|
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: 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: 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: Priority Health Cigna Priority Health |
$2,055.30
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$27.25
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Aetna Commercial |
$24.52
|
| Rate for Payer: Aetna Commercial |
$25.45
|
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Commercial |
$29.65
|
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: Aetna Medicare |
$13.76
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: Aetna Medicare |
$14.14
|
| Rate for Payer: Aetna Medicare |
$16.47
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR ASR |
$27.43
|
| Rate for Payer: ASR ASR |
$26.43
|
| Rate for Payer: ASR ASR |
$26.70
|
| Rate for Payer: ASR ASR |
$31.95
|
| Rate for Payer: ASR Commercial |
$24.04
|
| Rate for Payer: ASR Commercial |
$26.43
|
| Rate for Payer: ASR Commercial |
$31.95
|
| Rate for Payer: ASR Commercial |
$27.43
|
| Rate for Payer: ASR Commercial |
$26.70
|
| Rate for Payer: BCBS Complete |
$13.18
|
| Rate for Payer: BCBS Complete |
$9.91
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: BCBS Complete |
$11.01
|
| Rate for Payer: BCBS Complete |
$11.31
|
| Rate for Payer: BCBS Trust/PPO |
$23.16
|
| Rate for Payer: BCBS Trust/PPO |
$22.54
|
| Rate for Payer: BCBS Trust/PPO |
$20.29
|
| Rate for Payer: BCBS Trust/PPO |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$26.97
|
| Rate for Payer: BCN Commercial |
$21.93
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: BCN Commercial |
$21.13
|
| Rate for Payer: BCN Commercial |
$21.34
|
| Rate for Payer: BCN Commercial |
$25.54
|
| Rate for Payer: Cash Price |
$26.35
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cash Price |
$22.63
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.63
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cash Price |
$26.35
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$25.62
|
| Rate for Payer: Cofinity Commercial |
$26.58
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Cofinity Commercial |
$25.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Healthscope Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$27.53
|
| Rate for Payer: Healthscope Commercial |
$27.25
|
| Rate for Payer: Healthscope Commercial |
$32.94
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Whirlpool |
$31.95
|
| Rate for Payer: Healthscope Whirlpool |
$26.43
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$27.43
|
| Rate for Payer: Healthscope Whirlpool |
$26.70
|
| Rate for Payer: Mclaren Commercial |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Mclaren Commercial |
$24.52
|
| Rate for Payer: Mclaren Commercial |
$24.78
|
| Rate for Payer: Mclaren Commercial |
$29.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Nomi Health Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$22.34
|
| Rate for Payer: Nomi Health Commercial |
$27.01
|
| Rate for Payer: Nomi Health Commercial |
$23.19
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.82
|
| Rate for Payer: Priority Health Narrow Network |
$1.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.46
|
| Rate for Payer: Priority Health Narrow Network |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.23
|
|
|
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 |
$17.71 |
| Max. Negotiated Rate |
$27.25 |
| Rate for Payer: Aetna Commercial |
$24.52
|
| Rate for Payer: Aetna Commercial |
$25.45
|
| Rate for Payer: Aetna Commercial |
$29.65
|
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: ASR ASR |
$31.95
|
| Rate for Payer: ASR ASR |
$27.43
|
| Rate for Payer: ASR ASR |
$26.70
|
| Rate for Payer: ASR ASR |
$26.43
|
| Rate for Payer: ASR ASR |
$24.04
|
| Rate for Payer: ASR Commercial |
$26.70
|
| Rate for Payer: ASR Commercial |
$31.95
|
| Rate for Payer: ASR Commercial |
$27.43
|
| Rate for Payer: ASR Commercial |
$26.43
|
| Rate for Payer: ASR Commercial |
$24.04
|
| Rate for Payer: BCBS Trust/PPO |
$26.84
|
| Rate for Payer: BCBS Trust/PPO |
$20.19
|
| Rate for Payer: BCBS Trust/PPO |
$22.21
|
| Rate for Payer: BCBS Trust/PPO |
$23.05
|
| Rate for Payer: BCBS Trust/PPO |
$22.43
|
| Rate for Payer: BCN Commercial |
$21.13
|
| Rate for Payer: BCN Commercial |
$25.54
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: BCN Commercial |
$21.34
|
| Rate for Payer: BCN Commercial |
$21.93
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Cash Price |
$22.63
|
| Rate for Payer: Cash Price |
$26.35
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$25.62
|
| Rate for Payer: Cofinity Commercial |
$25.88
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Cofinity Commercial |
$26.58
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Healthscope Commercial |
$27.53
|
| Rate for Payer: Healthscope Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$27.25
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$32.94
|
| Rate for Payer: Healthscope Whirlpool |
$31.95
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$26.70
|
| Rate for Payer: Healthscope Whirlpool |
$26.43
|
| Rate for Payer: Healthscope Whirlpool |
$27.43
|
