|
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27380
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27385
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT
|
Facility
|
OP
|
$19,611.80
|
|
|
Service Code
|
CPT 27386
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,734.39 |
| Max. Negotiated Rate |
$19,611.80 |
| Rate for Payer: Aetna Medicare |
$7,245.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,708.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,708.92
|
| Rate for Payer: BCBS Complete |
$3,921.11
|
| Rate for Payer: BCBS MAPPO |
$6,967.14
|
| Rate for Payer: BCN Medicare Advantage |
$6,967.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,967.14
|
| Rate for Payer: Mclaren Medicaid |
$3,734.39
|
| Rate for Payer: Mclaren Medicare |
$6,967.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,315.50
|
| Rate for Payer: Meridian Medicaid |
$3,921.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,012.21
|
| Rate for Payer: PACE Medicare |
$6,618.78
|
| Rate for Payer: PACE SWMI |
$6,967.14
|
| Rate for Payer: PHP Medicare Advantage |
$6,967.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,734.39
|
| Rate for Payer: Priority Health Medicare |
$6,967.14
|
| Rate for Payer: Railroad Medicare Medicare |
$6,967.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,611.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,967.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,967.14
|
| Rate for Payer: UHCCP Medicaid |
$3,922.50
|
| Rate for Payer: VA VA |
$6,967.14
|
|
|
SUVOREXANT 10 MG TABLET
|
Facility
|
OP
|
$533.99
|
|
|
Service Code
|
NDC 00006003310
|
| Hospital Charge Code |
173275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$480.59 |
| Rate for Payer: Aetna Commercial |
$453.89
|
| Rate for Payer: Aetna Medicare |
$267.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.09
|
| Rate for Payer: BCBS Complete |
$213.60
|
| Rate for Payer: Cash Price |
$427.19
|
| Rate for Payer: Cofinity Commercial |
$373.79
|
| Rate for Payer: Cofinity Commercial |
$459.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$373.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.19
|
| Rate for Payer: Healthscope Commercial |
$480.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.89
|
| Rate for Payer: PHP Commercial |
$453.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.09
|
| Rate for Payer: Priority Health SBD |
$336.41
|
|
|
SUVOREXANT 10 MG TABLET
|
Facility
|
IP
|
$1,601.96
|
|
|
Service Code
|
NDC 00006003330
|
| Hospital Charge Code |
173275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,009.23 |
| Max. Negotiated Rate |
$1,441.76 |
| Rate for Payer: Aetna Commercial |
$1,361.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,041.27
|
| Rate for Payer: Cash Price |
$1,281.57
|
| Rate for Payer: Cofinity Commercial |
$1,121.37
|
| Rate for Payer: Cofinity Commercial |
$1,377.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,121.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.57
|
| Rate for Payer: Healthscope Commercial |
$1,441.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.67
|
| Rate for Payer: PHP Commercial |
$1,361.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.27
|
| Rate for Payer: Priority Health SBD |
$1,009.23
|
|
|
SUVOREXANT 10 MG TABLET
|
Facility
|
OP
|
$1,601.96
|
|
|
Service Code
|
NDC 00006003330
|
| Hospital Charge Code |
173275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$640.78 |
| Max. Negotiated Rate |
$1,441.76 |
| Rate for Payer: Aetna Commercial |
$1,361.67
|
| Rate for Payer: Aetna Medicare |
$800.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,041.27
|
| Rate for Payer: BCBS Complete |
$640.78
|
| Rate for Payer: Cash Price |
$1,281.57
|
| Rate for Payer: Cofinity Commercial |
$1,121.37
|
| Rate for Payer: Cofinity Commercial |
$1,377.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,121.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.57
|
| Rate for Payer: Healthscope Commercial |
$1,441.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.67
|
| Rate for Payer: PHP Commercial |
$1,361.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.27
|
| Rate for Payer: Priority Health SBD |
$1,009.23
|
|
|
SUVOREXANT 10 MG TABLET
|
Facility
|
IP
|
$533.99
|
|
|
Service Code
|
NDC 00006003310
|
| Hospital Charge Code |
173275
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$336.41 |
| Max. Negotiated Rate |
$480.59 |
| Rate for Payer: Aetna Commercial |
$453.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.09
|
| Rate for Payer: Cash Price |
$427.19
|
| Rate for Payer: Cofinity Commercial |
$373.79
|
| Rate for Payer: Cofinity Commercial |
$459.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$373.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$427.19
|
| Rate for Payer: Healthscope Commercial |
