|
TONSILLECTOMY AND ADENOIDECTOMY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 42820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,248.18
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 42826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,780.71
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
TONSILLECTOMY, PRIMARY OR SECONDARY; YOUNGER THAN AGE 12
|
Facility
|
OP
|
$16,240.34
|
|
|
Service Code
|
CPT 42825
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,092.41 |
| Max. Negotiated Rate |
$16,240.34 |
| Rate for Payer: Aetna Medicare |
$6,000.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,211.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,211.77
|
| Rate for Payer: BCBS Complete |
$3,247.03
|
| Rate for Payer: BCBS MAPPO |
$5,769.42
|
| Rate for Payer: BCN Medicare Advantage |
$5,769.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,769.42
|
| Rate for Payer: Mclaren Medicaid |
$3,092.41
|
| Rate for Payer: Mclaren Medicare |
$5,769.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,057.89
|
| Rate for Payer: Meridian Medicaid |
$3,247.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,634.83
|
| Rate for Payer: PACE Medicare |
$5,480.95
|
| Rate for Payer: PACE SWMI |
$5,769.42
|
| Rate for Payer: PHP Medicare Advantage |
$5,769.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,092.41
|
| Rate for Payer: Priority Health Medicare |
$5,769.42
|
| Rate for Payer: Railroad Medicare Medicare |
$5,769.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,240.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,769.42
|
| Rate for Payer: UHC Medicare Advantage |
$5,769.42
|
| Rate for Payer: UHCCP Medicaid |
$3,248.18
|
| Rate for Payer: VA VA |
$5,769.42
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 68084034411
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health SBD |
$241.20
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
IP
|
$382.85
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.20 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health SBD |
$241.20
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 68084034401
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.14 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$191.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health SBD |
$241.20
|
|
|
TOPIRAMATE 100 MG TABLET
|
Facility
|
OP
|
$382.85
|
|
|
Service Code
|
NDC 68084034411
|
| Hospital Charge Code |
18922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.14 |
| Max. Negotiated Rate |
$344.56 |
| Rate for Payer: Aetna Commercial |
$325.42
|
| Rate for Payer: Aetna Medicare |
$191.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.85
|
| Rate for Payer: BCBS Complete |
$153.14
|
| Rate for Payer: Cash Price |
$306.28
|
| Rate for Payer: Cofinity Commercial |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$329.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$268.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.28
|
| Rate for Payer: Healthscope Commercial |
$344.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.42
|
| Rate for Payer: PHP Commercial |
$325.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.85
|
| Rate for Payer: Priority Health SBD |
$241.20
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.26 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$1,380.18
|
|
|
Service Code
|
NDC 50458063965
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$869.51 |
| Max. Negotiated Rate |
$1,242.16 |
| Rate for Payer: Aetna Commercial |
$1,173.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.12
|
| Rate for Payer: Cash Price |
$1,104.14
|
| Rate for Payer: Cofinity Commercial |
$1,186.95
|
| Rate for Payer: Cofinity Commercial |
$966.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.14
|
| Rate for Payer: Healthscope Commercial |
$1,242.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.15
|
| Rate for Payer: PHP Commercial |
$1,173.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.12
|
| Rate for Payer: Priority Health SBD |
$869.51
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$57.81
|
|
|
Service Code
|
NDC 68382013814
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$52.03 |
| Rate for Payer: Aetna Commercial |
$49.14
|
| Rate for Payer: Aetna Medicare |
$28.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.58
|
| Rate for Payer: BCBS Complete |
$23.12
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cofinity Commercial |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$49.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Healthscope Commercial |
$52.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.14
|
| Rate for Payer: PHP Commercial |
$49.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.58
|
| Rate for Payer: Priority Health SBD |
$36.42
|
|
|
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 |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034211
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.86 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$57.81
|
|
|
Service Code
|
NDC 68382013814
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$52.03 |
| Rate for Payer: Aetna Commercial |
$49.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.58
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cofinity Commercial |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$49.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Healthscope Commercial |
$52.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.14
|
| Rate for Payer: PHP Commercial |
$49.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.58
|
| Rate for Payer: Priority Health SBD |
$36.42
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
OP
|
$1,380.18
|
|
|
Service Code
|
NDC 50458063965
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$552.07 |
| Max. Negotiated Rate |
$1,242.16 |
| Rate for Payer: Aetna Commercial |
$1,173.15
|
| Rate for Payer: Aetna Medicare |
$690.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.12
|
| Rate for Payer: BCBS Complete |
$552.07
|
| Rate for Payer: Cash Price |
$1,104.14
|
| Rate for Payer: Cofinity Commercial |
$1,186.95
|
| Rate for Payer: Cofinity Commercial |
$966.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$966.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,104.14
|
| Rate for Payer: Healthscope Commercial |
$1,242.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,173.15
