|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$176.13
|
| Rate for Payer: ASR ASR |
$189.83
|
| Rate for Payer: ASR Commercial |
$189.83
|
| Rate for Payer: BCBS Trust/PPO |
$159.48
|
| Rate for Payer: BCN Commercial |
$151.73
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$183.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$195.70
|
| Rate for Payer: Healthscope Whirlpool |
$189.83
|
| Rate for Payer: Mclaren Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.22
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.17 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$194.09
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: ASR Commercial |
$209.18
|
| Rate for Payer: BCBS Trust/PPO |
$175.73
|
| Rate for Payer: BCN Commercial |
$167.19
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$202.71
|
| 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 |
$194.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.26 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$194.09
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: ASR Commercial |
$209.18
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: BCBS Trust/PPO |
$176.60
|
| Rate for Payer: BCN Commercial |
$167.19
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$202.71
|
| 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 |
$194.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.28 |
| Max. Negotiated Rate |
$195.70 |
| Rate for Payer: Aetna Commercial |
$176.13
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: ASR ASR |
$189.83
|
| Rate for Payer: ASR Commercial |
$189.83
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS Trust/PPO |
$160.26
|
| Rate for Payer: BCN Commercial |
$151.73
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$183.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$195.70
|
| Rate for Payer: Healthscope Whirlpool |
$189.83
|
| Rate for Payer: Mclaren Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: Nomi Health Commercial |
$160.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.47
|
| Rate for Payer: Priority Health Narrow Network |
$137.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$172.22
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
NDC 50268075511
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: ASR ASR |
$2.03
|
| Rate for Payer: ASR Commercial |
$2.03
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$2.09
|
| Rate for Payer: Healthscope Whirlpool |
$2.03
|
| Rate for Payer: Mclaren Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.83
|
| Rate for Payer: Priority Health Narrow Network |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.84
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$104.50
|
|
|
Service Code
|
NDC 50268075515
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$94.05
|
| Rate for Payer: Aetna Medicare |
$52.25
|
| Rate for Payer: ASR ASR |
$101.36
|
| Rate for Payer: ASR Commercial |
$101.36
|
| Rate for Payer: BCBS Complete |
$41.80
|
| Rate for Payer: BCBS Trust/PPO |
$85.58
|
| Rate for Payer: BCN Commercial |
$81.02
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cofinity Commercial |
$98.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.60
|
| Rate for Payer: Healthscope Commercial |
$104.50
|
| Rate for Payer: Healthscope Whirlpool |
$101.36
|
| Rate for Payer: Mclaren Commercial |
$94.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.83
|
| Rate for Payer: Nomi Health Commercial |
$85.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.56
|
| Rate for Payer: Priority Health Narrow Network |
$73.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.96
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
NDC 50111091601
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Medicare |
$237.50
|
| Rate for Payer: ASR ASR |
$460.75
|
| Rate for Payer: ASR Commercial |
$460.75
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: BCBS Trust/PPO |
$388.98
|
| 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 Commercial |
$403.75
|
| Rate for Payer: Nomi Health Commercial |
$389.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$416.19
|
| Rate for Payer: Priority Health Narrow Network |
$332.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$418.00
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 31722053001
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$345.45 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: Aetna Medicare |
$172.72
|
| Rate for Payer: ASR ASR |
$335.09
|
| Rate for Payer: ASR Commercial |
$335.09
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: BCBS Trust/PPO |
$282.89
|
| Rate for Payer: BCN Commercial |
$267.83
|
| 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 |
$345.45
|
| Rate for Payer: Healthscope Whirlpool |
$335.09
|
| 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: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: 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
|
IP
|
$104.50
|
|
|
Service Code
|
NDC 50268075515
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$94.05
|
| Rate for Payer: ASR ASR |
$101.36
|
| Rate for Payer: ASR Commercial |
$101.36
|
| Rate for Payer: BCBS Trust/PPO |
$85.16
|
| Rate for Payer: BCN Commercial |
$81.02
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cofinity Commercial |
$98.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$83.60
|
| Rate for Payer: Healthscope Commercial |
$104.50
|