| Rate for Payer: Mclaren Commercial |
$24.52
|
| Rate for Payer: Mclaren Commercial |
$24.78
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Mclaren Commercial |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$29.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Nomi Health Commercial |
$22.57
|
| Rate for Payer: Nomi Health Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$22.34
|
| Rate for Payer: Nomi Health Commercial |
$27.01
|
| Rate for Payer: Nomi Health Commercial |
$23.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.89
|
|
|
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 |
$1.46 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: ASR ASR |
$3.53
|
| Rate for Payer: ASR Commercial |
$3.53
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.82
|
| 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 |
$3.64
|
| Rate for Payer: Healthscope Whirlpool |
$3.53
|
| Rate for Payer: Mclaren Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: 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 |
$3.20
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
OP
|
$182.12
|
|
|
Service Code
|
NDC 50268085115
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna Commercial |
$163.91
|
| Rate for Payer: Aetna Medicare |
$91.06
|
| Rate for Payer: ASR ASR |
$176.66
|
| Rate for Payer: ASR Commercial |
$176.66
|
| Rate for Payer: BCBS Complete |
$72.85
|
| Rate for Payer: BCBS Trust/PPO |
$149.14
|
| Rate for Payer: BCN Commercial |
$141.20
|
| Rate for Payer: Cash Price |
$145.70
|
| Rate for Payer: Cofinity Commercial |
$171.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.70
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: Healthscope Whirlpool |
$176.66
|
| Rate for Payer: Mclaren Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.80
|
| Rate for Payer: Nomi Health Commercial |
$149.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.57
|
| 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
|
$3.64
|
|
|
Service Code
|
NDC 50268085111
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: ASR ASR |
$3.53
|
| Rate for Payer: ASR Commercial |
$3.53
|
| Rate for Payer: BCBS Trust/PPO |
$2.97
|
| Rate for Payer: BCN Commercial |
$2.82
|
| 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 |
$3.64
|
| Rate for Payer: Healthscope Whirlpool |
$3.53
|
| Rate for Payer: Mclaren Commercial |
$3.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.20
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG TABLET
|
Facility
|
IP
|
$182.12
|
|
|
Service Code
|
NDC 50268085115
|
| Hospital Charge Code |
7877
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.38 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna Commercial |
$163.91
|
| Rate for Payer: ASR ASR |
$176.66
|
| Rate for Payer: ASR Commercial |
$176.66
|
| Rate for Payer: BCBS Trust/PPO |
$148.41
|
| Rate for Payer: BCN Commercial |
$141.20
|
| Rate for Payer: Cash Price |
$145.70
|
| Rate for Payer: Cofinity Commercial |
$171.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.70
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: Healthscope Whirlpool |
$176.66
|
| Rate for Payer: Mclaren Commercial |
$163.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.80
|
| Rate for Payer: Nomi Health Commercial |
$149.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.38
|
| 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 |
$252.04 |
| Max. Negotiated Rate |
$387.75 |
| Rate for Payer: Aetna Commercial |
$348.98
|
| Rate for Payer: ASR ASR |
$376.12
|
| Rate for Payer: ASR Commercial |
$376.12
|
| Rate for Payer: BCBS Trust/PPO |
$315.98
|
| Rate for Payer: BCN Commercial |
$300.62
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$364.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$387.75
|
| Rate for Payer: Healthscope Whirlpool |
$376.12
|
| Rate for Payer: Mclaren Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| 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 |
$155.10 |
| Max. Negotiated Rate |
$387.75 |
| Rate for Payer: Aetna Commercial |
$348.98
|
| Rate for Payer: Aetna Medicare |
$193.88
|
| Rate for Payer: ASR ASR |
$376.12
|
| Rate for Payer: ASR Commercial |
$376.12
|
| Rate for Payer: BCBS Complete |
$155.10
|
| Rate for Payer: BCBS Trust/PPO |
$317.53
|
| Rate for Payer: BCN Commercial |
$300.62
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cofinity Commercial |
$364.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.20
|
| Rate for Payer: Healthscope Commercial |
$387.75
|
| Rate for Payer: Healthscope Whirlpool |
$376.12
|
| Rate for Payer: Mclaren Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.59
|
| Rate for Payer: Nomi Health Commercial |
$317.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.04
|
| Rate for Payer: 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
|
OP
|
$3.88
|
|
|
Service Code
|
NDC 77333093425
|
| Hospital Charge Code |
119871
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: ASR ASR |
$3.76
|
| Rate for Payer: ASR Commercial |
$3.76
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.01
|
| 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 |
$3.88
|
| Rate for Payer: Healthscope Whirlpool |
$3.76
|
