|
THERMAGE NECK
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 00141
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$489.60 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$795.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
|
|
THERMAGE THIGH - 1 THIGH
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 00147
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Medicare |
$969.00
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,259.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
|
|
THERMAGE THIGH - BILATERAL
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 00148
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,055.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$27.53
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.01 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Commercial |
$24.00
|
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Medicare |
$13.56
|
| Rate for Payer: Aetna Medicare |
$14.12
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna Medicare |
$12.94
|
| Rate for Payer: Aetna Medicare |
$11.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.85
|
| Rate for Payer: BCBS Complete |
$10.35
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Complete |
$10.85
|
| Rate for Payer: BCBS Complete |
$9.14
|
| Rate for Payer: BCBS Complete |
$11.29
|
| Rate for Payer: Cash Price |
$18.27
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$22.26
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$19.76
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Healthscope Commercial |
$23.29
|
| Rate for Payer: Healthscope Commercial |
$20.56
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$25.41
|
| Rate for Payer: Healthscope Commercial |
$24.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.00
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$23.05
|
| Rate for Payer: PHP Commercial |
$22.00
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.63
|
| Rate for Payer: Priority Health SBD |
$17.78
|
| Rate for Payer: Priority Health SBD |
$14.39
|
| Rate for Payer: Priority Health SBD |
$16.30
|
| Rate for Payer: Priority Health SBD |
$17.34
|
| Rate for Payer: Priority Health SBD |
$17.09
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.84
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$20.56 |
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Commercial |
$22.00
|
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Commercial |
$24.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.89
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$18.27
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Cofinity Commercial |
$18.12
|
| Rate for Payer: Cofinity Commercial |
$15.99
|
| Rate for Payer: Cofinity Commercial |
$19.64
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$22.26
|
| Rate for Payer: Cofinity Commercial |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$19.27
|
| Rate for Payer: Cofinity Commercial |
$19.76
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$25.41
|
| Rate for Payer: Healthscope Commercial |
$20.56
|
| Rate for Payer: Healthscope Commercial |
$23.29
|
| Rate for Payer: Healthscope Commercial |
$24.41
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.00
|
| Rate for Payer: PHP Commercial |
$23.40
|
| Rate for Payer: PHP Commercial |
$19.41
|
| Rate for Payer: PHP Commercial |
$22.00
|
| Rate for Payer: PHP Commercial |
$23.05
|
| Rate for Payer: PHP Commercial |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.35
|
| Rate for Payer: Priority Health SBD |
$17.78
|
| Rate for Payer: Priority Health SBD |
$16.30
|
| Rate for Payer: Priority Health SBD |
$17.09
|
| Rate for Payer: Priority Health SBD |
$14.39
|
| Rate for Payer: Priority Health SBD |
$17.34
|
|
|
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 Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.56
|
| 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: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| 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 Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| 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: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
|
|
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 |
$42.30 |
| 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 Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| 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: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
|
|
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 |
$1.46 |
| 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 Commercial |
$2.56
|
| Rate for Payer: Cofinity Commercial |
$3.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.56
|
| 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: PHP Commercial |
$3.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: Priority Health SBD |
$2.30
|
|
|
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 Commercial |
$127.49
|
| Rate for Payer: Cofinity Commercial |
$156.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.49
|
| 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: PHP Commercial |
$154.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.38
|
| Rate for Payer: Priority Health SBD |
$114.74
|
|
|
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 |
$72.85 |
| 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 Commercial |
$127.49
|
| Rate for Payer: Cofinity Commercial |
$156.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$127.49
|
| 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: PHP Commercial |
$154.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.38
|
| Rate for Payer: Priority Health SBD |
$114.74
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$411.25
|
|
|
Service Code
|
NDC 68094011661
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$259.09 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.31
|
| Rate for Payer: Priority Health SBD |
$259.09
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$411.25
|
|
|
Service Code
|
NDC 68094011661
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.50 |
| Max. Negotiated Rate |
$370.12 |
| Rate for Payer: Aetna Commercial |
$349.56
|
| Rate for Payer: Aetna Medicare |
$205.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: BCBS Complete |
$164.50
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Cofinity Commercial |
$353.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$287.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$329.00
|
| Rate for Payer: Healthscope Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.56