$480.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$453.89
|
| Rate for Payer: PHP Commercial |
$453.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.09
|
| Rate for Payer: Priority Health SBD |
$336.41
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$504.96
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$318.12 |
| Max. Negotiated Rate |
$454.46 |
| Rate for Payer: Aetna Commercial |
$429.22
|
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Aetna Commercial |
$4.29
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: Cash Price |
$403.97
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$247.63
|
| Rate for Payer: Cofinity Commercial |
$304.23
|
| Rate for Payer: Cofinity Commercial |
$434.27
|
| Rate for Payer: Cofinity Commercial |
$353.47
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.04
|
| Rate for Payer: Healthscope Commercial |
$318.38
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Healthscope Commercial |
$454.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$429.22
|
| Rate for Payer: PHP Commercial |
$300.70
|
| Rate for Payer: PHP Commercial |
$4.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: Priority Health SBD |
$318.12
|
| Rate for Payer: Priority Health SBD |
$222.87
|
| Rate for Payer: Priority Health SBD |
$3.18
|
|
|
TACROLIMUS 0.5 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$504.96
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
24914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$201.98 |
| Max. Negotiated Rate |
$454.46 |
| Rate for Payer: Aetna Commercial |
$429.22
|
| Rate for Payer: Aetna Commercial |
$300.70
|
| Rate for Payer: Aetna Commercial |
$4.29
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$2.52
|
| Rate for Payer: Aetna Medicare |
$252.48
|
| Rate for Payer: Aetna Medicare |
$176.88
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$328.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: BCBS Complete |
$141.50
|
| Rate for Payer: BCBS Complete |
$201.98
|
| Rate for Payer: Cash Price |
$4.04
|
| Rate for Payer: Cash Price |
$283.01
|
| Rate for Payer: Cash Price |
$403.97
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Commercial |
$304.23
|
| Rate for Payer: Cofinity Commercial |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$353.47
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Commercial |
$434.27
|
| Rate for Payer: Cofinity Commercial |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Cofinity Commercial |
$247.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$353.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$191.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$403.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.01
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Healthscope Commercial |
$318.38
|
| Rate for Payer: Healthscope Commercial |
$454.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: PHP Commercial |
$300.70
|
| Rate for Payer: PHP Commercial |
$4.29
|
| Rate for Payer: PHP Commercial |
$429.22
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: Priority Health SBD |
$318.12
|
| Rate for Payer: Priority Health SBD |
$222.87
|
| Rate for Payer: Priority Health SBD |
$3.18
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Aetna Commercial |
$4.77
|
| Rate for Payer: Aetna Commercial |
$476.14
|
| Rate for Payer: Aetna Commercial |
$494.50
|
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Medicare |
$280.08
|
| Rate for Payer: Aetna Medicare |
$290.88
|
| Rate for Payer: Aetna Medicare |
$2.81
|
| Rate for Payer: Aetna Medicare |
$254.64
|
| Rate for Payer: Aetna Medicare |
$142.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: BCBS Complete |
$203.71
|
| Rate for Payer: BCBS Complete |
$2.24
|
| Rate for Payer: BCBS Complete |
$224.06
|
| Rate for Payer: BCBS Complete |
$114.05
|
| Rate for Payer: BCBS Complete |
$232.70
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cash Price |
$448.13
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cofinity Commercial |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$199.58
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Commercial |
$392.11
|
| Rate for Payer: Cofinity Commercial |
$481.74
|
| Rate for Payer: Cofinity Commercial |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$407.23
|
| Rate for Payer: Cofinity Commercial |
$500.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Healthscope Commercial |
$5.05
|
| Rate for Payer: Healthscope Commercial |
$523.58
|
| Rate for Payer: Healthscope Commercial |
$504.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.50
|
| Rate for Payer: PHP Commercial |
$4.77
|
| Rate for Payer: PHP Commercial |
$476.14
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: PHP Commercial |
