|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
7012110495
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$7.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Medicare |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.63
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
7012110491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
7012110491
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$7.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Medicare |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.63
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP
|
Facility
|
IP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
7012110492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$5.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP
|
Facility
|
OP
|
$10.20
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
7012110492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$8.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.61
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.20
|
| Rate for Payer: Aetna Government |
$1.20
|
| Rate for Payer: Brighton Health Commercial |
$7.65
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.94
|
| Rate for Payer: EmblemHealth Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Commercial |
$5.10
|
| Rate for Payer: Group Health Inc Medicare |
$3.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.10
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.84
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.63
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
0065054301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML IO SUSP
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
0065054301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$24.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$24.50
|
| Rate for Payer: Aetna Government |
$24.50
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$17.15
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$17.15
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$17.15
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$24.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Elderplan Medicare Advantage |
$24.50
|
| Rate for Payer: EmblemHealth Commercial |
$24.50
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$22.05
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$20.82
|
| Rate for Payer: Fidelis Essential Plan QHP |
$21.80
|
| Rate for Payer: Fidelis Medicare Advantage |
$24.50
|
| Rate for Payer: Fidelis Qualified Health Plan |
$21.80
|
| Rate for Payer: Group Health Inc Commercial |
$24.50
|
| Rate for Payer: Group Health Inc Medicare |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$24.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$24.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$24.50
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.82
|
| Rate for Payer: Healthfirst QHP |
$24.50
|
| Rate for Payer: Humana Medicare |
$24.99
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$24.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$23.27
|
| Rate for Payer: Wellcare Medicare |
$23.27
|
|
|
TRIAMTERENE 50 MG PO CAPS
|
Facility
|
IP
|
$11.93
|
|
|
Service Code
|
NDC 6699383102
|
| Hospital Charge Code |
6699383102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$5.96 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.96
|
|
|
TRIAMTERENE 50 MG PO CAPS
|
Facility
|
OP
|
$11.93
|
|
|
Service Code
|
NDC 6699383102
|
| Hospital Charge Code |
6699383102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.17 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.96
|
| Rate for Payer: Aetna Government |
$5.96
|
| Rate for Payer: Brighton Health Commercial |
$8.94
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.54
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.11
|
| Rate for Payer: EmblemHealth Commercial |
$5.96
|
| Rate for Payer: Group Health Inc Commercial |
$5.96
|
| Rate for Payer: Group Health Inc Medicare |
$4.17
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.75
|
|
|
TRIAMTERENE-HCTZ 37.5-25 MG PO TABS
|
Facility
|
IP
|
$0.39
|
|
|
Service Code
|
NDC 6050526561
|
| Hospital Charge Code |
6050526561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
|
|
TRIAMTERENE-HCTZ 37.5-25 MG PO TABS
|
Facility
|
OP
|
$0.39
|
|
|
Service Code
|
NDC 6050526561
|
| Hospital Charge Code |
6050526561
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
| Rate for Payer: Aetna Government |
$0.20
|
| Rate for Payer: Brighton Health Commercial |
$0.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.27
|
| Rate for Payer: EmblemHealth Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Commercial |
$0.20
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.26
|
|
|
TRIFLUOPERAZINE HCL 10 MG PO TABS
|
Facility
|
IP
|
$2.45
|
|
|
Service Code
|
NDC 0378241001
|
| Hospital Charge Code |
0378241001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
|
|
TRIFLUOPERAZINE HCL 10 MG PO TABS
|
Facility
|
OP
|
$2.45
|
|
|
Service Code
|
NDC 0378241001
|
| Hospital Charge Code |
0378241001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.96 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.22
|
| Rate for Payer: Aetna Government |
$1.22
|
| Rate for Payer: Brighton Health Commercial |
$1.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.96
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.66
|
| Rate for Payer: EmblemHealth Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Commercial |
$1.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.59
|
|
|
TRIFLUOPERAZINE HCL 1 MG PO TABS
|
Facility
|
OP
|
$0.88
|
|
|
Service Code
|
NDC 0378240101
|
| Hospital Charge Code |
0378240101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.44
|
| Rate for Payer: Aetna Government |
$0.44
|
| Rate for Payer: Brighton Health Commercial |
$0.66
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.60
|
| Rate for Payer: EmblemHealth Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Commercial |
$0.44
|
| Rate for Payer: Group Health Inc Medicare |
$0.31
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.44
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.57
|
|
|
TRIFLUOPERAZINE HCL 1 MG PO TABS
|
Facility
|
IP
|
$0.88
|
|
|
Service Code
|
NDC 0378240101
|
| Hospital Charge Code |
0378240101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.44
|
|
|
TRIFLUOPERAZINE HCL 2 MG PO TABS
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 5107957320
|
| Hospital Charge Code |
5107957320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
|
|
TRIFLUOPERAZINE HCL 2 MG PO TABS
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 5107957320
|
| Hospital Charge Code |
5107957320
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.00
|
| Rate for Payer: Aetna Government |
$1.00
|
| Rate for Payer: Brighton Health Commercial |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.36
|
| Rate for Payer: EmblemHealth Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Commercial |
$1.00
|
| Rate for Payer: Group Health Inc Medicare |
$0.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.30
|
|
|
TRIFLUOPERAZINE HCL 5 MG PO TABS
|
Facility
|
OP
|
$2.55
|
|
|
Service Code
|
NDC 5107957420
|
| Hospital Charge Code |
5107957420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.27
|
| Rate for Payer: Aetna Government |
$1.27
|
| Rate for Payer: Brighton Health Commercial |
$1.91
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.04
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.73
|
| Rate for Payer: EmblemHealth Commercial |
$1.27
|
| Rate for Payer: Group Health Inc Commercial |
$1.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.66
|
|
|
TRIFLUOPERAZINE HCL 5 MG PO TABS
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 5107957420
|
| Hospital Charge Code |
5107957420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.27
|
|
|
TRIFLURIDINE 1 % OP SOLN
|
Facility
|
OP
|
$29.73
|
|
|
Service Code
|
NDC 6131404475
|
| Hospital Charge Code |
6131404475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$23.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$16.35
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.86
|
| Rate for Payer: Aetna Government |
$14.86
|
| Rate for Payer: Brighton Health Commercial |
$22.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$23.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$20.21
|
| Rate for Payer: EmblemHealth Commercial |
$14.86
|
| Rate for Payer: Group Health Inc Commercial |
$14.86
|
| Rate for Payer: Group Health Inc Medicare |
$10.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.86
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$19.32
|
|
|
TRIFLURIDINE 1 % OP SOLN
|
Facility
|
IP
|
$29.73
|
|
|
Service Code
|
NDC 6131404475
|
| Hospital Charge Code |
6131404475
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.86
|
|
|
TRIHEXYPHENIDYL HCL 0.4 MG/ML PO SOLN
|
Facility
|
IP
|
$0.11
|
|
|
Service Code
|
NDC 0121065816
|
| Hospital Charge Code |
0121065816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
TRIHEXYPHENIDYL HCL 0.4 MG/ML PO SOLN
|
Facility
|
OP
|
$0.11
|
|
|
Service Code
|
NDC 0121065816
|
| Hospital Charge Code |
0121065816
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
TRIHEXYPHENIDYL HCL 2 MG PO TABS
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0591533501
|
| Hospital Charge Code |
0591533501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
TRIHEXYPHENIDYL HCL 2 MG PO TABS
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0591533501
|
| Hospital Charge Code |
0591533501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