| 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: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: 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
|
|
|
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 |
$2.52 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Aetna Commercial |
$3.49
|
| Rate for Payer: ASR ASR |
$3.76
|
| Rate for Payer: ASR Commercial |
$3.76
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$3.01
|
| 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 |
$3.88
|
| Rate for Payer: Healthscope Whirlpool |
$3.76
|
| 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: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.41
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 51079056601
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: ASR Commercial |
$4.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Healthscope Whirlpool |
$4.54
|
| Rate for Payer: Mclaren Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
IP
|
$468.35
|
|
|
Service Code
|
NDC 51079056620
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$304.43 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna Commercial |
$421.52
|
| Rate for Payer: ASR ASR |
$454.30
|
| Rate for Payer: ASR Commercial |
$454.30
|
| Rate for Payer: BCBS Trust/PPO |
$381.66
|
| Rate for Payer: BCN Commercial |
$363.11
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$440.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.68
|
| Rate for Payer: Healthscope Commercial |
$468.35
|
| Rate for Payer: Healthscope Whirlpool |
$454.30
|
| Rate for Payer: Mclaren Commercial |
$421.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.10
|
| Rate for Payer: Nomi Health Commercial |
$384.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.15
|
|
|
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 |
$468.35 |
| Rate for Payer: Aetna Commercial |
$421.52
|
| Rate for Payer: Aetna Medicare |
$234.18
|
| Rate for Payer: ASR ASR |
$454.30
|
| Rate for Payer: ASR Commercial |
$454.30
|
| Rate for Payer: BCBS Complete |
$187.34
|
| Rate for Payer: BCBS Trust/PPO |
$383.53
|
| Rate for Payer: BCN Commercial |
$363.11
|
| Rate for Payer: Cash Price |
$374.68
|
| Rate for Payer: Cofinity Commercial |
$440.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.68
|
| Rate for Payer: Healthscope Commercial |
$468.35
|
| Rate for Payer: Healthscope Whirlpool |
$454.30
|
| Rate for Payer: Mclaren Commercial |
$421.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.10
|
| Rate for Payer: Nomi Health Commercial |
$384.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.37
|
| Rate for Payer: Priority Health Narrow Network |
$328.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.15
|
|
|
THIORIDAZINE 25 MG TABLET
|
Facility
|
OP
|
$4.68
|
|
|
Service Code
|
NDC 51079056601
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: ASR Commercial |
$4.54
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Healthscope Whirlpool |
$4.54
|
| Rate for Payer: Mclaren Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.10
|
| Rate for Payer: Priority Health Narrow Network |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
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 |
$299.04 |
| Rate for Payer: Aetna Commercial |
$269.14
|
| Rate for Payer: Aetna Medicare |
$149.52
|
| Rate for Payer: ASR ASR |
$290.07
|
| Rate for Payer: ASR Commercial |
$290.07
|
| Rate for Payer: BCBS Complete |
$119.62
|
| Rate for Payer: BCBS Trust/PPO |
$244.88
|
| Rate for Payer: BCN Commercial |
$231.85
|
| 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 |
$299.04
|
| Rate for Payer: Healthscope Whirlpool |
$290.07
|
| 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: Priority Health Cigna Priority Health |
$194.38
|
| Rate for Payer: 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
|
$299.04
|
|
|
Service Code
|
NDC 00378061401
|
| Hospital Charge Code |
7899
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.38 |
| Max. Negotiated Rate |
$299.04 |
| Rate for Payer: Aetna Commercial |
$269.14
|
| Rate for Payer: ASR ASR |
$290.07
|
| Rate for Payer: ASR Commercial |
$290.07
|
| Rate for Payer: BCBS Trust/PPO |
$243.69
|
| Rate for Payer: BCN Commercial |
$231.85
|
| 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 |
$299.04
|
| Rate for Payer: Healthscope Whirlpool |
$290.07
|
| 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: Priority Health Cigna Priority Health |
$194.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$263.16
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE
|
Facility
|
OP
|
$938.93
|
|
|
Service Code
|
CPT 32555
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.69 |
| Max. Negotiated Rate |
$938.93 |
| Rate for Payer: Aetna Medicare |
$605.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$605.76
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Commercial |
$666.34
|
| Rate for Payer: PHP Medicaid |
$324.69
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.15
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$377.72
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$938.93
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP DNSP |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GUIDANCE
|
Facility
