|
THERMAGE FACE & NECK
|
Professional
|
$2,800.00
|
|
|
Service Code
|
HCPCS 00143
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,120.00 |
| Max. Negotiated Rate |
$1,960.00 |
| Rate for Payer: BCBS Complete |
$1,120.00
|
| Rate for Payer: Cash Price |
$2,240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,960.00
|
|
|
THERMAGE FACE, NECK, & EYES
|
Professional
|
$3,500.00
|
|
|
Service Code
|
HCPCS 00144
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,400.00 |
| Max. Negotiated Rate |
$2,450.00 |
| Rate for Payer: BCBS Complete |
$1,400.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,450.00
|
|
|
THERMAGE KNEES - BILATERAL
|
Professional
|
$1,200.00
|
|
|
Service Code
|
HCPCS 00151
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: BCBS Complete |
$480.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
|
|
THERMAGE NECK
|
Professional
|
$1,200.00
|
|
|
Service Code
|
HCPCS 00141
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: BCBS Complete |
$480.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.00
|
|
|
THERMAGE THIGH - 1 THIGH
|
Professional
|
$1,900.00
|
|
|
Service Code
|
HCPCS 00147
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$1,330.00 |
| Rate for Payer: BCBS Complete |
$760.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.00
|
|
|
THERMAGE THIGH - BILATERAL
|
Professional
|
$3,100.00
|
|
|
Service Code
|
HCPCS 00148
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,240.00 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: BCBS Complete |
$1,240.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,170.00
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$32.44
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$32.44 |
| Rate for Payer: Aetna Commercial |
$29.20
|
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Commercial |
$25.45
|
| Rate for Payer: Aetna Commercial |
$25.40
|
| Rate for Payer: Aetna Commercial |
$24.52
|
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR ASR |
$27.43
|
| Rate for Payer: ASR ASR |
$26.43
|
| Rate for Payer: ASR ASR |
$27.37
|
| Rate for Payer: ASR ASR |
$26.70
|
| Rate for Payer: ASR ASR |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.93
|
| Rate for Payer: BCBS Trust/PPO |
$25.15
|
| Rate for Payer: BCBS Trust/PPO |
$19.21
|
| Rate for Payer: BCBS Trust/PPO |
$21.88
|
| Rate for Payer: BCBS Trust/PPO |
$21.34
|
| Rate for Payer: BCN Commercial |
$21.34
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: BCN Commercial |
$21.13
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: BCN Commercial |
$21.93
|
| Rate for Payer: BCN Commercial |
$25.15
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cash Price |
$22.63
|
| Rate for Payer: Cash Price |
$25.95
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Cofinity Commercial |
$26.53
|
| Rate for Payer: Cofinity Commercial |
$25.88
|
| Rate for Payer: Cofinity Commercial |
$26.58
|
| Rate for Payer: Cofinity Commercial |
$25.62
|
| Rate for Payer: Cofinity Commercial |
$30.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$27.53
|
| Rate for Payer: Healthscope Commercial |
$32.44
|
| Rate for Payer: Healthscope Commercial |
$27.25
|
| Rate for Payer: Healthscope Commercial |
$28.22
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Whirlpool |
$27.37
|
| Rate for Payer: Healthscope Whirlpool |
$31.47
|
| Rate for Payer: Healthscope Whirlpool |
$26.43
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$27.43
|
| Rate for Payer: Healthscope Whirlpool |
$26.70
|
| Rate for Payer: Mclaren Commercial |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$24.52
|
| Rate for Payer: Mclaren Commercial |
$24.78
|
| Rate for Payer: Mclaren Commercial |
$29.20
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Mclaren Commercial |
$25.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.55
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
IP
|
$177.43
|
|
|
Service Code
|
NDC 5026885115
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.20 |
| Max. Negotiated Rate |
$177.43 |
| Rate for Payer: Aetna Commercial |
$159.69
|
| Rate for Payer: ASR ASR |
$172.11
|
| Rate for Payer: BCBS Trust/PPO |
$137.56
|
| Rate for Payer: BCN Commercial |
$137.56
|
| Rate for Payer: Cash Price |
$141.94
|
| Rate for Payer: Cofinity Commercial |
