payer: BCBS Complete |
$84.74
|
| Rate for Payer: BCBS Trust/PPO |
$174.67
|
| Rate for Payer: BCN Commercial |
$174.67
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Commercial |
$199.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$205.49
|
| Rate for Payer: Healthscope Whirlpool |
$211.85
|
| Rate for Payer: Mclaren Commercial |
$190.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Nomi Health Commercial |
$173.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$185.62
|
| Rate for Payer: Priority Health Narrow Network |
$148.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.43
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$232.75
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.12 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$209.47
|
| Rate for Payer: Aetna Medicare |
$86.12
|
| Rate for Payer: ASR ASR |
$225.77
|
| Rate for Payer: BCBS Complete |
$93.10
|
| Rate for Payer: BCBS Trust/PPO |
$191.90
|
| Rate for Payer: BCN Commercial |
$191.90
|
| Rate for Payer: Cash Price |
$186.20
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$186.20
|
| Rate for Payer: Healthscope Commercial |
$225.77
|
| Rate for Payer: Healthscope Whirlpool |
$232.75
|
| Rate for Payer: Mclaren Commercial |
$209.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$197.84
|
| Rate for Payer: Nomi Health Commercial |
$190.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$203.94
|
| Rate for Payer: Priority Health Narrow Network |
$163.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$204.82
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$465.50
|
|
|
Service Code
|
NDC 50111091601
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.24 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Aetna Commercial |
$418.95
|
| Rate for Payer: Aetna Medicare |
$172.24
|
| Rate for Payer: ASR ASR |
$451.54
|
| Rate for Payer: BCBS Complete |
$186.20
|
| Rate for Payer: BCBS Trust/PPO |
$383.80
|
| Rate for Payer: BCN Commercial |
$383.80
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$437.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$451.54
|
| Rate for Payer: Healthscope Whirlpool |
$465.50
|
| Rate for Payer: Mclaren Commercial |
$418.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Nomi Health Commercial |
$381.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$407.87
|
| Rate for Payer: Priority Health Narrow Network |
$326.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$409.64
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 50268075511
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.03
|
| Rate for Payer: ASR ASR |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$1.85
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.18
|
| Rate for Payer: Healthscope Whirlpool |
$2.25
|
| Rate for Payer: Mclaren Commercial |
$2.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.91
|
| Rate for Payer: Nomi Health Commercial |
$1.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.98
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 31722053001
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.09 |
| Max. Negotiated Rate |
$345.45 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: ASR ASR |
$335.09
|
| Rate for Payer: BCBS Trust/PPO |
$283.68
|
| Rate for Payer: BCN Commercial |
$283.68
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$324.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$335.09
|
| Rate for Payer: Healthscope Whirlpool |
$345.45
|
| Rate for Payer: Mclaren Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Nomi Health Commercial |
$283.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.00
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$112.58
|
|
|
Service Code
|
NDC 50268075515
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.43 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Aetna Commercial |
$101.32
|
| Rate for Payer: ASR ASR |
$109.20
|
| Rate for Payer: BCBS Trust/PPO |
$92.45
|
| Rate for Payer: BCN Commercial |
$92.45
|
| Rate for Payer: Cash Price |
$90.06
|
| Rate for Payer: Cofinity Commercial |
$105.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.06
|
| Rate for Payer: Healthscope Commercial |
$109.20
|
| Rate for Payer: Healthscope Whirlpool |
$112.58
|
| Rate for Payer: Mclaren Commercial |
$101.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.69
|
| Rate for Payer: Nomi Health Commercial |
$92.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.07
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 31722053001
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$345.45 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Aetna Medicare |
$127.82
|
| Rate for Payer: ASR ASR |
$335.09
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: BCBS Trust/PPO |
$284.82
|
| Rate for Payer: BCN Commercial |
$284.82
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$324.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$335.09
|
| Rate for Payer: Healthscope Whirlpool |
$345.45
|
| Rate for Payer: Mclaren Commercial |
$310.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Nomi Health Commercial |
$283.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$302.68
|
| Rate for Payer: Priority Health Narrow Network |
$242.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.00
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 50268075511
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.25 |
| Rate for Payer: Aetna Commercial |
$2.03
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: ASR ASR |
$2.18
|
| Rate for Payer: BCBS Complete |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$1.86
|
| Rate for Payer: BCN Commercial |
$1.86
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.18
|
| Rate for Payer: Healthscope Whirlpool |
$2.25
|
| Rate for Payer: Mclaren Commercial |
$2.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.91
|
| Rate for Payer: Nomi Health Commercial |
$1.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.97
|
| Rate for Payer: Priority Health Narrow Network |
$1.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.98
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$465.50
|
|
|
Service Code
|
NDC 50111091601
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.12 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Aetna Commercial |
$418.95
|
| Rate for Payer: ASR ASR |
$451.54
|
| Rate for Payer: BCBS Trust/PPO |
$382.27
|
| Rate for Payer: BCN Commercial |
$382.27
|
| Rate for Payer: Cash Price |
$372.40
|
| Rate for Payer: Cofinity Commercial |
