|
THIAMINE 100 MG/ML INJ
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
41642526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| 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: Brighton Health Commercial |
$5.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.52
|
| 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: 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 |
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
|
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/ML INJ
|
Facility
|
OP
|
$9.60
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
41652526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| 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: Brighton Health Commercial |
$5.76
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.52
|
| 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: 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 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: Brighton Health Commercial |
$0.02
|
| 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 |
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: Brighton Health Commercial |
$0.02
|
| 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 HCL 100 MG/ML IJ SOLN [7876]
|
Facility
|
OP
|
$5.97
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
63323001301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.08
|
| Rate for Payer: Aetna Government |
$3.08
|
| Rate for Payer: Brighton Health Commercial |
$4.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.88
|
|
|
THIAMINE HCL 100 MG/ML IJ SOLN [7876]
|
Facility
|
OP
|
$5.97
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
63323001302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.08
|
| Rate for Payer: Aetna Government |
$3.08
|
| Rate for Payer: Brighton Health Commercial |
$4.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.88
|
|
|
THIAMINE HCL 100 MG/ML IJ SOLN [7876]
|
Facility
|
OP
|
$5.33
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
67457019602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.93
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.08
|
| Rate for Payer: Aetna Government |
$3.08
|
| Rate for Payer: Brighton Health Commercial |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.27
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.63
|
| Rate for Payer: Group Health Inc Commercial |
$2.67
|
| Rate for Payer: Group Health Inc Medicare |
$1.87
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.67
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.47
|
|
|
THIAMINE HCL 100 MG/ML IJ SOLN [7876]
|
Facility
|
OP
|
$4.15
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
63323001326
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.08
|
| Rate for Payer: Aetna Government |
$3.08
|
| Rate for Payer: Brighton Health Commercial |
$3.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.32
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.82
|
| Rate for Payer: Group Health Inc Commercial |
$2.08
|
| Rate for Payer: Group Health Inc Medicare |
$1.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.08
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.70
|
|
|
THIAMINE HCL 100 MG/ML IJ SOLN [7876]
|
Facility
|
OP
|
$5.97
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
25021050002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.08
|
| Rate for Payer: Aetna Government |
$3.08
|
| Rate for Payer: Brighton Health Commercial |
$4.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.78
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.06
|
| Rate for Payer: Group Health Inc Commercial |
$2.98
|
| Rate for Payer: Group Health Inc Medicare |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.98
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.88
|
|
|
THIAMINE HCL 100 MG/ML IJ SOLN [7876]
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
72485050701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$3.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.05
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.08
|
| Rate for Payer: Aetna Government |
$3.08
|
| Rate for Payer: Brighton Health Commercial |
$2.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.53
|
| Rate for Payer: Group Health Inc Commercial |
$1.86
|
| Rate for Payer: Group Health Inc Medicare |
$1.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.86
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.86
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$2.26
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$2.40
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$2.40
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.42
|
|
|
THIAMINE MONONITRATE 100 MG PO TABS [11538]
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 77333093410
|
| Hospital Charge Code |
77333093410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
THIAMINE MONONITRATE 100 MG PO TABS [11538]
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
NDC 50268085115
|
| Hospital Charge Code |
50268085115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.16
|
| Rate for Payer: Aetna Government |
$0.16
|
| Rate for Payer: Brighton Health Commercial |
$0.24
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: Group Health Inc Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
THIERSCH PROCEDURE
|
Facility
|
IP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 15050
|
| Hospital Charge Code |
40011235
|
|
Hospital Revenue Code
|
360
|
| Rate for Payer: Cash Price |
$726.29
|
|
|
THIERSCH PROCEDURE
|
Facility
|
OP
|
$1,505.35
|
|
|
Service Code
|
HCPCS 15050
|
| Hospital Charge Code |
40011235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$581.03 |
| 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: Brighton Health Commercial |
$1,129.01
|
| 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 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 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
|
IP
|
$50.65
|
|
|
Service Code
|
HCPCS 88142
|
| Hospital Charge Code |
40635497
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$20.26
|
|
|
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 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 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 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 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
|
IP
|
$50.65
|
|
|
Service Code
|
HCPCS 88142
|
| Hospital Charge Code |
40635463
|
|
Hospital Revenue Code
|
311
|
| Rate for Payer: Cash Price |
$20.26
|
|
|
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: Brighton Health Commercial |
$0.75
|
| 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 |
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: Brighton Health Commercial |
$0.75
|
| 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: Brighton Health Commercial |
$0.75
|
| 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: Brighton Health Commercial |
$0.75
|
| 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 |
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: Brighton Health Commercial |
$0.26
|
| 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
|
|
