|
THERMAGE FACE & NECK
|
Professional
|
Both
|
$2,942.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,176.80 |
| Max. Negotiated Rate |
$2,206.50 |
| Rate for Payer: BCBS Complete |
$1,176.80
|
| Rate for Payer: Cash Price |
$2,353.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,206.50
|
|
|
THERMAGE FACE, NECK, & EYES
|
Professional
|
Both
|
$3,677.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,470.80 |
| Max. Negotiated Rate |
$2,757.75 |
| Rate for Payer: BCBS Complete |
$1,470.80
|
| Rate for Payer: Cash Price |
$2,941.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,757.75
|
|
|
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: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| 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: BCBS Complete |
$504.40
|
| Rate for Payer: Cash Price |
$1,008.80
|
| 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: BCBS Complete |
$798.40
|
| Rate for Payer: Cash Price |
$1,596.80
|
| 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: BCBS Complete |
$1,302.80
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.41
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$24.41 |
| Rate for Payer: Aetna Commercial |
$21.97
|
| Rate for Payer: Aetna Commercial |
$24.52
|
| Rate for Payer: Aetna Commercial |
$21.13
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Aetna Medicare |
$10.08
|
| Rate for Payer: Aetna Medicare |
$7.33
|
| Rate for Payer: Aetna Medicare |
$9.06
|
| Rate for Payer: Aetna Medicare |
$9.03
|
| Rate for Payer: Aetna Medicare |
$8.69
|
| Rate for Payer: ASR ASR |
$23.67
|
| Rate for Payer: ASR ASR |
$26.43
|
| Rate for Payer: ASR ASR |
$23.76
|
| Rate for Payer: ASR ASR |
$22.77
|
| Rate for Payer: ASR ASR |
$19.22
|
| Rate for Payer: BCBS Complete |
$9.80
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: BCBS Complete |
$9.76
|
| Rate for Payer: BCBS Complete |
$9.39
|
| Rate for Payer: BCBS Trust/PPO |
$16.34
|
| Rate for Payer: BCBS Trust/PPO |
$19.35
|
| Rate for Payer: BCBS Trust/PPO |
$20.20
|
| Rate for Payer: BCBS Trust/PPO |
$22.47
|
| Rate for Payer: BCBS Trust/PPO |
$20.12
|
| Rate for Payer: BCN Commercial |
$20.20
|
| Rate for Payer: BCN Commercial |
$19.35
|
| Rate for Payer: BCN Commercial |
$16.34
|
| Rate for Payer: BCN Commercial |
$22.47
|
| Rate for Payer: BCN Commercial |
$20.12
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Cash Price |
$15.85
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cash Price |
$15.85
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$22.06
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$23.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.78
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Healthscope Commercial |
$26.43
|
| Rate for Payer: Healthscope Commercial |
$23.67
|
| Rate for Payer: Healthscope Commercial |
$23.76
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Healthscope Whirlpool |
$19.82
|
| Rate for Payer: Healthscope Whirlpool |
$23.47
|
| Rate for Payer: Healthscope Whirlpool |
$27.25
|
| Rate for Payer: Healthscope Whirlpool |
$24.49
|
| Rate for Payer: Mclaren Commercial |
$21.13
|
| Rate for Payer: Mclaren Commercial |
$17.84
|
| Rate for Payer: Mclaren Commercial |
$24.52
|
| Rate for Payer: Mclaren Commercial |
$22.04
|
| Rate for Payer: Mclaren Commercial |
$21.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Nomi Health Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$16.25
|
| Rate for Payer: Nomi Health Commercial |
$22.34
|
| Rate for Payer: Nomi Health Commercial |
$20.09
|
| Rate for Payer: Nomi Health Commercial |
$20.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.87
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: Priority Health Narrow Network |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.48
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.25
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Aetna Commercial |
$24.52
|
| Rate for Payer: Aetna Commercial |
$21.97
|
| Rate for Payer: Aetna Commercial |
$22.04
|
| Rate for Payer: Aetna Commercial |
$21.13
|
| Rate for Payer: Aetna Commercial |
$17.84
|
| Rate for Payer: ASR ASR |
$23.67
|
| Rate for Payer: ASR ASR |
$19.22
|
| Rate for Payer: ASR ASR |
$26.43
|
| Rate for Payer: ASR ASR |
$22.77
|
| Rate for Payer: ASR ASR |
$23.76
|
| Rate for Payer: BCBS Trust/PPO |
$22.38
|
| Rate for Payer: BCBS Trust/PPO |
$19.28
|
| Rate for Payer: BCBS Trust/PPO |
$16.27
