|
THERMAGE KNEES - BILATERAL
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
|
|
THERMAGE NECK
|
Professional
|
Both
|
$1,261.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$945.75 |
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$819.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$945.75
|
|
|
THERMAGE THIGH - 1 THIGH
|
Professional
|
Both
|
$1,996.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$798.40 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Aetna Medicare |
$998.00
|
| Rate for Payer: BCBS Complete |
$798.40
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,297.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.00
|
|
|
THERMAGE THIGH - BILATERAL
|
Professional
|
Both
|
$3,257.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,302.80 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: Aetna Medicare |
$1,628.50
|
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,117.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.07
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$18.96 |
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Commercial |
$18.08
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Cash Price |
$17.02
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Advantage |
$16.83
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$13.87
|
| Rate for Payer: Cofinity Advantage |
$14.75
|
| Rate for Payer: Cofinity Advantage |
$14.89
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Advantage |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Healthscope Commercial |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$19.14
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$23.05
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$18.08
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: PHP Commercial |
$17.91
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$13.40
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$21.27
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna Commercial |
$18.08
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Commercial |
$17.91
|
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: Aetna Commercial |
$17.37
|
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Medicare |
$10.22
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna Medicare |
$11.70
|
| Rate for Payer: Aetna Medicare |
$10.63
|
| Rate for Payer: Aetna Medicare |
$13.56
|
| Rate for Payer: Aetna Medicare |
$10.54
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.21
|
| Rate for Payer: BCBS Complete |
$8.51
|
| Rate for Payer: BCBS Complete |
$8.43
|
| Rate for Payer: BCBS Complete |
$10.85
|
| Rate for Payer: BCBS Complete |
$9.36
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Complete |
$8.18
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCBS Trust/PPO |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: BCN Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$17.02
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$16.35
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$17.02
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$18.72
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cofinity Advantage |
$14.31
|
| Rate for Payer: Cofinity Advantage |
$14.89
|
| Rate for Payer: Cofinity Advantage |
$14.75
|
| Rate for Payer: Cofinity Advantage |
$13.87
|
| Rate for Payer: Cofinity Advantage |
$16.83
|
| Rate for Payer: Cofinity Advantage |
$18.98
|
| Rate for Payer: Cofinity Advantage |
$16.38
|
| Rate for Payer: Cofinity Commercial |
$20.12
|
| Rate for Payer: Cofinity Commercial |
$18.29
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$17.58
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.72
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Healthscope Commercial |
$17.84
|
| Rate for Payer: Healthscope Commercial |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$21.06
|
| Rate for Payer: Healthscope Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$19.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.03
|
| Rate for Payer: PHP Commercial |
$16.85
|
| Rate for Payer: PHP Commercial |
$17.91
|
| Rate for Payer: PHP Commercial |
$18.08
|
| Rate for Payer: PHP Commercial |
$19.89
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$23.05
|
| Rate for Payer: PHP Commercial |
$17.37
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: Priority Health SBD |
$14.74
|
| Rate for Payer: Priority Health SBD |
$13.40
|
| Rate for Payer: Priority Health SBD |
$12.88
|
| Rate for Payer: Priority Health SBD |
$13.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Core |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
| Rate for Payer: UHC Exchange |
$2.99
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$182.13
|
|
|
Service Code
|
NDC 50268085115
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.74 |
| Max. Negotiated Rate |
$163.92 |
| Rate for Payer: Aetna Commercial |
$154.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.38
|
| Rate for Payer: Cash Price |
$145.70
|
| Rate for Payer: Cofinity Advantage |
$127.49
|
| Rate for Payer: Cofinity Commercial |
$156.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.70
|
| Rate for Payer: Healthscope Commercial |
