RC 343
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Generation details were not recorded for this description.
Original text from hospital filings
KIT FOR PREPARATION OF GA-68-GOZETOTIDE 25 MCG INTRAVENOUS SOLUTION
Low
$5
Average
$1.8k
Median
$1.0k
High
$14.0k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
221 hospitals; the 90th percentile is 14.4× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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240 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | ROBERT PACKER HOSPITAL Sayre, PA facility · other · outpatient | 2 | $634 | $2.2k | $3.3k | 150% | 111–192 | $10 – $11.5k |
| 2 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $671 | $1.7k | $2.6k | 155% | 57–93 | $10 – $10.8k |
| 3 | Mercy Hospital Springfield Ozark, MO facility · other · outpatient | 1 | $999 | $1.1k | $659 | 59% | 56–74 | $49 – $2.3k |
| 4 | Mercy Hospital Springfield Springfield, MO facility · other · outpatient | 1 | $999 | $1.1k | $659 | 59% | 56–74 | $49 – $2.3k |
| 5 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 2 | $693 | $2.4k | $3.3k | 140% | 33–87 | $8 – $11.5k |
| 6 | PRISMA HEALTH BAPTIST COLUMBIA HOSPITAL COLUMBIA, SC other · both | 1 | $332 | $332 | — | — | 30 | $332 – $332 |
| 7 | Mercy Hospital Aurora Aurora, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $91 | $114 | $74 | 65% | 4–40 | $13 – $350 |
| 8 | Aspen Valley Hospital District Aspen, CO facility · percent of total billed charges · bothfrom % of charges | 4 | $544 | $1.9k | $3.3k | 170% | 3–30 | $155 – $16.7k |
| 9 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $89 | $166 | $187 | 113% | 3–30 | $6 – $680 |
| 10 | Mercy Hospital Berryville Berryville, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $102 | $349 | $457 | 131% | 3–30 | $12 – $1.8k |
| 11 | Mercy Hospital Fort Smith Smith, AR facility · other · outpatient | 1 | $916 | $1.0k | $616 | 59% | 3–30 | $49 – $2.3k |
| 12 | Mercy Hospital Fort Smith Smith, AR facility · other · outpatient | 1 | $916 | $1.0k | $616 | 59% | 3–30 | $49 – $2.3k |
| 13 | Mercy Perry Perryville, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $119 | $187 | $260 | 139% | 2–20 | $15 – $1.3k |
| 14 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $787 | $656 | $387 | 59% | — | $10 – $1.0k |
| 15 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $10.6k | $10.6k | — | — | — | $10.6k – $10.6k |
| 16 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $526 | $1.6k | $2.2k | 139% | — | $36 – $8.1k |
| 17 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $777 | $2.6k | $3.7k | 142% | — | $25 – $15.0k |
| 18 | Ascension Calumet Hospital, Inc. Chilton, WI percent of total billed charges · bothfrom % of charges | 1 | $189 | $636 | $1.0k | 161% | — | $2 – $3.7k |
| 19 | Ascension Calumet Hospital, Inc. Chilton, WI percent of total billed charges · outpatientfrom % of charges | 1 | $189 | $636 | $1.0k | 161% | — | $2 – $3.7k |
| 20 | Ascension Cedar Park Park, TX percent of total billed charges · bothfrom % of charges | 1 | $370 | $1.2k | $1.7k | 140% | — | $9 – $6.8k |
| 21 | Ascension Cedar Park Park, TX percent of total billed charges · outpatientfrom % of charges | 1 | $370 | $1.2k | $1.7k | 140% | — | $9 – $6.8k |
| 22 | Ascension Seton Austin, TX percent of total billed charges · bothfrom % of charges | 1 | $492 | $1.5k | $2.0k | 129% | — | $2 – $9.5k |
| 23 | Ascension Seton Austin, TX percent of total billed charges · outpatientfrom % of charges | 1 | $492 | $1.5k | $2.0k | 129% | — | $2 – $9.5k |
| 24 | Ascension Seton Austin, TX percent of total billed charges · bothfrom % of charges | 1 | $408 | $1.1k | $1.4k | 127% | — | $2 – $4.4k |
| 25 | Ascension Seton Austin, TX percent of total billed charges · outpatientfrom % of charges | 1 | $408 | $1.1k | $1.4k | 127% | — | $2 – $4.4k |
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