|
THERMAGE ARMS - 1 ARM
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 00145
|
|
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 ARMS - BILATERAL
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 00146
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna Medicare |
$1,071.00
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
|
|
THERMAGE EYES
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 00140
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Medicare |
$484.50
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
|
|
THERMAGE FACE
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 00139
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Medicare |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
|
|
THERMAGE FACE & EYES
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 00142
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Medicare |
$1,377.00
|
| Rate for Payer: BCBS Complete |
$1,101.60
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,790.10
|
|
|
THERMAGE FACE & NECK
|
Professional
|
Both
|
$2,856.00
|
|
|
Service Code
|
HCPCS 00143
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,142.40 |
| Max. Negotiated Rate |
$1,856.40 |
| Rate for Payer: Aetna Medicare |
$1,428.00
|
| Rate for Payer: BCBS Complete |
$1,142.40
|
| Rate for Payer: Cash Price |
$2,284.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,856.40
|
|
|
THERMAGE FACE, NECK, & EYES
|
Professional
|
Both
|
$3,570.00
|
|
|
Service Code
|
HCPCS 00144
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$2,320.50 |
| Rate for Payer: Aetna Medicare |
$1,785.00
|
| Rate for Payer: BCBS Complete |
$1,428.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.50
|
|
|
THERMAGE KNEES - BILATERAL
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS 00151
|
|
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 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
|
$24.78
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
7876
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$24.78 |
| Rate for Payer: Aetna Commercial |
$22.30
|
| Rate for Payer: Aetna Commercial |
$25.45
|
| Rate for Payer: Aetna Commercial |
$29.65
|
| Rate for Payer: Aetna Commercial |
$24.52
|
| Rate for Payer: Aetna Commercial |
$24.78
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: Aetna Medicare |
$13.77
|
| Rate for Payer: Aetna Medicare |
$12.39
|
| Rate for Payer: Aetna Medicare |
$16.47
|
| Rate for Payer: Aetna Medicare |
$14.14
|
| Rate for Payer: ASR ASR |
$31.95
|
| Rate for Payer: ASR ASR |
$26.70
|
| 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 Commercial |
$31.95
|
| Rate for Payer: ASR Commercial |
$26.43
|
| Rate for Payer: ASR Commercial |
$26.70
|
| Rate for Payer: ASR Commercial |
$27.43
|
| Rate for Payer: ASR Commercial |
$24.04
|
| Rate for Payer: BCBS Complete |
$13.18
|
| 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 Complete |
$9.91
|
| Rate for Payer: BCBS Trust/PPO |
$23.16
|
| Rate for Payer: BCBS Trust/PPO |
$20.29
|
| Rate for Payer: BCBS Trust/PPO |
$22.32
|
| Rate for Payer: BCBS Trust/PPO |
$22.54
|
| Rate for Payer: BCBS Trust/PPO |
$26.97
|
| Rate for Payer: BCN Commercial |
$25.54
|
| Rate for Payer: BCN Commercial |
$21.93
|
| Rate for Payer: BCN Commercial |
$21.13
|
| Rate for Payer: BCN Commercial |
$19.21
|
| Rate for Payer: BCN Commercial |
$21.34
|
| 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 |
$22.02
|
| Rate for Payer: Cash Price |
$19.82
|
| Rate for Payer: Cofinity Commercial |
$30.96
|
| Rate for Payer: Cofinity Commercial |
$26.58
|
| Rate for Payer: Cofinity Commercial |
$25.88
|
| Rate for Payer: Cofinity Commercial |
$25.61
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.62
|
| Rate for Payer: Healthscope Commercial |
$27.53
|
| Rate for Payer: Healthscope Commercial |
$28.28
|
| Rate for Payer: Healthscope Commercial |
$32.94
|
| Rate for Payer: Healthscope Commercial |
$24.78
|
| Rate for Payer: Healthscope Commercial |
$27.25
|
| Rate for Payer: Healthscope Whirlpool |
$27.43
|
| Rate for Payer: Healthscope Whirlpool |
$26.70
|
| Rate for Payer: Healthscope Whirlpool |
$26.43
|
| Rate for Payer: Healthscope Whirlpool |
$24.04
|
| Rate for Payer: Healthscope Whirlpool |
$31.95
|
| Rate for Payer: Mclaren Commercial |
$29.65
|
| Rate for Payer: Mclaren Commercial |
$24.78
|
| Rate for Payer: Mclaren Commercial |
$24.52
|
| Rate for Payer: Mclaren Commercial |
$25.45
|
| Rate for Payer: Mclaren Commercial |
$22.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| 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 |
$28.00
|
| Rate for Payer: Nomi Health Commercial |
$23.19
|
| 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: Priority Health Cigna Priority Health |
$17.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.86
|
| Rate for Payer: Priority Health Narrow Network |
$23.09
|
| Rate for Payer: Priority Health Narrow Network |
$19.82
|
| Rate for Payer: Priority Health Narrow Network |
$19.10
|
| Rate for Payer: Priority Health Narrow Network |
$17.37
|
| Rate for Payer: Priority Health Narrow Network |
$19.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.99
|
| 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 |
$21.81
|
| 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 |
$25.61
|
| 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
|
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 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
|
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 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
|
|
|
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
|
$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 |
$364.49
|
| 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 |
$317.95
|
| 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 |
$364.49
|
| 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 |
$317.95
|
| 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
|
|
|
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
|
$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
|
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
|
$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 |
$421.51
|
| 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 |
$421.51
|
| 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
|
|