$494.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.10
|
| Rate for Payer: Priority Health SBD |
$366.51
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: Priority Health SBD |
$320.85
|
| Rate for Payer: Priority Health SBD |
$3.53
|
| Rate for Payer: Priority Health SBD |
$352.90
|
|
|
TACROLIMUS 1 MG CAPSULE, IMMEDIATE-RELEASE
|
Facility
|
IP
|
$285.12
|
|
|
Service Code
|
HCPCS J7507
|
| Hospital Charge Code |
12933
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$179.63 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Commercial |
$432.89
|
| Rate for Payer: Aetna Commercial |
$476.14
|
| Rate for Payer: Aetna Commercial |
$4.77
|
| Rate for Payer: Aetna Commercial |
$494.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.03
|
| Rate for Payer: Cash Price |
$465.41
|
| Rate for Payer: Cash Price |
$407.42
|
| Rate for Payer: Cash Price |
$4.49
|
| Rate for Payer: Cash Price |
$448.13
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$356.50
|
| Rate for Payer: Cofinity Commercial |
$199.58
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Cofinity Commercial |
$500.31
|
| Rate for Payer: Cofinity Commercial |
$407.23
|
| Rate for Payer: Cofinity Commercial |
$437.98
|
| Rate for Payer: Cofinity Commercial |
$4.82
|
| Rate for Payer: Cofinity Commercial |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$392.11
|
| Rate for Payer: Cofinity Commercial |
$481.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$407.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$392.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$356.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$448.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$465.41
|
| Rate for Payer: Healthscope Commercial |
$504.14
|
| Rate for Payer: Healthscope Commercial |
$458.35
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Healthscope Commercial |
$5.05
|
| Rate for Payer: Healthscope Commercial |
$523.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$476.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$494.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: PHP Commercial |
$4.77
|
| Rate for Payer: PHP Commercial |
$494.50
|
| Rate for Payer: PHP Commercial |
$476.14
|
| Rate for Payer: PHP Commercial |
$432.89
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.65
|
| Rate for Payer: Priority Health SBD |
$3.53
|
| Rate for Payer: Priority Health SBD |
$320.85
|
| Rate for Payer: Priority Health SBD |
$352.90
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: Priority Health SBD |
$366.51
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$617.39
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$388.96 |
| Max. Negotiated Rate |
$555.65 |
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna Commercial |
$1,749.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,337.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: Cash Price |
$1,646.35
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cofinity Commercial |
$1,440.56
|
| Rate for Payer: Cofinity Commercial |
$432.17
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Commercial |
$1,769.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,440.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,646.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Healthscope Commercial |
$1,852.15
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$1,749.25
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.66
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| Rate for Payer: Priority Health SBD |
$1,296.50
|
|
|
TACROLIMUS XR 1 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$617.39
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175522
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.96 |
| Max. Negotiated Rate |
$555.65 |
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna Commercial |
$1,749.25
|
| Rate for Payer: Aetna Medicare |
$1,028.97
|
| Rate for Payer: Aetna Medicare |
$308.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,337.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.30
|
| Rate for Payer: BCBS Complete |
$246.96
|
| Rate for Payer: BCBS Complete |
$823.18
|
| Rate for Payer: Cash Price |
$1,646.35
|
| Rate for Payer: Cash Price |
$493.91
|
| Rate for Payer: Cofinity Commercial |
$1,440.56
|
| Rate for Payer: Cofinity Commercial |
$432.17
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Cofinity Commercial |
$1,769.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$432.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,440.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,646.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$493.91
|
| Rate for Payer: Healthscope Commercial |
$1,852.15
|
| Rate for Payer: Healthscope Commercial |
$555.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,749.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$524.78