$163.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.60
|
| Rate for Payer: PHP Commercial |
$154.81
|
| Rate for Payer: Priority Health SBD |
$114.74
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$3.65
|
|
|
Service Code
|
NDC 50268085111
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Advantage |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.74
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health SBD |
$2.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.37
|
| Rate for Payer: UHC Core |
$1.90
|
| Rate for Payer: UHC Exchange |
$1.43
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$3.65
|
|
|
Service Code
|
NDC 50268085111
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$3.29 |
| Rate for Payer: Aetna Commercial |
$3.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.37
|
| Rate for Payer: Cash Price |
$2.92
|
| Rate for Payer: Cofinity Advantage |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.92
|
| Rate for Payer: Healthscope Commercial |
$3.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.74
|
| Rate for Payer: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health SBD |
$2.30
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 79854020010
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Advantage |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.31
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health SBD |
$66.62
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$182.13
|
|
|
Service Code
|
NDC 50268085115
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.58 |
| Max. Negotiated Rate |
$163.92 |
| Rate for Payer: Aetna Commercial |
$154.81
|
| Rate for Payer: Aetna Medicare |
$91.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.38
|
| Rate for Payer: BCBS Complete |
$72.85
|
| Rate for Payer: Cash Price |
$145.70
|
| Rate for Payer: Cofinity Advantage |
$127.49
|
| Rate for Payer: Cofinity Commercial |
$156.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.70
|
| Rate for Payer: Healthscope Commercial |
$163.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.60
|
| Rate for Payer: PHP Commercial |
$154.81
|
| Rate for Payer: Priority Health SBD |
$114.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.38
|
| Rate for Payer: UHC Core |
$94.89
|
| Rate for Payer: UHC Exchange |
$71.58
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 79854020010
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Advantage |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.31
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.74
|
| Rate for Payer: UHC Core |
$55.10
|
| Rate for Payer: UHC Exchange |
$41.56
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$4.52
|
|
|
Service Code
|
NDC 68094011659
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Advantage |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health SBD |
$2.85
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$451.20
|
|
|
Service Code
|
NDC 68094011661
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.32 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: BCBS Complete |
$180.48
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Advantage |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.40
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health SBD |
$284.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.28
|
| Rate for Payer: UHC Core |
$235.08
|
| Rate for Payer: UHC Exchange |
$177.32
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$451.20
|
|
|
Service Code
|
NDC 68094011661
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.26 |
| Max. Negotiated Rate |
$406.08 |
| Rate for Payer: Aetna Commercial |
$383.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.28
|
| Rate for Payer: Cash Price |
$360.96
|
| Rate for Payer: Cofinity Advantage |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$388.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.96
|
| Rate for Payer: Healthscope Commercial |
$406.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$383.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$338.40
|
| Rate for Payer: PHP Commercial |
$383.52
|
| Rate for Payer: Priority Health SBD |
$284.26
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$4.52
|
|
|
Service Code
|
NDC 68094011659
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.07 |
| Rate for Payer: Aetna Commercial |
$3.84
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Advantage |
$3.16
|
| Rate for Payer: Cofinity Commercial |
$3.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.39
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.94
|
| Rate for Payer: UHC Core |
$2.35
|
| Rate for Payer: UHC Exchange |
$1.78
|
|
|
THIOGLYCOLIC ACID SALT BODY CREAM (NAIR)
|
Facility
|
IP
|
$21.96
|
|
|
Service Code
|
NDC 09900002059
|
| Hospital Charge Code |
302081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.27
|
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: Cofinity Advantage |
$15.37
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.57
|
| Rate for Payer: Healthscope Commercial |
$19.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.47
|
| Rate for Payer: PHP Commercial |
$18.67
