|
THERMA-GUARD PLUS
|
Facility
OP
|
$522.22
|
|
| Hospital Charge Code |
64902875
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$182.78 |
| Max. Negotiated Rate |
$417.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$287.22
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$261.11
|
| Rate for Payer: Aetna Government |
$261.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$417.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$355.11
|
| Rate for Payer: Group Health Inc Commercial |
$261.11
|
| Rate for Payer: Group Health Inc Medicare |
$182.78
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$261.11
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$261.11
|
|
|
THERMOMETER TEMPA DOT ORAL
|
Facility
OP
|
$0.18
|
|
| Hospital Charge Code |
64901108
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.14 |
| 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: Cigna HMO/Network Benefit Plan/Open Access |
$0.14
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.12
|
| 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
|
|
|
THERMOMETER TEMPA DOT RECTAL
|
Facility
OP
|
$0.34
|
|
| Hospital Charge Code |
64901110
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.17
|
| Rate for Payer: Aetna Government |
$0.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.17
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.17
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.17
|
|
|
THER/PROPH/DIAG ING IA
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96373
|
| Hospital Charge Code |
30303090
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.48 |
| Max. Negotiated Rate |
$306.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Brighton Health Commercial |
$233.00
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$204.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$173.89
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$19.48
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$250.00
|
| Rate for Payer: Group Health Inc Medicare |
$250.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.65
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
THER/PROPH/DIAG IV INF, INT
|
Facility
OP
|
$556.50
|
|
|
Service Code
|
HCPCS 96365
|
| Hospital Charge Code |
30103083
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$70.94 |
| Max. Negotiated Rate |
$445.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$306.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$247.87
|
| Rate for Payer: Aetna Government |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Cash Price |
$247.87
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$247.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$445.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$378.42
|
| Rate for Payer: Elderplan Medicare Advantage |
$247.87
|
| Rate for Payer: EmblemHealth Commercial |
$247.87
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$70.94
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$210.69
|
| Rate for Payer: Fidelis Essential Plan QHP |
$220.60
|
| Rate for Payer: Fidelis Medicare Advantage |
$247.87
|
| Rate for Payer: Fidelis Qualified Health Plan |
$220.60
|
| Rate for Payer: Group Health Inc Commercial |
$247.87
|
| Rate for Payer: Group Health Inc Medicare |
$247.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$278.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$247.87
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$78.82
|
| Rate for Payer: Healthfirst Medicare Advantage |
$210.69
|
| Rate for Payer: Healthfirst QHP |
$247.87
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$247.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$247.87
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$198.30
|
| Rate for Payer: Wellcare Medicare |
$235.48
|
|
|
THIABENDAZOLE 500 MG CHEW TAB
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41641522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
THIABENDAZOLE 500 MG CHEW TAB
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
41651522
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
THIAMINE 100 MG/ML INJ
|
Facility
IP
|
$9.60
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
41652526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.80
|
|
|
THIAMINE 100 MG/ML INJ
|
Facility
OP
|
$9.60
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
41642526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.08
|
| Rate for Payer: Aetna Government |
$3.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.25
|
| Rate for Payer: Group Health Inc Commercial |
$4.80
|
| Rate for Payer: Group Health Inc Medicare |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.40
|
| Rate for Payer: SOMOS Essential |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.24
|
|
|
THIAMINE 100 MG/ML INJ
|
Facility
OP
|
$9.60
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
41652526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$6.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.08
|
| Rate for Payer: Aetna Government |
$3.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.52
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$2.25
|
| Rate for Payer: Group Health Inc Commercial |
$4.80
|
| Rate for Payer: Group Health Inc Medicare |
$3.36
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.80
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$2.50
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$2.40
|
| Rate for Payer: SOMOS Essential |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.24
|
|
|
THIAMINE 100 MG/ML INJ
|
Facility
IP
|
$9.60
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
41642526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.80
|
|
|
THIAMINE 100 MG TAB
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41653587
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
THIAMINE 100 MG TAB