|
| Rate for Payer: PHP Commercial |
$1,173.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$897.12
|
| Rate for Payer: Priority Health SBD |
$869.51
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 68084034201
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.86 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
|
|
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 |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.17
|
| Rate for Payer: Priority Health SBD |
$135.86
|
|
|
TOPIRAMATE 25 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00904692861
|
| Hospital Charge Code |
18920
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.29 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
|
|
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$105.88
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
152057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$95.29 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Commercial |
$384.25
|
| Rate for Payer: Aetna Commercial |
$314.47
|
| Rate for Payer: Aetna Commercial |
$127.07
|
| Rate for Payer: Aetna Medicare |
$184.98
|
| Rate for Payer: Aetna Medicare |
$226.03
|
| Rate for Payer: Aetna Medicare |
$74.75
|
| Rate for Payer: Aetna Medicare |
$52.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.17
|
| Rate for Payer: BCBS Complete |
$180.82
|
| Rate for Payer: BCBS Complete |
$42.35
|
| Rate for Payer: BCBS Complete |
$59.80
|
| Rate for Payer: BCBS Complete |
$147.98
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Cash Price |
$361.65
|
| Rate for Payer: Cash Price |
$119.59
|
| Rate for Payer: Cash Price |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$74.12
|
| Rate for Payer: Cofinity Commercial |
$318.17
|
| Rate for Payer: Cofinity Commercial |
$104.64
|
| Rate for Payer: Cofinity Commercial |
$128.56
|
| Rate for Payer: Cofinity Commercial |
$91.06
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Cofinity Commercial |
$388.77
|
| Rate for Payer: Cofinity Commercial |
$316.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.97
|
| Rate for Payer: Healthscope Commercial |
$134.54
|
| Rate for Payer: Healthscope Commercial |
$95.29
|
| Rate for Payer: Healthscope Commercial |
$332.96
|
| Rate for Payer: Healthscope Commercial |
$406.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.00
|
| Rate for Payer: PHP Commercial |
$314.47
|
| Rate for Payer: PHP Commercial |
$127.07
|
| Rate for Payer: PHP Commercial |
$90.00
|
| Rate for Payer: PHP Commercial |
$384.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.84
|
| Rate for Payer: Priority Health SBD |
$233.07
|
| Rate for Payer: Priority Health SBD |
$94.18
|
| Rate for Payer: Priority Health SBD |
$66.70
|
| Rate for Payer: Priority Health SBD |
$284.80
|
|
|
TOPOTECAN 4 MG/4 ML (1 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$369.96
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
152057
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$233.07 |
| Max. Negotiated Rate |
$332.96 |
| Rate for Payer: Aetna Commercial |
$314.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.47
|
| Rate for Payer: Cash Price |
$295.97
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Cofinity Commercial |
$318.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.97
|
| Rate for Payer: Healthscope Commercial |
$332.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$314.47
|
| Rate for Payer: PHP Commercial |
$314.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.47
|
| Rate for Payer: Priority Health SBD |
$233.07
|
|
|
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 |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.36
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Cofinity Commercial |
$1.46
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.67
|
| Rate for Payer: Healthscope Commercial |
$1.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.36
|
| Rate for Payer: Priority Health SBD |
$1.32
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 31722053001
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.63 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$241.81
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: Priority Health SBD |
$217.63
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$199.75
|
|
|
Service Code
|
NDC 23155087201
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.84 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna Commercial |
$169.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$171.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.80
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.79
|
| Rate for Payer: PHP Commercial |
$169.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health SBD |
$125.84
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
OP
|
$199.75
|
|
|
Service Code
|
NDC 23155087201
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$179.78 |
| Rate for Payer: Aetna Commercial |
$169.79
|
| Rate for Payer: Aetna Medicare |
$99.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.84
|
| Rate for Payer: BCBS Complete |
$79.90
|
| Rate for Payer: Cash Price |
$159.80
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$171.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$139.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.80
|
| Rate for Payer: Healthscope Commercial |
$179.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.79
|
| Rate for Payer: PHP Commercial |
$169.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.84
|
| Rate for Payer: Priority Health SBD |
$125.84
|
|
|
TORSEMIDE 10 MG TABLET
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
NDC 50111091601
|
| Hospital Charge Code |
18292
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.25 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.75
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$332.50
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$332.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health SBD |
$299.25
|
|
|
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 |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Medicare |
$237.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.75
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$332.50
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$332.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health SBD |
$299.25
|
|