|
| Rate for Payer: BCBS Trust/PPO |
$20.11
|
| Rate for Payer: BCBS Trust/PPO |
$20.04
|
| Rate for Payer: BCN Commercial |
$20.04
|
| Rate for Payer: BCN Commercial |
$19.28
|
| Rate for Payer: BCN Commercial |
$20.11
|
| Rate for Payer: BCN Commercial |
$22.38
|
| Rate for Payer: BCN Commercial |
$16.27
|
| Rate for Payer: Cash Price |
$15.85
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Cash Price |
$19.60
|
| Rate for Payer: Cash Price |
$18.78
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$22.06
|
| Rate for Payer: Cofinity Commercial |
$23.02
|
| Rate for Payer: Cofinity Commercial |
$18.63
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Cofinity Commercial |
$25.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Healthscope Commercial |
$23.67
|
| Rate for Payer: Healthscope Commercial |
$22.77
|
| Rate for Payer: Healthscope Commercial |
$23.76
|
| Rate for Payer: Healthscope Commercial |
$19.22
|
| Rate for Payer: Healthscope Commercial |
$26.43
|
| Rate for Payer: Healthscope Whirlpool |
$24.49
|
| Rate for Payer: Healthscope Whirlpool |
$27.25
|
| Rate for Payer: Healthscope Whirlpool |
$19.82
|
| Rate for Payer: Healthscope Whirlpool |
$23.47
|
| Rate for Payer: Healthscope Whirlpool |
$24.41
|
| Rate for Payer: Mclaren Commercial |
$21.13
|
| Rate for Payer: Mclaren Commercial |
$22.04
|
| Rate for Payer: Mclaren Commercial |
$17.84
|
| Rate for Payer: Mclaren Commercial |
$24.52
|
| Rate for Payer: Mclaren Commercial |
$21.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Nomi Health Commercial |
$20.09
|
| Rate for Payer: Nomi Health Commercial |
$20.01
|
| Rate for Payer: Nomi Health Commercial |
$19.25
|
| Rate for Payer: Nomi Health Commercial |
$16.25
|
| Rate for Payer: Nomi Health Commercial |
$22.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.44
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$3.64
|
|
|
Service Code
|
NDC 50268085111
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: ASR ASR |
$3.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Healthscope Whirlpool |
$3.64
|
| Rate for Payer: Mclaren Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: Nomi Health Commercial |
$2.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.21
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$3.64
|
|
|
Service Code
|
NDC 50268085111
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna Medicare |
$1.35
|
| Rate for Payer: ASR ASR |
$3.53
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$2.91
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.91
|
| Rate for Payer: Healthscope Commercial |
$3.53
|
| Rate for Payer: Healthscope Whirlpool |
$3.64
|
| Rate for Payer: Mclaren Commercial |
$3.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.10
|
| Rate for Payer: Nomi Health Commercial |
$2.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.19
|
| Rate for Payer: Priority Health Narrow Network |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.21
|
|
|
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 |
$67.39 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna Commercial |
$163.91
|
| Rate for Payer: Aetna Medicare |
$67.39
|
| Rate for Payer: ASR ASR |
$176.66
|
| Rate for Payer: BCBS Complete |
$72.85
|
| Rate for Payer: BCBS Trust/PPO |
$150.16
|
| Rate for Payer: BCN Commercial |
$150.16
|
| Rate for Payer: Cash Price |
$145.70
|
| Rate for Payer: Cofinity Commercial |
$171.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.70
|
| Rate for Payer: Healthscope Commercial |
$176.66
|
| Rate for Payer: Healthscope Whirlpool |
$182.12
|
| Rate for Payer: Mclaren Commercial |
$163.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.81
|
| Rate for Payer: Nomi Health Commercial |
$149.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$159.58
|
| Rate for Payer: Priority Health Narrow Network |
$127.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.27
|
|
|
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 |
$136.59 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna Commercial |
$163.91
|
| Rate for Payer: ASR ASR |
$176.66
|
| Rate for Payer: BCBS Trust/PPO |
$149.56
|
| Rate for Payer: BCN Commercial |
$149.56
|
| Rate for Payer: Cash Price |
$145.70
|
| Rate for Payer: Cofinity Commercial |
$171.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.70
|
| Rate for Payer: Healthscope Commercial |
$176.66
|
| Rate for Payer: Healthscope Whirlpool |
$182.12