|
| Rate for Payer: Priority Health SBD |
$13.83
|
|
|
THIOGLYCOLIC ACID SALT BODY CREAM (NAIR)
|
Facility
|
OP
|
$21.96
|
|
|
Service Code
|
NDC 09900002059
|
| Hospital Charge Code |
302081
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$19.76 |
| Rate for Payer: Aetna Commercial |
$18.67
|
| Rate for Payer: Aetna Medicare |
$10.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.27
|
| Rate for Payer: BCBS Complete |
$8.78
|
| Rate for Payer: Cash Price |
$17.57
|
| Rate for Payer: Cofinity Advantage |
$15.37
|
| Rate for Payer: Cofinity Commercial |
$18.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.57
|
| Rate for Payer: Healthscope Commercial |
$19.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.47
|
| Rate for Payer: PHP Commercial |
$18.67
|
| Rate for Payer: Priority Health SBD |
$13.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.27
|
| Rate for Payer: UHC Core |
$11.44
|
| Rate for Payer: UHC Exchange |
$8.63
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 51079058001
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.13
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
IP
|
$426.24
|
|
|
Service Code
|
NDC 00378061801
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.53 |
| Max. Negotiated Rate |
$383.62 |
| Rate for Payer: Aetna Commercial |
$362.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.06
|
| Rate for Payer: Cash Price |
$340.99
|
| Rate for Payer: Cofinity Advantage |
$298.37
|
| Rate for Payer: Cofinity Commercial |
$366.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.99
|
| Rate for Payer: Healthscope Commercial |
$383.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.68
|
| Rate for Payer: PHP Commercial |
$362.30
|
| Rate for Payer: Priority Health SBD |
$268.53
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
OP
|
$337.44
|
|
|
Service Code
|
NDC 51079058020
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.61 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Aetna Commercial |
$286.82
|
| Rate for Payer: Aetna Medicare |
$168.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.34
|
| Rate for Payer: BCBS Complete |
$134.98
|
| Rate for Payer: Cash Price |
$269.95
|
| Rate for Payer: Cofinity Advantage |
$236.21
|
| Rate for Payer: Cofinity Commercial |
$290.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.95
|
| Rate for Payer: Healthscope Commercial |
$303.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$269.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.08
|
| Rate for Payer: PHP Commercial |
$286.82
|
| Rate for Payer: Priority Health SBD |
$212.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.34
|
| Rate for Payer: UHC Core |
$175.81
|
| Rate for Payer: UHC Exchange |
$132.61
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
IP
|
$337.44
|
|
|
Service Code
|
NDC 51079058020
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.59 |
| Max. Negotiated Rate |
$303.70 |
| Rate for Payer: Aetna Commercial |
$286.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.34
|
| Rate for Payer: Cash Price |
$269.95
|
| Rate for Payer: Cofinity Advantage |
$236.21
|
| Rate for Payer: Cofinity Commercial |
$290.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.95
|
| Rate for Payer: Healthscope Commercial |
$303.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.08
|
| Rate for Payer: PHP Commercial |
$286.82
|
| Rate for Payer: Priority Health SBD |
$212.59
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
OP
|
$426.24
|
|
|
Service Code
|
NDC 00378061801
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.51 |
| Max. Negotiated Rate |
$383.62 |
| Rate for Payer: Aetna Commercial |
$362.30
|
| Rate for Payer: Aetna Medicare |
$213.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.06
|
| Rate for Payer: BCBS Complete |
$170.50
|
| Rate for Payer: Cash Price |
$340.99
|
| Rate for Payer: Cofinity Advantage |
$298.37
|
| Rate for Payer: Cofinity Commercial |
$366.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.99
|
| Rate for Payer: Healthscope Commercial |
$383.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.68
|
| Rate for Payer: PHP Commercial |
$362.30
|
| Rate for Payer: Priority Health SBD |
$268.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.06
|
| Rate for Payer: UHC Core |
$222.07
|
| Rate for Payer: UHC Exchange |
$167.51
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 51079058001
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Advantage |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.54
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.20
|
| Rate for Payer: UHC Core |
$1.76
|
| Rate for Payer: UHC Exchange |
$1.33
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$2.64
|
|
|
Service Code
|
NDC 51079056601
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.38 |
| Rate for Payer: Aetna Commercial |
$2.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.72
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cofinity Advantage |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.11
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.98
|
| Rate for Payer: PHP Commercial |
$2.24
|
| Rate for Payer: Priority Health SBD |
$1.66
|
|