$437.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.40
|
| Rate for Payer: Healthscope Commercial |
$451.54
|
| Rate for Payer: Healthscope Whirlpool |
$465.50
|
| Rate for Payer: Mclaren Commercial |
$418.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.68
|
| Rate for Payer: Nomi Health Commercial |
$381.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$409.64
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$112.58
|
|
|
Service Code
|
NDC 50268075515
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$112.58 |
| Rate for Payer: Aetna Commercial |
$101.32
|
| Rate for Payer: Aetna Medicare |
$41.65
|
| Rate for Payer: ASR ASR |
$109.20
|
| Rate for Payer: BCBS Complete |
$45.03
|
| Rate for Payer: BCBS Trust/PPO |
$92.82
|
| Rate for Payer: BCN Commercial |
$92.82
|
| Rate for Payer: Cash Price |
$90.06
|
| Rate for Payer: Cofinity Commercial |
$105.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.06
|
| Rate for Payer: Healthscope Commercial |
$109.20
|
| Rate for Payer: Healthscope Whirlpool |
$112.58
|
| Rate for Payer: Mclaren Commercial |
$101.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.69
|
| Rate for Payer: Nomi Health Commercial |
$92.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$98.64
|
| Rate for Payer: Priority Health Narrow Network |
$78.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.07
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$288.80
|
|
|
Service Code
|
NDC 904728361
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.86 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna Commercial |
$259.92
|
| Rate for Payer: Aetna Medicare |
$106.86
|
| Rate for Payer: ASR ASR |
$280.14
|
| Rate for Payer: BCBS Complete |
$115.52
|
| Rate for Payer: BCBS Trust/PPO |
$238.12
|
| Rate for Payer: BCN Commercial |
$238.12
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Commercial |
$271.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$280.14
|
| Rate for Payer: Healthscope Whirlpool |
$288.80
|
| Rate for Payer: Mclaren Commercial |
$259.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Nomi Health Commercial |
$236.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$253.05
|
| Rate for Payer: Priority Health Narrow Network |
$202.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.14
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$317.30
|
|
|
Service Code
|
NDC 68084053901
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.40 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna Commercial |
$285.57
|
| Rate for Payer: Aetna Medicare |
$117.40
|
| Rate for Payer: ASR ASR |
$307.78
|
| Rate for Payer: BCBS Complete |
$126.92
|
| Rate for Payer: BCBS Trust/PPO |
$261.61
|
| Rate for Payer: BCN Commercial |
$261.61
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cofinity Commercial |
$298.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Healthscope Commercial |
$307.78
|
| Rate for Payer: Healthscope Whirlpool |
$317.30
|
| Rate for Payer: Mclaren Commercial |
$285.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$253.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Nomi Health Commercial |
$260.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.02
|
| Rate for Payer: Priority Health Narrow Network |
$222.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.22
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$317.30
|
|
|
Service Code
|
NDC 68084053901
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.97 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna Commercial |
$285.57
|
| Rate for Payer: ASR ASR |
$307.78
|
| Rate for Payer: BCBS Trust/PPO |
$260.57
|
| Rate for Payer: BCN Commercial |
$260.57
|
| Rate for Payer: Cash Price |
$253.84
|
| Rate for Payer: Cofinity Commercial |
$298.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.84
|
| Rate for Payer: Healthscope Commercial |
$307.78
|
| Rate for Payer: Healthscope Whirlpool |
$317.30
|
| Rate for Payer: Mclaren Commercial |
$285.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.70
|
| Rate for Payer: Nomi Health Commercial |
$260.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.22
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: ASR ASR |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.36
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Mclaren Commercial |
$2.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.06
|
| Rate for Payer: ASR ASR |
$2.78
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.30
|
| Rate for Payer: Healthscope Commercial |
$2.78
|
| Rate for Payer: Healthscope Whirlpool |
$2.87
|
| Rate for Payer: Mclaren Commercial |
$2.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.44
|
| Rate for Payer: Nomi Health Commercial |
$2.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.51
|
| Rate for Payer: Priority Health Narrow Network |
$2.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.52
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$288.80
|
|
|
Service Code
|
NDC 904728361
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.60 |
| Max. Negotiated Rate |
$288.80 |
| Rate for Payer: Aetna Commercial |
$259.92
|
| Rate for Payer: ASR ASR |
$280.14
|
| Rate for Payer: BCBS Trust/PPO |
$237.16
|
| Rate for Payer: BCN Commercial |
$237.16
|
| Rate for Payer: Cash Price |
$231.04
|
| Rate for Payer: Cofinity Commercial |
$271.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.04
|
| Rate for Payer: Healthscope Commercial |
$280.14
|
| Rate for Payer: Healthscope Whirlpool |
$288.80
|
| Rate for Payer: Mclaren Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.48
|
| Rate for Payer: Nomi Health Commercial |
$236.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.14
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$129.10
|
| Rate for Payer: Aetna Medicare |
$53.08
|
| Rate for Payer: ASR ASR |
$139.15
|
| Rate for Payer: BCBS Complete |
$57.38
|
| Rate for Payer: BCBS Trust/PPO |
$118.27
|
| Rate for Payer: BCN Commercial |
$118.27
|
| Rate for Payer: Cash Price |
$114.76
|
| Rate for Payer: Cofinity Commercial |
$134.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.76
|
| Rate for Payer: Healthscope Commercial |
$139.15
|
| Rate for Payer: Healthscope Whirlpool |
$143.45
|
| Rate for Payer: Mclaren Commercial |
$129.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Nomi Health Commercial |
$117.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$125.69
|
| Rate for Payer: Priority Health Narrow Network |
$100.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.24
|
|