|
| Rate for Payer: Mclaren Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.81
|
| Rate for Payer: Nomi Health Commercial |
$149.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.27
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$387.75
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.81 |
| 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 |
$318.42
|
| Rate for Payer: BCN Commercial |
$318.42
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$364.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$376.12
|
| Rate for Payer: Healthscope Whirlpool |
$387.75
|
| Rate for Payer: Mclaren Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$341.22
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$387.75
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.47 |
| Max. Negotiated Rate |
$387.75 |
| Rate for Payer: Aetna Commercial |
$348.98
|
| Rate for Payer: Aetna Medicare |
$143.47
|
| Rate for Payer: ASR ASR |
$376.12
|
| Rate for Payer: BCBS Complete |
$155.10
|
| Rate for Payer: BCBS Trust/PPO |
$319.70
|
| Rate for Payer: BCN Commercial |
$319.70
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$364.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$376.12
|
| Rate for Payer: Healthscope Whirlpool |
$387.75
|
| Rate for Payer: Mclaren Commercial |
$348.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$310.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$339.75
|
| Rate for Payer: Priority Health Narrow Network |
$271.81
|
| 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 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.91 |
| 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 |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| 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 |
$3.76
|
| Rate for Payer: Healthscope Whirlpool |
$3.88
|
| Rate for Payer: Mclaren Commercial |
$3.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
|
THIAMINE MONONITRATE (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: ASR ASR |
$3.76
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.20
|
| Rate for Payer: BCN Commercial |
$3.20
|
| 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 |
$3.76
|
| Rate for Payer: Healthscope Whirlpool |
$3.88
|
| Rate for Payer: Mclaren Commercial |
$3.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.30
|
| Rate for Payer: Nomi Health Commercial |
$3.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.40
|
| Rate for Payer: Priority Health Narrow Network |
$2.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$2.64
|
|
|
Service Code
|
NDC 51079056601
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: ASR ASR |
$2.56
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.11
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.64
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.24
|
| Rate for Payer: Nomi Health Commercial |
$2.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.31
|
| Rate for Payer: Priority Health Narrow Network |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.32
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
NDC 51079056620
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.68 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Medicare |
$97.68
|
| Rate for Payer: ASR ASR |
$256.08
|
| Rate for Payer: BCBS Complete |
$105.60
|
| Rate for Payer: BCBS Trust/PPO |
$217.67
|
| Rate for Payer: BCN Commercial |
$217.67
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$248.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.20
|
| Rate for Payer: Healthscope Commercial |
$256.08
|
| Rate for Payer: Healthscope Whirlpool |
$264.00
|
| Rate for Payer: Mclaren Commercial |
$237.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.40
|
| Rate for Payer: Nomi Health Commercial |
$216.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$231.32
|
| Rate for Payer: Priority Health Narrow Network |
$185.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.32
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$299.04
|
|
|
Service Code
|
NDC 378061401
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.64 |
| Max. Negotiated Rate |
$299.04 |
| Rate for Payer: Aetna Commercial |
$269.14
|
| Rate for Payer: Aetna Medicare |
$110.64
|
| Rate for Payer: ASR ASR |
$290.07
|
| Rate for Payer: BCBS Complete |
$119.62
|
| Rate for Payer: BCBS Trust/PPO |
$246.56
|
| Rate for Payer: BCN Commercial |
$246.56
|