|
Facility
OP
|
$0.02
|
|
| Hospital Charge Code |
41643587
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.01
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.01
|
| Rate for Payer: Aetna Government |
$0.01
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.01
|
| Rate for Payer: Group Health Inc Commercial |
$0.01
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.01
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.01
|
|
|
THIERSCH PROCEDURE
|
Facility
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 15050
|
| Hospital Charge Code |
40011235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$517.07 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,888.00
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$726.29
|
| Rate for Payer: Aetna Government |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Cash Price |
$726.29
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$726.29
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$726.29
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$517.07
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$617.35
|
| Rate for Payer: Fidelis Essential Plan QHP |
$646.40
|
| Rate for Payer: Fidelis Medicare Advantage |
$726.29
|
| Rate for Payer: Fidelis Qualified Health Plan |
$646.40
|
| Rate for Payer: Group Health Inc Commercial |
$726.29
|
| Rate for Payer: Group Health Inc Medicare |
$726.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$752.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$726.29
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$574.52
|
| Rate for Payer: Healthfirst Medicare Advantage |
$617.35
|
| Rate for Payer: Healthfirst QHP |
$726.29
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$726.29
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$726.29
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$581.03
|
| Rate for Payer: Wellcare Medicare |
$689.98
|
|
|
THIN PREP PAP BY TECH CHARGE ONLY
|
Facility
OP
|
$50.65
|
|
|
Service Code
|
HCPCS 88142
|
| Hospital Charge Code |
40635497
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.26
|
| Rate for Payer: Aetna Government |
$20.26
|
| Rate for Payer: Brighton Health Commercial |
$20.26
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.26
|
| Rate for Payer: EmblemHealth Commercial |
$20.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.03
|
| Rate for Payer: Group Health Inc Commercial |
$20.26
|
| Rate for Payer: Group Health Inc Medicare |
$20.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.26
|
| Rate for Payer: Healthfirst QHP |
$20.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.21
|
| Rate for Payer: Wellcare Medicare |
$18.23
|
|
|
THIN PREP PAP SMEAR ABNORMAL W/MD
|
Facility
OP
|
$50.65
|
|
|
Service Code
|
HCPCS 88142
|
| Hospital Charge Code |
40635463
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.21 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$27.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$20.26
|
| Rate for Payer: Aetna Government |
$20.26
|
| Rate for Payer: Brighton Health Commercial |
$20.26
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Cash Price |
$20.26
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$20.26
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$32.20
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$27.25
|
| Rate for Payer: Elderplan Medicare Advantage |
$20.26
|
| Rate for Payer: EmblemHealth Commercial |
$20.26
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$18.23
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$17.22
|
| Rate for Payer: Fidelis Essential Plan QHP |
$18.03
|
| Rate for Payer: Fidelis Medicare Advantage |
$20.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$18.03
|
| Rate for Payer: Group Health Inc Commercial |
$20.26
|
| Rate for Payer: Group Health Inc Medicare |
$20.26
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$25.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$20.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$20.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$20.26
|
| Rate for Payer: Healthfirst QHP |
$20.26
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$20.26
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$20.26
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$16.21
|
| Rate for Payer: Wellcare Medicare |
$18.23
|
|
|
THIORIDAZINE 100 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
THIORIDAZINE 100 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640870
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
THIORIDAZINE 10 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41640935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
THIORIDAZINE 10 MG TAB
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41650935
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
THIORIDAZINE 25 MG TAB
|
Facility
OP
|
$0.35
|
|
| Hospital Charge Code |
41654115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
THIORIDAZINE 25 MG TAB
|
Facility
OP
|
$0.35
|
|
| Hospital Charge Code |
41644115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
| Rate for Payer: Aetna Government |
$0.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
| Rate for Payer: Group Health Inc Commercial |
$0.18
|
| Rate for Payer: Group Health Inc Medicare |
$0.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
|
THIOTHIXENE 10 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41654117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
THIOTHIXENE 10 MG CAP
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
41644117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
THIOTHIXENE 1 MG CAP
|
Facility
OP
|
$0.13
|
|
| Hospital Charge Code |
41644116
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.07
|
| Rate for Payer: Group Health Inc Medicare |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
