|
TOPAZ EPF MICRODEBIDER
|
Facility
OP
|
$700.00
|
|
| Hospital Charge Code |
40200964
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$385.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$350.00
|
| Rate for Payer: Aetna Government |
$350.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$560.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$476.00
|
| Rate for Payer: Group Health Inc Commercial |
$350.00
|
| Rate for Payer: Group Health Inc Medicare |
$245.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$350.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$350.00
|
|
|
TOPICAL APPLICATION OF FLUORIDE E
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
HCPCS D1208
|
| Hospital Charge Code |
42300255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.68
|
| Rate for Payer: Aetna Government |
$9.68
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$17.50
|
| Rate for Payer: Group Health Inc Medicare |
$12.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$17.50
|
|
|
TOPICAL FLUORIDE VARNISH
|
Facility
OP
|
$20.00
|
|
|
Service Code
|
HCPCS D1206
|
| Hospital Charge Code |
30300087
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.51
|
| Rate for Payer: Aetna Government |
$16.51
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.00
|
|
|
TOPICAL FLUORIDE VARNISH
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
HCPCS D1206
|
| Hospital Charge Code |
42303419
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$41.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.51
|
| Rate for Payer: Aetna Government |
$16.51
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Group Health Inc Commercial |
$37.50
|
| Rate for Payer: Group Health Inc Medicare |
$26.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$37.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$37.50
|
|
|
TOPIRAMATE 100 MG TAB
|
Facility
OP
|
$0.39
|
|
| Hospital Charge Code |
41645129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
TOPIRAMATE 100 MG TAB
|
Facility
OP
|
$0.39
|
|
| Hospital Charge Code |
41655129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.21
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.25
|
|
|
TOPIRAMATE 15MG CAP
|
Facility
OP
|
$1.62
|
|
| Hospital Charge Code |
41645157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.81
|
| Rate for Payer: Aetna Government |
$0.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.81
|
| Rate for Payer: Group Health Inc Medicare |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.05
|
|
|
TOPIRAMATE 15MG CAP
|
Facility
OP
|
$1.62
|
|
| Hospital Charge Code |
41655157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.81
|
| Rate for Payer: Aetna Government |
$0.81
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.30
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.81
|
| Rate for Payer: Group Health Inc Medicare |
$0.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.05
|
|
|
TOPIRAMATE 200 MG TAB
|
Facility
OP
|
$0.83
|
|
| Hospital Charge Code |
41645130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
|
TOPIRAMATE 200 MG TAB
|
Facility
OP
|
$0.83
|
|
| Hospital Charge Code |
41655130
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
| Rate for Payer: Aetna Government |
$0.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.56
|
| Rate for Payer: Group Health Inc Commercial |
$0.42
|
| Rate for Payer: Group Health Inc Medicare |
$0.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.54
|
|
|
TOPIRAMATE (TOPAMAX), SERUM
|
Facility
OP
|
$29.80
|
|
|
Service Code
|
HCPCS 80201
|
| Hospital Charge Code |
40609811
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.92
|
| Rate for Payer: Aetna Government |
$11.92
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Cash Price |
$11.92
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.04
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.92
|
| Rate for Payer: EmblemHealth Commercial |
$11.92
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.73
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$10.13
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.61
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.92
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.61
|
| Rate for Payer: Group Health Inc Commercial |
$11.92
|
| Rate for Payer: Group Health Inc Medicare |
$11.92
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.90
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.92
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.92
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.92
|
| Rate for Payer: Healthfirst QHP |
$11.92
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.92
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.92
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.54
|
| Rate for Payer: Wellcare Medicare |
$10.73
|
|
|
TOPOTECAN 4 MG INJ
|
Facility
OP
|
$18.79
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
41644506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna Government |
$0.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$9.40
|
| Rate for Payer: Group Health Inc Medicare |
$6.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.24
|
| Rate for Payer: SOMOS Essential |
$1.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.21
|
|
|
TOPOTECAN 4 MG INJ
|
Facility
IP
|
$18.79
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
41644506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.40
|
|
|
TOPOTECAN INJECTION 0.1 MG/2
|
Facility
OP
|
$18.79
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
41654506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.33
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.77
|
| Rate for Payer: Aetna Government |
$0.77
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.80
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$0.45
|
| Rate for Payer: Group Health Inc Commercial |
$9.40
|
| Rate for Payer: Group Health Inc Medicare |
$6.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.40
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$1.24
|
| Rate for Payer: SOMOS Essential |
$1.24
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.21
|
|
|
TOPOTECAN INJECTION 0.1 MG/2
|
Facility
IP
|
$18.79
|
|
|
Service Code
|
HCPCS J9351
|
| Hospital Charge Code |
41654506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$9.40 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.40
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.40
|
|
|
TORQUE DEVICE ABBOTT
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
66522093
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.00
|
| Rate for Payer: Aetna Government |
$5.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.80
|
| Rate for Payer: Group Health Inc Commercial |
$5.00
|
| Rate for Payer: Group Health Inc Medicare |
$3.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.00
|
|
|
TORSEMIDE 100MG TAB
|
Facility
OP
|
$0.52
|
|
| Hospital Charge Code |
41646605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
| Rate for Payer: Aetna Government |
$0.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
TORSEMIDE 10 MG/ML INJ
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
HCPCS J3265
|
| Hospital Charge Code |
41643479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
|
|
TORSEMIDE 10 MG/ML INJ
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J3265
|
| Hospital Charge Code |
41643479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.05
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
TORSEMIDE 10 MG/ML INJ
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J3265
|
| Hospital Charge Code |
41653479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.05
|
| Rate for Payer: Group Health Inc Commercial |
$7.00
|
| Rate for Payer: Group Health Inc Medicare |
$4.90
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.10
|
|
|
TORSEMIDE 10 MG/ML INJ
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
HCPCS J3265
|
| Hospital Charge Code |
41653479
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.00
|
|
|
TORSEMIDE 50 MG/ML INJ
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J3265
|
| Hospital Charge Code |
41653480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.78
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.05
|
|
|
TORSEMIDE 50 MG/ML INJ
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J3265
|
| Hospital Charge Code |
41643480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
TORSEMIDE 50 MG/ML INJ
|
Facility
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J3265
|
| Hospital Charge Code |
41653480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
|
|
TORSEMIDE 50 MG/ML INJ
|
Facility
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J3265
|
| Hospital Charge Code |
41643480
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.46
|
| Rate for Payer: Aetna Government |
$2.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.78
|
| Rate for Payer: Group Health Inc Commercial |
$8.50
|
| Rate for Payer: Group Health Inc Medicare |
$5.95
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.05
|
|