$166.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.94
|
| Rate for Payer: Healthscope Commercial |
$177.43
|
| Rate for Payer: Healthscope Whirlpool |
$172.11
|
| Rate for Payer: Mclaren Commercial |
$159.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$150.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.14
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
IP
|
$3.55
|
|
|
Service Code
|
NDC 5026885111
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: ASR ASR |
$3.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCN Commercial |
$2.75
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.84
|
| Rate for Payer: Healthscope Commercial |
$3.55
|
| Rate for Payer: Healthscope Whirlpool |
$3.44
|
| Rate for Payer: Mclaren Commercial |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.12
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
IP
|
$387.75
|
|
|
Service Code
|
NDC 7733393410
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.42 |
| Max. Negotiated Rate |
$387.75 |
| Rate for Payer: Aetna Commercial |
$348.98
|
| Rate for Payer: ASR ASR |
$376.12
|
| Rate for Payer: BCBS Trust/PPO |
$300.62
|
| Rate for Payer: BCN Commercial |
$300.62
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$364.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$387.75
|
| Rate for Payer: Healthscope Whirlpool |
$376.12
|
| Rate for Payer: Mclaren Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$341.22
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
IP
|
$3.88
|
|
|
Service Code
|
NDC 7733393425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: ASR ASR |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$3.01
|
| Rate for Payer: BCN Commercial |
$3.01
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.88
|
| Rate for Payer: Healthscope Whirlpool |
$3.76
|
| Rate for Payer: Mclaren Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
IP
|
$4.68
|
|
|
Service Code
|
NDC 51079-566-01
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Healthscope Whirlpool |
$4.54
|
| Rate for Payer: Mclaren Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
IP
|
$468.35
|
|
|
Service Code
|
NDC 51079-566-20
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.84 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna Commercial |
$421.52
|
| Rate for Payer: ASR ASR |
$454.30
|
| Rate for Payer: BCBS Trust/PPO |
$363.11
|
| Rate for Payer: BCN Commercial |
$363.11
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$440.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.68
|
| Rate for Payer: Healthscope Commercial |
$468.35
|
| Rate for Payer: Healthscope Whirlpool |
$454.30
|
| Rate for Payer: Mclaren Commercial |
$421.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.15
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
IP
|
$299.04
|
|
|
Service Code
|
NDC 0378-0614-01
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.33 |
| Max. Negotiated Rate |
$299.04 |
| Rate for Payer: Aetna Commercial |
$269.14
|
| Rate for Payer: ASR ASR |
$290.07
|
| Rate for Payer: BCBS Trust/PPO |
$231.85
|
| Rate for Payer: BCN Commercial |
$231.85
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Commercial |
$281.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$299.04
|
| Rate for Payer: Healthscope Whirlpool |
$290.07
|
| Rate for Payer: Mclaren Commercial |
$269.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$254.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.16
|
|
|
THROMBIN (BOVINE) 5,000 UNIT NASAL SPRAY SYRINGE
|
Facility
IP
|
$216.83
|
|
|
Service Code
|
NDC 60793-205-05
|
| Hospital Charge Code |
161618
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$216.83 |
| Rate for Payer: Aetna Commercial |
$195.15
|
| Rate for Payer: ASR ASR |
$210.33
|
| Rate for Payer: BCBS Trust/PPO |
$168.11
|
| Rate for Payer: BCN Commercial |
$168.11
|
| Rate for Payer: Cash Price |
$173.47
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.46
|
| Rate for Payer: Healthscope Commercial |
$216.83
|
| Rate for Payer: Healthscope Whirlpool |
$210.33
|
| Rate for Payer: Mclaren Commercial |
$195.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.81
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
IP
|
$193.58
|
|
|
Service Code
|
NDC 60793-215-05
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.51 |