|
| Rate for Payer: PHP Commercial |
$349.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.31
|
| Rate for Payer: Priority Health SBD |
$259.09
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$4.12
|
|
|
Service Code
|
NDC 68094011659
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna Medicare |
$2.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: BCBS Complete |
$1.65
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: Priority Health SBD |
$2.60
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$4.12
|
|
|
Service Code
|
NDC 68094011659
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.68
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.30
|
| Rate for Payer: Healthscope Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.50
|
| Rate for Payer: PHP Commercial |
$3.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.68
|
| Rate for Payer: Priority Health SBD |
$2.60
|
|
|
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 Commercial |
$236.21
|
| Rate for Payer: Cofinity Commercial |
$290.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.21
|
| 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: PHP Commercial |
$286.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.34
|
| Rate for Payer: Priority Health SBD |
$212.59
|
|
|
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 Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.37
|
| 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: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$2.13
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 51079058001
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| 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 Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.37
|
| 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: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$2.13
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
OP
|
$425.76
|
|
|
Service Code
|
NDC 00378061801
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Aetna Medicare |
$212.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.74
|
| Rate for Payer: BCBS Complete |
$170.30
|
| Rate for Payer: Cash Price |
$340.61
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Cofinity Commercial |
$366.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.61
|
| Rate for Payer: Healthscope Commercial |
$383.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.90
|
| Rate for Payer: PHP Commercial |
$361.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.74
|
| Rate for Payer: Priority Health SBD |
$268.23
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
IP
|
$425.76
|
|
|
Service Code
|
NDC 00378061801
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.23 |
| Max. Negotiated Rate |
$383.18 |
| Rate for Payer: Aetna Commercial |
$361.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.74
|
| Rate for Payer: Cash Price |
$340.61
|
| Rate for Payer: Cofinity Commercial |
$298.03
|
| Rate for Payer: Cofinity Commercial |
$366.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.61
|
| Rate for Payer: Healthscope Commercial |
$383.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.90
|
| Rate for Payer: PHP Commercial |
$361.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.74
|
| Rate for Payer: Priority Health SBD |
$268.23
|
|
|
THIORIDAZINE 100 MG TABLET
|
Facility
|
OP
|
$337.44
|
|
|
Service Code
|
NDC 51079058020
|
| Hospital Charge Code |
7895
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.98 |
| 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 Commercial |
$236.21
|
| Rate for Payer: Cofinity Commercial |
$290.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.21
|
| 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: PHP Commercial |
$286.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.34
|
| Rate for Payer: Priority Health SBD |
$212.59
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$299.04
|
|
|
Service Code
|
NDC 00378061401
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.62 |
| Max. Negotiated Rate |
$269.14 |
| Rate for Payer: Aetna Commercial |
$254.18
|
| Rate for Payer: Aetna Medicare |
$149.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.38
|
| Rate for Payer: BCBS Complete |
$119.62
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Commercial |
$209.33
|
| Rate for Payer: Cofinity Commercial |
$257.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$269.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: PHP Commercial |
$254.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.38
|
| Rate for Payer: Priority Health SBD |
$188.40
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$299.04
|
|
|
Service Code
|
NDC 00378061401
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.40 |
| Max. Negotiated Rate |
$269.14 |
| Rate for Payer: Aetna Commercial |
$254.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.38
|
| Rate for Payer: Cash Price |
$239.23
|
| Rate for Payer: Cofinity Commercial |
$209.33
|
| Rate for Payer: Cofinity Commercial |
$257.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$209.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$239.23
|
| Rate for Payer: Healthscope Commercial |
$269.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: PHP Commercial |
$254.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.38
|
| Rate for Payer: Priority Health SBD |
$188.40
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 51079056601
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.05
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$4.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.99
|
| Rate for Payer: PHP Commercial |
$3.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.05
|
| Rate for Payer: Priority Health SBD |
$2.95
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$468.35
|
|
|
Service Code
|
NDC 51079056620
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.34 |
| Max. Negotiated Rate |
$421.51 |
| Rate for Payer: Aetna Commercial |
$398.10
|
| Rate for Payer: Aetna Medicare |
$234.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.43
|
| Rate for Payer: BCBS Complete |
$187.34
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$327.85
|
| Rate for Payer: Cofinity Commercial |
$402.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.68
|
| Rate for Payer: Healthscope Commercial |
$421.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.10
|
| Rate for Payer: PHP Commercial |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.43
|
| Rate for Payer: Priority Health SBD |
$295.06
|
|