|
| Rate for Payer: PHP Commercial |
$1,749.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,337.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.30
|
| Rate for Payer: Priority Health SBD |
$388.96
|
| Rate for Payer: Priority Health SBD |
$1,296.50
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$2,469.31
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,555.67 |
| Max. Negotiated Rate |
$2,222.38 |
| Rate for Payer: Aetna Commercial |
$2,098.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,605.05
|
| Rate for Payer: Cash Price |
$1,975.45
|
| Rate for Payer: Cofinity Commercial |
$1,728.52
|
| Rate for Payer: Cofinity Commercial |
$2,123.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,728.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.45
|
| Rate for Payer: Healthscope Commercial |
$2,222.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,098.91
|
| Rate for Payer: PHP Commercial |
$2,098.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.05
|
| Rate for Payer: Priority Health SBD |
$1,555.67
|
|
|
TACROLIMUS XR 4 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$2,469.31
|
|
|
Service Code
|
HCPCS J7503
|
| Hospital Charge Code |
175523
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$987.72 |
| Max. Negotiated Rate |
$2,222.38 |
| Rate for Payer: Aetna Commercial |
$2,098.91
|
| Rate for Payer: Aetna Medicare |
$1,234.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,605.05
|
| Rate for Payer: BCBS Complete |
$987.72
|
| Rate for Payer: Cash Price |
$1,975.45
|
| Rate for Payer: Cofinity Commercial |
$1,728.52
|
| Rate for Payer: Cofinity Commercial |
$2,123.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,728.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,975.45
|
| Rate for Payer: Healthscope Commercial |
$2,222.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,098.91
|
| Rate for Payer: PHP Commercial |
$2,098.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.05
|
| Rate for Payer: Priority Health SBD |
$1,555.67
|
|
|
TALQUETAMAB-TGVS 2 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$2,650.01
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204984
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$2,385.01 |
| Rate for Payer: Aetna Commercial |
$2,252.51
|
| Rate for Payer: Aetna Medicare |
$75.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,722.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.78
|
| Rate for Payer: BCBS Complete |
$40.87
|
| Rate for Payer: BCBS MAPPO |
$72.62
|
| Rate for Payer: BCN Medicare Advantage |
$72.62
|
| Rate for Payer: Cash Price |
$2,120.01
|
| Rate for Payer: Cash Price |
$2,120.01
|
| Rate for Payer: Cofinity Commercial |
$1,855.01
|
| Rate for Payer: Cofinity Commercial |
$2,279.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,855.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,120.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$2,385.01
|
| Rate for Payer: Mclaren Medicaid |
$38.92
|
| Rate for Payer: Mclaren Medicare |
$72.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.25
|
| Rate for Payer: Meridian Medicaid |
$40.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,252.51
|
| Rate for Payer: PACE Medicare |
$68.99
|
| Rate for Payer: PACE SWMI |
$72.62
|
| Rate for Payer: PHP Commercial |
$2,252.51
|
| Rate for Payer: PHP Medicare Advantage |
$72.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,722.51
|
| Rate for Payer: Priority Health Medicare |
$72.62
|
| Rate for Payer: Priority Health SBD |
$1,669.51
|
| Rate for Payer: Railroad Medicare Medicare |
$72.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.62
|
| Rate for Payer: UHC Medicare Advantage |
$72.62
|
| Rate for Payer: UHCCP Medicaid |
$40.89
|
| Rate for Payer: VA VA |
$72.62
|
|
|
TALQUETAMAB-TGVS 40 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$35,263.61
|
|
|
Service Code
|
HCPCS J3055
|
| Hospital Charge Code |
204983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$31,737.25 |
| Rate for Payer: Aetna Commercial |
$29,974.07
|
| Rate for Payer: Aetna Medicare |
$75.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22,921.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$90.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$90.78
|
| Rate for Payer: BCBS Complete |
$40.87
|
| Rate for Payer: BCBS MAPPO |
$72.62
|
| Rate for Payer: BCN Medicare Advantage |
$72.62
|
| Rate for Payer: Cash Price |
$28,210.89
|
| Rate for Payer: Cash Price |
$28,210.89
|
| Rate for Payer: Cofinity Commercial |
$24,684.53
|
| Rate for Payer: Cofinity Commercial |
$30,326.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$24,684.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28,210.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.62