| Max. Negotiated Rate |
$193.58 |
| Rate for Payer: Aetna Commercial |
$174.22
|
| Rate for Payer: ASR ASR |
$187.77
|
| Rate for Payer: BCBS Trust/PPO |
$150.08
|
| Rate for Payer: BCN Commercial |
$150.08
|
| Rate for Payer: Cash Price |
$154.87
|
| Rate for Payer: Cofinity Commercial |
$181.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.86
|
| Rate for Payer: Healthscope Commercial |
$193.58
|
| Rate for Payer: Healthscope Whirlpool |
$187.77
|
| Rate for Payer: Mclaren Commercial |
$174.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$164.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$170.35
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
IP
|
$19,156.00
|
|
|
Service Code
|
MS-DRG 626
|
| Min. Negotiated Rate |
$13,596.35 |
| Max. Negotiated Rate |
$19,156.00 |
| Rate for Payer: Aetna Medicare |
$14,311.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,889.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,889.94
|
| Rate for Payer: BCBS MAPPO |
$14,311.95
|
| Rate for Payer: BCN Medicare Advantage |
$14,311.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,311.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,311.95
|
| Rate for Payer: Mclaren Medicare |
$14,311.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,027.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,458.74
|
| Rate for Payer: PACE Medicare |
$13,596.35
|
| Rate for Payer: PACE SWMI |
$14,311.95
|
| Rate for Payer: PHP Commercial |
$15,743.14
|
| Rate for Payer: PHP Medicare Advantage |
$14,311.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19,156.00
|
| Rate for Payer: Priority Health Medicare |
$14,311.95
|
| Rate for Payer: Priority Health Narrow Network |
$15,324.80
|
| Rate for Payer: Railroad Medicare Medicare |
$14,311.95
|
| Rate for Payer: UHC Medicare Advantage |
$14,741.31
|
| Rate for Payer: VA VA |
$14,311.95
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
IP
|
$37,508.21
|
|
|
Service Code
|
MS-DRG 625
|
| Min. Negotiated Rate |
$25,092.33 |
| Max. Negotiated Rate |
$37,508.21 |
| Rate for Payer: Aetna Medicare |
$26,412.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,016.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,016.22
|
| Rate for Payer: BCBS MAPPO |
$26,412.98
|
| Rate for Payer: BCN Medicare Advantage |
$26,412.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26,412.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$26,412.98
|
| Rate for Payer: Mclaren Medicare |
$26,412.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27,733.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30,374.93
|
| Rate for Payer: PACE Medicare |
$25,092.33
|
| Rate for Payer: PACE SWMI |
$26,412.98
|
| Rate for Payer: PHP Commercial |
$29,054.28
|
| Rate for Payer: PHP Medicare Advantage |
$26,412.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37,508.21
|
| Rate for Payer: Priority Health Medicare |
$26,412.98
|
| Rate for Payer: Priority Health Narrow Network |
$30,006.57
|
| Rate for Payer: Railroad Medicare Medicare |
$26,412.98
|
| Rate for Payer: UHC Medicare Advantage |
$27,205.37
|
| Rate for Payer: VA VA |
$26,412.98
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$15,870.24
|
|
|
Service Code
|
MS-DRG 627
|
| Min. Negotiated Rate |
$11,538.13 |
| Max. Negotiated Rate |
$15,870.24 |
| Rate for Payer: Aetna Medicare |
$12,145.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,181.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,181.75
|
| Rate for Payer: BCBS MAPPO |
$12,145.40
|
| Rate for Payer: BCN Medicare Advantage |
$12,145.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,145.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,145.40
|
| Rate for Payer: Mclaren Medicare |
$12,145.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,752.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,967.21
|
| Rate for Payer: PACE Medicare |
$11,538.13
|
| Rate for Payer: PACE SWMI |
$12,145.40
|
| Rate for Payer: PHP Commercial |
$13,359.94
|
| Rate for Payer: PHP Medicare Advantage |
$12,145.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,870.24
|
| Rate for Payer: Priority Health Medicare |
$12,145.40
|
| Rate for Payer: Priority Health Narrow Network |
$12,696.19
|
| Rate for Payer: Railroad Medicare Medicare |