| Rate for Payer: Healthscope Whirlpool |
$101.36
|
| Rate for Payer: Mclaren Commercial |
$94.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.83
|
| Rate for Payer: Nomi Health Commercial |
$85.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.96
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 31722053001
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.54 |
| Max. Negotiated Rate |
$345.45 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: ASR ASR |
$335.09
|
| Rate for Payer: ASR Commercial |
$335.09
|
| Rate for Payer: BCBS Trust/PPO |
$281.51
|
| Rate for Payer: BCN Commercial |
$267.83
|
| 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 |
$345.45
|
| Rate for Payer: Healthscope Whirlpool |
$335.09
|
| 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: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.00
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
NDC 50268075511
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: ASR ASR |
$2.03
|
| Rate for Payer: ASR Commercial |
$2.03
|
| Rate for Payer: BCBS Trust/PPO |
$1.70
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$2.09
|
| Rate for Payer: Healthscope Whirlpool |
$2.03
|
| Rate for Payer: Mclaren Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.84
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
NDC 50111091601
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$475.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: ASR ASR |
$460.75
|
| Rate for Payer: ASR Commercial |
$460.75
|
| Rate for Payer: BCBS Trust/PPO |
$387.08
|
| 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 Commercial |
$403.75
|
| Rate for Payer: Nomi Health Commercial |
$389.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$418.00
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: ASR ASR |
$2.78
|
| Rate for Payer: ASR Commercial |
$2.78
|
| Rate for Payer: BCBS Complete |
$1.15
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.23
|
| 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 |
$2.87
|
| Rate for Payer: Healthscope Whirlpool |
$2.78
|
| 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: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: 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 |
$2.53
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 68084053901
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.74 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$153.43
|
| Rate for Payer: ASR ASR |
$297.64
|
| Rate for Payer: ASR Commercial |
$297.64
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: BCBS Trust/PPO |
$251.28
|
| Rate for Payer: BCN Commercial |
$237.90
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$288.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$306.85
|
| Rate for Payer: Healthscope Whirlpool |
$297.64
|
| Rate for Payer: Mclaren Commercial |
$276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.86
|
| Rate for Payer: Priority Health Narrow Network |
$215.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.03
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$278.35
|
|
|
Service Code
|
NDC 00904728361
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.93 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna Commercial |
$250.51
|
| Rate for Payer: ASR ASR |
$270.00
|
| Rate for Payer: ASR Commercial |
$270.00
|
| Rate for Payer: BCBS Trust/PPO |
$226.83
|
| Rate for Payer: BCN Commercial |
$215.80
|
| Rate for Payer: Cash Price |
$222.68
|
| Rate for Payer: Cofinity Commercial |
$261.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$278.35
|
| Rate for Payer: Healthscope Whirlpool |
$270.00
|
| Rate for Payer: Mclaren Commercial |
$250.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.60
|
| Rate for Payer: Nomi Health Commercial |
$228.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.95
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$129.10
|
| Rate for Payer: ASR ASR |
$139.15
|
| Rate for Payer: ASR Commercial |
$139.15
|
| Rate for Payer: BCBS Trust/PPO |
$116.90
|
| Rate for Payer: BCN Commercial |
$111.22
|
| 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 |
$143.45
|
| Rate for Payer: Healthscope Whirlpool |
$139.15
|
| Rate for Payer: Mclaren Commercial |
$129.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Nomi Health Commercial |
$117.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.24
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 50268075611
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: ASR ASR |
$2.78
|
| Rate for Payer: ASR Commercial |
$2.78
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.23
|
| 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 |
$2.87
|
| Rate for Payer: Healthscope Whirlpool |
$2.78
|
| 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: Priority Health Cigna Priority Health |
$1.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.53
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$278.35
|
|
|
Service Code
|
NDC 00904728361
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.34 |
| Max. Negotiated Rate |
$278.35 |
| Rate for Payer: Aetna Commercial |
$250.51
|
| Rate for Payer: Aetna Medicare |
$139.18
|
| Rate for Payer: ASR ASR |
$270.00
|
| Rate for Payer: ASR Commercial |
$270.00
|
| Rate for Payer: BCBS Complete |
$111.34
|
| Rate for Payer: BCBS Trust/PPO |
$227.94
|
| Rate for Payer: BCN Commercial |
$215.80
|
| Rate for Payer: Cash Price |
$222.68
|