|
| Rate for Payer: Healthscope Commercial |
$31,737.25
|
| Rate for Payer: Mclaren Medicaid |
$38.92
|
| Rate for Payer: Mclaren Medicare |
$72.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.25
|
| Rate for Payer: Meridian Medicaid |
$40.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$83.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,974.07
|
| Rate for Payer: PACE Medicare |
$68.99
|
| Rate for Payer: PACE SWMI |
$72.62
|
| Rate for Payer: PHP Commercial |
$29,974.07
|
| Rate for Payer: PHP Medicare Advantage |
$72.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22,921.35
|
| Rate for Payer: Priority Health Medicare |
$72.62
|
| Rate for Payer: Priority Health SBD |
$22,216.07
|
| Rate for Payer: Railroad Medicare Medicare |
$72.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.62
|
| Rate for Payer: UHC Medicare Advantage |
$72.62
|
| Rate for Payer: UHCCP Medicaid |
$40.89
|
| Rate for Payer: VA VA |
$72.62
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$279.18
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.88 |
| Max. Negotiated Rate |
$251.26 |
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.47
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cofinity Commercial |
$195.43
|
| Rate for Payer: Cofinity Commercial |
$240.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.34
|
| Rate for Payer: Healthscope Commercial |
$251.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.30
|
| Rate for Payer: PHP Commercial |
$237.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.47
|
| Rate for Payer: Priority Health SBD |
$175.88
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
IP
|
$387.60
|
|
|
Service Code
|
NDC 63739014310
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$244.19 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Cofinity Commercial |
$271.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health SBD |
$244.19
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$387.60
|
|
|
Service Code
|
NDC 63739014310
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.04 |
| Max. Negotiated Rate |
$348.84 |
| Rate for Payer: Aetna Commercial |
$329.46
|
| Rate for Payer: Aetna Medicare |
$193.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.94
|
| Rate for Payer: BCBS Complete |
$155.04
|
| Rate for Payer: Cash Price |
$310.08
|
| Rate for Payer: Cofinity Commercial |
$271.32
|
| Rate for Payer: Cofinity Commercial |
$333.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.08
|
| Rate for Payer: Healthscope Commercial |
$348.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.46
|
| Rate for Payer: PHP Commercial |
$329.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.94
|
| Rate for Payer: Priority Health SBD |
$244.19
|
|
|
TAMOXIFEN 10 MG TABLET
|
Facility
|
OP
|
$279.18
|
|
|
Service Code
|
NDC 00378014491
|
| Hospital Charge Code |
7711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.67 |
| Max. Negotiated Rate |
$251.26 |
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Medicare |
$139.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.47
|
| Rate for Payer: BCBS Complete |
$111.67
|
| Rate for Payer: Cash Price |
$223.34
|
| Rate for Payer: Cofinity Commercial |
$195.43
|
| Rate for Payer: Cofinity Commercial |
$240.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.34
|
| Rate for Payer: Healthscope Commercial |
$251.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.30
|
| Rate for Payer: PHP Commercial |
$237.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.47
|
| Rate for Payer: Priority Health SBD |
$175.88
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$230.85
|
|
|
Service Code
|
NDC 68084029901
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Commercial |
$161.59
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.05
|
| Rate for Payer: Priority Health SBD |
$145.44
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
NDC 63739056710
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.52 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$261.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$243.20
|
| Rate for Payer: Healthscope Commercial |
$273.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$258.40
|
| Rate for Payer: PHP Commercial |
$258.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: Priority Health SBD |
$191.52
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00904640161
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.50 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health SBD |
$121.50
|
|
|
TAMSULOSIN 0.4 MG CAPSULE
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 50268074011
|
| Hospital Charge Code |
103890
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.64
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health SBD |
$1.59
|
|