| 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 |
$290.07
|
| Rate for Payer: Healthscope Whirlpool |
$299.04
|
| Rate for Payer: Mclaren Commercial |
$269.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$239.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: Nomi Health Commercial |
$245.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.02
|
| Rate for Payer: Priority Health Narrow Network |
$209.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.16
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$2.64
|
|
|
Service Code
|
NDC 51079056601
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.11
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Healthscope Whirlpool |
$2.64
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.24
|
| Rate for Payer: Nomi Health Commercial |
$2.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.32
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
NDC 51079056620
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: ASR ASR |
$256.08
|
| Rate for Payer: BCBS Trust/PPO |
$216.80
|
| Rate for Payer: BCN Commercial |
$216.80
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$248.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$211.20
|
| Rate for Payer: Healthscope Commercial |
$256.08
|
| Rate for Payer: Healthscope Whirlpool |
$264.00
|
| Rate for Payer: Mclaren Commercial |
$237.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.40
|
| Rate for Payer: Nomi Health Commercial |
$216.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$232.32
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$299.04
|
|
|
Service Code
|
NDC 378061401
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.28 |
| 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 |
$245.57
|
| Rate for Payer: BCN Commercial |
$245.57
|
| 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 |
$290.07
|
| Rate for Payer: Healthscope Whirlpool |
$299.04
|
| Rate for Payer: Mclaren Commercial |
$269.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.18
|
| Rate for Payer: Nomi Health Commercial |
$245.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.16
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$213.23
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$159.92 |
| Max. Negotiated Rate |
$213.23 |
| Rate for Payer: Aetna Commercial |
$191.91
|
| Rate for Payer: ASR ASR |
$206.83
|
| Rate for Payer: BCBS Trust/PPO |
$175.11
|
| Rate for Payer: BCN Commercial |
$175.11
|
| Rate for Payer: Cash Price |
$170.58
|
| Rate for Payer: Cofinity Commercial |
$200.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.58
|
| Rate for Payer: Healthscope Commercial |
$206.83
|
| Rate for Payer: Healthscope Whirlpool |
$213.23
|
| Rate for Payer: Mclaren Commercial |
$191.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.25
|
| Rate for Payer: Nomi Health Commercial |
$174.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.64
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$213.23
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$213.23 |
| Rate for Payer: Aetna Commercial |
$191.91
|
| Rate for Payer: Aetna Medicare |
$78.90
|
| Rate for Payer: ASR ASR |
$206.83
|
| Rate for Payer: BCBS Complete |
$85.29
|
| Rate for Payer: BCBS Trust/PPO |
$175.81
|
| Rate for Payer: BCN Commercial |
$175.81
|
| Rate for Payer: Cash Price |
$170.58
|
| Rate for Payer: Cofinity Commercial |
$200.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.58
|
| Rate for Payer: Healthscope Commercial |
$206.83
|
| Rate for Payer: Healthscope Whirlpool |
$213.23
|
| Rate for Payer: Mclaren Commercial |
$191.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$170.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.25
|
| Rate for Payer: Nomi Health Commercial |
$174.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$186.83
|
| Rate for Payer: Priority Health Narrow Network |
$149.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.64
|
|
|
THYROID DISORDERS
|
Facility
|
IP
|
$4,591.20
|
|
|
Service Code
|
APR-DRG 4272
|
| Min. Negotiated Rate |
$4,151.00 |
| Max. Negotiated Rate |
$4,591.20 |
| Rate for Payer: BCBS Complete |
$4,591.20
|
| Rate for Payer: Mclaren Medicaid |
$4,372.57
|
| Rate for Payer: Meridian Medicaid |
$4,591.20
|
| Rate for Payer: PHP Medicaid |
$4,151.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,372.57
|
| Rate for Payer: UHC Medicaid |
$4,372.57
|
| Rate for Payer: UHCCP Medicaid |
$4,372.57
|
|