| Rate for Payer: Cofinity Commercial |
$261.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.68
|
| Rate for Payer: Healthscope Commercial |
$278.35
|
| Rate for Payer: Healthscope Whirlpool |
$270.00
|
| Rate for Payer: Mclaren Commercial |
$250.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.60
|
| Rate for Payer: Nomi Health Commercial |
$228.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.89
|
| Rate for Payer: Priority Health Narrow Network |
$195.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$244.95
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 68084053911
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: ASR ASR |
$297.64
|
| Rate for Payer: ASR Commercial |
$297.64
|
| Rate for Payer: BCBS Trust/PPO |
$250.05
|
| Rate for Payer: BCN Commercial |
$237.90
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$288.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$306.85
|
| Rate for Payer: Healthscope Whirlpool |
$297.64
|
| Rate for Payer: Mclaren Commercial |
$276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.03
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 68084053901
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: ASR ASR |
$297.64
|
| Rate for Payer: ASR Commercial |
$297.64
|
| Rate for Payer: BCBS Trust/PPO |
$250.05
|
| Rate for Payer: BCN Commercial |
$237.90
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$288.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$306.85
|
| Rate for Payer: Healthscope Whirlpool |
$297.64
|
| Rate for Payer: Mclaren Commercial |
$276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.03
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$143.45
|
|
|
Service Code
|
NDC 50268075615
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.38 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$129.10
|
| Rate for Payer: Aetna Medicare |
$71.72
|
| Rate for Payer: ASR ASR |
$139.15
|
| Rate for Payer: ASR Commercial |
$139.15
|
| Rate for Payer: BCBS Complete |
$57.38
|
| Rate for Payer: BCBS Trust/PPO |
$117.47
|
| Rate for Payer: BCN Commercial |
$111.22
|
| 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 |
$143.45
|
| Rate for Payer: Healthscope Whirlpool |
$139.15
|
| Rate for Payer: Mclaren Commercial |
$129.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.93
|
| Rate for Payer: Nomi Health Commercial |
$117.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.24
|
| Rate for Payer: 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
|
|
|
TORSEMIDE 20 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 68084053911
|
| Hospital Charge Code |
18293
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.74 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$153.43
|
| Rate for Payer: ASR ASR |
$297.64
|
| Rate for Payer: ASR Commercial |
$297.64
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: BCBS Trust/PPO |
$251.28
|
| Rate for Payer: BCN Commercial |
$237.90
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$288.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$306.85
|
| Rate for Payer: Healthscope Whirlpool |
$297.64
|
| Rate for Payer: Mclaren Commercial |
$276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.86
|
| Rate for Payer: Priority Health Narrow Network |
$215.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.03
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
OP
|
$1.01
|
|
|
Service Code
|
NDC 51079099101
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna Commercial |
$0.91
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: ASR ASR |
$0.98
|
| Rate for Payer: ASR Commercial |
$0.98
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.83
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cofinity Commercial |
$0.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$1.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.98
|
| Rate for Payer: Mclaren Commercial |
$0.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.86
|
| Rate for Payer: Nomi Health Commercial |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.88
|
| Rate for Payer: Priority Health Narrow Network |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.89
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$1.01
|
|
|
Service Code
|
NDC 51079099101
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna Commercial |
$0.91
|
| Rate for Payer: ASR ASR |
$0.98
|
| Rate for Payer: ASR Commercial |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$0.82
|
| Rate for Payer: BCN Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Cofinity Commercial |
$0.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$0.81
|
| Rate for Payer: Healthscope Commercial |
$1.01
|
| Rate for Payer: Healthscope Whirlpool |
$0.98
|
| Rate for Payer: Mclaren Commercial |
$0.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.86
|
| Rate for Payer: Nomi Health Commercial |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.89
|
|
|
TRAMADOL 50 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 68084080801
|
| Hospital Charge Code |
14632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.83 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: ASR Commercial |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$231.72
|
| Rate for Payer: BCN Commercial |
$220.46
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$284.35
|
| Rate for Payer: Healthscope Whirlpool |
$275.82
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