|
OP
|
$938.93
|
|
|
Service Code
|
CPT 32554
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$324.69 |
| Max. Negotiated Rate |
$938.93 |
| Rate for Payer: Aetna Medicare |
$605.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$757.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$757.20
|
| Rate for Payer: BCBS Complete |
$340.92
|
| Rate for Payer: BCBS MAPPO |
$605.76
|
| Rate for Payer: BCN Medicare Advantage |
$605.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$605.76
|
| Rate for Payer: Mclaren Medicaid |
$324.69
|
| Rate for Payer: Mclaren Medicare |
$605.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$636.05
|
| Rate for Payer: Meridian Medicaid |
$340.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$696.62
|
| Rate for Payer: PACE Medicare |
$575.47
|
| Rate for Payer: PACE SWMI |
$605.76
|
| Rate for Payer: PHP Commercial |
$666.34
|
| Rate for Payer: PHP Medicaid |
$324.69
|
| Rate for Payer: PHP Medicare Advantage |
$605.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.15
|
| Rate for Payer: Priority Health Medicare |
$605.76
|
| Rate for Payer: Priority Health Narrow Network |
$377.72
|
| Rate for Payer: Railroad Medicare Medicare |
$605.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.76
|
| Rate for Payer: UHC Exchange |
$938.93
|
| Rate for Payer: UHC Medicare Advantage |
$605.76
|
| Rate for Payer: UHCCP DNSP |
$605.76
|
| Rate for Payer: UHCCP Medicaid |
$324.69
|
| Rate for Payer: VA VA |
$605.76
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
IP
|
$208.05
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$135.23 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna Commercial |
$187.24
|
| Rate for Payer: ASR ASR |
$201.81
|
| Rate for Payer: ASR Commercial |
$201.81
|
| Rate for Payer: BCBS Trust/PPO |
$169.54
|
| Rate for Payer: BCN Commercial |
$161.30
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$195.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$208.05
|
| Rate for Payer: Healthscope Whirlpool |
$201.81
|
| Rate for Payer: Mclaren Commercial |
$187.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.08
|
|
|
THROMBIN (BOVINE) 5,000 UNIT TOPICAL SOLUTION
|
Facility
|
OP
|
$208.05
|
|
|
Service Code
|
NDC 60793021505
|
| Hospital Charge Code |
117741
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.22 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna Commercial |
$187.24
|
| Rate for Payer: Aetna Medicare |
$104.02
|
| Rate for Payer: ASR ASR |
$201.81
|
| Rate for Payer: ASR Commercial |
$201.81
|
| Rate for Payer: BCBS Complete |
$83.22
|
| Rate for Payer: BCBS Trust/PPO |
$170.37
|
| Rate for Payer: BCN Commercial |
$161.30
|
| Rate for Payer: Cash Price |
$166.44
|
| Rate for Payer: Cofinity Commercial |
$195.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.44
|
| Rate for Payer: Healthscope Commercial |
$208.05
|
| Rate for Payer: Healthscope Whirlpool |
$201.81
|
| Rate for Payer: Mclaren Commercial |
$187.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.84
|
| Rate for Payer: Nomi Health Commercial |
$170.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.29
|
| Rate for Payer: Priority Health Narrow Network |
$145.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.08
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
OP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$667.33 |
| Max. Negotiated Rate |
$1,668.33 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: Aetna Medicare |
$834.16
|
| Rate for Payer: ASR ASR |
$1,618.28
|
| Rate for Payer: ASR Commercial |
$1,618.28
|
| Rate for Payer: BCBS Complete |
$667.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,366.20
|
| Rate for Payer: BCN Commercial |
$1,293.46
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,568.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,668.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,618.28
|
| Rate for Payer: Mclaren Commercial |
$1,501.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Nomi Health Commercial |
$1,368.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,461.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,169.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,468.13
|
|
|
TICAGRELOR 90 MG TABLET
|
Facility
|
IP
|
$1,668.33
|
|
|
Service Code
|
NDC 00186077760
|
| Hospital Charge Code |
153169
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,084.41 |
| Max. Negotiated Rate |
$1,668.33 |
| Rate for Payer: Aetna Commercial |
$1,501.50
|
| Rate for Payer: ASR ASR |
$1,618.28
|
| Rate for Payer: ASR Commercial |
$1,618.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,359.52
|
| Rate for Payer: BCN Commercial |
$1,293.46
|
| Rate for Payer: Cash Price |
$1,334.66
|
| Rate for Payer: Cofinity Commercial |
$1,568.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,334.66
|
| Rate for Payer: Healthscope Commercial |
$1,668.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,618.28
|
| Rate for Payer: Mclaren Commercial |
$1,501.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,418.08
|
| Rate for Payer: Nomi Health Commercial |
$1,368.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,084.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,468.13
|
|