$12,145.40
|
| Rate for Payer: UHC Medicare Advantage |
$12,509.76
|
| Rate for Payer: VA VA |
$12,145.40
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
IP
|
$1,544.90
|
|
|
Service Code
|
NDC 0186-0777-60
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,081.43 |
| Max. Negotiated Rate |
$1,544.90 |
| Rate for Payer: Aetna Commercial |
$1,390.41
|
| Rate for Payer: ASR ASR |
$1,498.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,197.76
|
| Rate for Payer: BCN Commercial |
$1,197.76
|
| Rate for Payer: Cash Price |
$1,235.92
|
| Rate for Payer: Cofinity Commercial |
$1,452.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,235.92
|
| Rate for Payer: Healthscope Commercial |
$1,544.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,498.55
|
| Rate for Payer: Mclaren Commercial |
$1,390.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,313.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,359.51
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
IP
|
$2,574.83
|
|
|
Service Code
|
NDC 0186-0777-39
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,802.38 |
| Max. Negotiated Rate |
$2,574.83 |
| Rate for Payer: Aetna Commercial |
$2,317.35
|
| Rate for Payer: ASR ASR |
$2,497.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,996.27
|
| Rate for Payer: BCN Commercial |
$1,996.27
|
| Rate for Payer: Cash Price |
$2,059.86
|
| Rate for Payer: Cofinity Commercial |
$2,420.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,059.86
|
| Rate for Payer: Healthscope Commercial |
$2,574.83
|
| Rate for Payer: Healthscope Whirlpool |
$2,497.59
|
| Rate for Payer: Mclaren Commercial |
$2,317.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,188.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,802.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,265.85
|
|
|
TIMOLOL 5 MG TABLET
|
Facility
IP
|
$491.52
|
|
|
Service Code
|
NDC 0378-0055-01
|
| Hospital Charge Code |
7969
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$344.06 |
| Max. Negotiated Rate |
$491.52 |
| Rate for Payer: BCN Commercial |
$381.08
|
| Rate for Payer: Aetna Commercial |
$442.37
|
| Rate for Payer: ASR ASR |
$476.77
|
| Rate for Payer: BCBS Trust/PPO |
$381.08
|
| Rate for Payer: Cash Price |
$393.22
|
| Rate for Payer: Cofinity Commercial |
$462.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.22
|
| Rate for Payer: Healthscope Commercial |
$491.52
|
| Rate for Payer: Healthscope Whirlpool |
$476.77
|
| Rate for Payer: Mclaren Commercial |
$442.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$417.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.54
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
IP
|
$26.60
|
|
|
Service Code
|
NDC 61314-227-10
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna Commercial |
$23.94
|
| Rate for Payer: ASR ASR |
$25.80
|
| Rate for Payer: BCBS Trust/PPO |
$20.62
|
| Rate for Payer: BCN Commercial |
$20.62
|
| Rate for Payer: Cash Price |
$21.28
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.28
|
| Rate for Payer: Healthscope Commercial |
$26.60
|
| Rate for Payer: Healthscope Whirlpool |
$25.80
|
| Rate for Payer: Mclaren Commercial |
$23.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.41
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
IP
|
$19.71
|
|
|
Service Code
|
NDC 61314-227-05
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: ASR ASR |
$19.12
|
| Rate for Payer: BCBS Trust/PPO |
$15.28
|
| Rate for Payer: BCN Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$19.71
|
| Rate for Payer: Healthscope Whirlpool |
$19.12
|
| Rate for Payer: Mclaren Commercial |
$17.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.34
|
|
|
TIMOLOL MALEATE 0.5 % EYE DROPS
|
Facility
IP
|
$22.82
|
|
|
Service Code
|
NDC 17478-288-10
|
| Hospital Charge Code |
11562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.97 |
| Max. Negotiated Rate |
$22.82 |
| Rate for Payer: Aetna Commercial |
$20.54
|
| Rate for Payer: ASR ASR |
$22.14
|
| Rate for Payer: BCBS Trust/PPO |
$17.69
|
| Rate for Payer: BCN Commercial |
$17.69
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$22.82
|
| Rate for Payer: Healthscope Whirlpool |
$22.14
|
| Rate for Payer: Mclaren Commercial |
$20.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.08
|
|
